A study at a Veterans Affairs (VA) hospital suggests that allowing bedside nurses to independently order testing for Clostridioides difficile infection (CDI) shortened the time to receive test results, researchers reported today in the American Journal of Infection Control.
The policy at the Fargo VA Healthcare System in North Dakota allowed nurses to order stool tests for new patients displaying symptoms of CDI. Prior to the policy, only physicians, pharmacists, or certified nurse practitioners could order stool tests, which resulted in delays in acquiring test results. To test the effectiveness of the new policy, hospital staff compared the frequency of tests being ordered, the time to obtain test results, and the time to initiate treatment for positive test results before and after the change. They also analyzed the difference between nurses and physicians in the time to obtain test results.
The proportion of nurses and physicians ordering stool tests after the policy change was similar (51.1% vs 48.9%, respectively). The percent of positive test results before and after the policy change was relatively unaffected (13.9% vs 11.5%, respectively). But the difference in time to obtain the test result was statistically significant after the policy change (mean [standard deviation (SD)], 2.2 [1.3] vs 1.3 [0.7] hours), as was the time to obtain the test results between nurses and physicians after the policy change (mean [SD], 1.2 [0.7] vs 1.3 [0.7] hours).
Incentives exist for improving approaches to the prevention and spread of this infection.
Although there was no difference in the time to initiate treatment before and after the policy change (1.7 hours), nurses reported that they were able to order contact precautions earlier than they previously would have to prevent the spread of CDI to other patients.
"Given the implications of CDI on both a hospital and patient level, incentives exist for improving approaches to the prevention and spread of this infection in the clinical environment," lead study author Ashley Bartlett, MD, said in a press release. "Our findings suggest that allowing bedside nurses with appropriate training to order C. diff testing based on patient symptomology could be a valid strategy to help healthcare systems achieve this goal."