The case for letting nurses initiate C. diff testing

Allowing bedside nurses to independently order Clostridioides difficile testing could help hospitals lower the risk of patient infections and associated deaths, according to a study published May 11 in the American Journal of Infection Control.

For the study, researchers at the Fargo (N.D.) VA Healthcare System allowed hospital nurses to independently order stool samples for patients displaying C. diff symptoms without requiring a physician's sign-off. Researchers then compared outcomes in the 44 months before the policy change and the 59 months after.

Four findings:

1. The percentage of positive and negative tests did not change significantly, suggesting the new policy did not result in more unnecessary testing or financial burden for the hospital.   

2. The average time to obtain test results fell from 2.1 hours before the policy change to 1.3 hours after. 

3. Nurses were also associated with faster test results compared to physicians after the policy change (1.2 hours compared to 1.3). 

4. The time to initiate treatment remained unchanged throughout the study. Researchers suggest this is because nurses still needed physicians' approval to initiate antibiotics. 

"Allowing bedside nurses more autonomy to order the stool sample significantly decreased the amount of time to receive the results, potentially decreasing the risk of additional infections among patients and decreasing the economic burden on the hospital," researchers concluded.

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