Doctor of Nursing Practice
Sylvie Rosenbloom, DNP, APRN, FNP-BC, CDCES
Sahlee Samonte, DNP, RN
Introduction: Clostridium difficile infection (CDI) is the most prevalent nosocomial infection pathogen responsible for antibiotic associated diarrhea. CDI is a significant cause of morbidity and mortality rates of medical patients and has increased due to frequent broad spectrum antibiotic usage. CDI is associated with a mortality rate of 25% amongst medical patients. At this catholic hospital in the Northeast of the United States, there is currently no official intervention implemented to prescribe a probiotic when patients are started on antibiotics. Evidence supports that probiotics agents have demonstrated modest success in the risk reduction of CDI to patients receiving antibiotic therapy.
Purpose: The purpose of this quality improvement project is to educate nurses and physicians about the benefits of probiotics, implement an algorithm for providers to prescribe probiotics when prescribing antibiotics, then track probiotic prescription rates and CDI incidence rates.
Intervention and Setting: This quality improvement project was implemented on a 26-bed adult Medical-Surgical Unit in an acute in the Northeast of the United States. Probiotic educational sessions were delivered to nursing and physician staff. After the educational sessions were given, when an antibiotic was ordered for a patient, the nursing staff would obtain an order for a probiotic. Once the probiotic was administered, then those patients were monitored for acute diarrhea and any discharge diagnosis for acute diarrhea or CDI.
Evaluation: Prior to the project implementation the rate of probiotic prescription was 0%. After the intervention probiotic prescription increased by 15%. The readmission rate of patients prescribed a probiotic was 6%, but the readmission was due to other medical problems, not CDI. Of the patients who received the probiotic, the percentage of them having acute diarrhea as a discharge diagnosis was 0%.
Discussion: CDI is a significant cause of morbidity and mortality rates among medical-surgical patients. According to the evidence, there are numerous probiotic protocols that are evidence-based, that have been implemented in hospitals across the country as standard of practice. The CDI score for this acute facility is 0.347% giving the hospital a C ranking. The best score a hospital can receive is 0.000%, average score of hospitals in the USA is 0.575. An evidence-based probiotic algorithm would be best practice for this hospital to implement as a standard of practice to improve the CDI incidence rates.
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Bonvicini, M. (2023). Implementation of a probiotic intervention among medical-surgical patients: An evidence-based practice quality improvement project [Unpublished DNP project]. Sacred Heart University.