March 05, 2019
1 min read

Best practice alert increases guideline-based prescribing for CDI

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A best practice intervention linking a positive test result for Clostridoides difficile infection, or CDI, to a severity-based treatment order set increased guideline-based prescribing at a Nebraska hospital, researchers reported in Infection Control & Hospital Epidemiology.

“One tool to improve guideline-based prescribing is integrating clinical decision support systems (CDSS) into electronic medical records,” Holly L. Reed, PharmD, PGY2 emergency medicine pharmacy resident at Nebraska Medicine, and colleagues wrote. “Best practices with CDSS are to provide information in a form that is most appropriate for those who are most likely to act on it, to anticipate workflows in design, and to provide meaningful data that is directly actionable.”

Reed and colleagues conducted a retrospective, single-center, quasi-experimental study to evaluate the benefits of a C. difficile best practice alert implemented in March 2014, as well as measure guideline-based prescribing and CDI complications. According to the study, patients diagnosed with CDI in 2013 were used as controls, and patients diagnosed in 2016 represented the cases.

Doctor on computer 
Integrating clinical decision support systems into EMRs can improve guideline-based prescribing, researchers said.
Source: Adobe Stock

In 2013, 278 laboratory-confirmed cases of CDI were reported compared with 409 in 2016. The final cohort included 66 preimplementation controls and 65 postimplementation cases. The researchers said there were “notable differences” between the two groups because the subjects were not matched.

They found that patients were more likely to receive guideline-compliant CDI therapy after the best practice alert was implemented. Specifically, guideline-based prescriptions were given to 67.7% of patients in the postimplementation group compared with 39.4% in the preimplementation group.

The findings demonstrated a significant improvement in appropriate prescribing for CDI therapy after the best practice alert was implemented.

“Application of the [best practice alert] for outpatient antimicrobial stewardship and recommending discontinuation of active CDI treatment following negative CDI laboratory results may be feasible extensions of the alert,” Reed and colleagues wrote. “With further advancements in CDSS, data mining features could determine a patient’s CDI severity and the corresponding guideline-based treatment recommendation in the future.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.