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The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young Pediatric Patients

Published online by Cambridge University Press:  21 February 2017

Maribeth R. Nicholson ,
Peter N. Freswick ,
M. Cecilia Di Pentima ,
Li Wang ,
Kathryn M. Edwards ,
Gregory J. Wilson  and
Thomas R. Talbot
Maribeth R. Nicholson*
Affiliation:
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
Peter N. Freswick
Affiliation:
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Helen DeVos Children’s Hospital, Grand Rapids, Mighigan
M. Cecilia Di Pentima
Affiliation:
Division of Pediatric Infectious Diseases, Atlantic Health System, Morristown, New Jersey
Li Wang
Affiliation:
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
Kathryn M. Edwards
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Gregory J. Wilson
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
*
Address correspondence to Maribeth R. Nicholson, MD, MPH; Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Monroe Carell Jr. Children’s Hospital at Vanderbilt; 2200 Children’s Way; Nashville TN 37232 (maribeth.r.nicholson@vanderbilt.edu).
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Abstract

BACKGROUND

Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group.

OBJECTIVE

To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants.

DESIGN

An interventional age-targeted before-after trial with comparison group

SETTING

Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.

PATIENTS

All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert)

INTERVENTION

In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing.

RESULTS

The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile.

CONCLUSIONS

The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile.

Infect Control Hosp Epidemiol 2017;38:542–546

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 542 - 546
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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