MD Magazine (09/20/18) May, Brandon
A link has been established between employment of in-person discussions with nurses and prescribers regarding Clostridium difficile management recommendations and self-sustained practice changes and significant improvements in suboptimal C difficile practices. Researchers from the Johns Hopkins University School of Medicine prospectively reviewed medical charts of 96 adults hospitalized with positive C difficile tests and from them devised management recommendations. Two interventions were deployed over 11 months, using an in-person, real-time, case-based education and discussion with the patient by a CD Action Team (CDAT). The study's main outcome included both CDAT-prompted and CDAT-independent changes, and in the former, investigators compared the percentage of patients receiving optimized C difficile management within a 48-hour period following CDAT with the percentage of patients who received optimized management of C difficile during baseline. The CDAT spotted at least one opportunity to enhance management in 84 patients, and during intervention the team offered recommendations for 76 cases. Significant improvements were observed in response to CDAT-led direct interventions for subjects with bowl movement (BM) documentation, indicating that suboptimal BM documentation decreased 68 percent and 92 percent during the first intervention and second intervention, respectively.