"Hard Stop" Alert May Reduce C difficile Orders for Laxative-Taking Patients

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Implementing the hard stop alert resulted in a decrease in daily testing by 30%.
Implementing the hard stop alert resulted in a decrease in daily testing by 30%.
This article is part of Infectious Disease Advisor's coverage of IDWeek 2017™, taking place in San Diego, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

SAN DIEGO – A “hard stop” alerting system may effectively cause providers to discontinue C difficile orders among patients taking laxatives or those with an absence of documented diarrhea, according to study findings presented at IDWeek 2017.

“Patients may be over-diagnosed with C difficile infection (CDI) due to colonization, especially if laxatives are used,” noted the investigators. “Our objective was to strengthen our C difficile testing stewardship by creating a ‘hard stop' to require providers to think critically about C difficile testing.” they added.

Investigators initiated a laxative alert at their 2-hospital community-based academic healthcare system. The alert started >36 hours following admission, and the system evaluated patients for documented diarrhea (defined as >2 episodes/24 hours).

According to the findings, an average of 9 (SD, 4-14) daily orders of C difficile testing were observed at baseline. Implementing the hard stop alert resulted in a decrease in daily testing by 30%. Additionally, the hospital-onset CDI frequency decreased by 45% during the first month of the hard-stop implementation. The investigators comment that they have not “detected delayed diagnoses or empiric treatment without testing” to date.

“Given [polymerase chain reaction's] high sensitivity for C difficile, testing stewardship is critical to minimize false positive cases of CDI, which lead to inappropriate treatment, prolonged length of stay, and hospital penalties,” concluded the researchers. In addition, requiring a phone call to order C difficile testing “in the setting of laxative use or minimal diarrhea effectively reduced testing and was well accepted by nurses and providers.”

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Reference

Drees M, Dressler R, Taylor K, et al. Testing stewardship: a 'hard stop" to reduce inappropriate C. diff testing. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Oral abstract 79.

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