By: Diana Mazur
Team Members: Courtney Komar, Beth Wu, May Riley, Jenny Tran, Marcelo Quiroz, Amy Chang, Yuliya Behey, Laura Johnston
Team Sponsors: Barbara Mayer and Karen McIntyre
Clostridium difficile (C. diff) infection is a serious concern for patients admitted to hospitals, especially those undergoing blood and marrow transplant (BMT). BMT patients are at 5 times higher risk for developing C.diff infections given frequent hospitalization, prolonged antibiotic use, immunosuppression and altered intestinal mucosa. Symptoms of diarrhea on admission are potentially missed Community Onset C.diff if not identified early. This impacts patient safety due to potential for cross contamination to other immunocompromised patients, if not isolated early. A missed Community Onset C.diff is classified as Hospital Acquired, thereby negatively impacting the organization’s publicly reported quality and safety measures.
An inter-disciplinary team of experts was created to tackle this problem. We realized that C.diff infections is a complex problem, therefore we focused our work on aspects that we had control over. Catching Community Onset C.diff infection was where we landed. To analyze the problem, the team utilized gemba rounding, retrospective chart reviews, cross-walked current policies and procedures, and Epic playground navigation. We identified gaps in our current process with C.diff acceptance and rejection criteria and recognized that BMT did not have a screening process.
The most impactful interventions for this project included developing an enhanced C.diff/diarrhea screening process for all BMT direct patient admissions. We leveraged an existing workflow where unit Resource Nurses screened patients prior to admission. We also partnered with our ambulatory team/Infusion Treatment Area to screen patients prior to admission and collaborated with the BMT Advanced Practice Providers to screen patients during the admission intake We clarified the acceptance criteria, specifically number of stools for specimen collection and expanded the window of time for nursing to collect the specimen from 24 hours to 48 hours from admission date.
Lessons learned from this process improvement project are the importance of collaboration, following the process, narrowed scope and having baseline data! We look forward to continuing our work and expand best practices to other services who can benefit from our project.