Brandi Law, BSBN, BSN, RN Johnston Health Infection Preventionist Johnston Health C-diff 01/01/2015 to 10/31/2017 25 20 Began PCR Testing 15 10 Rate per 10000 Patient Days Patient 10000 perRate 5 0 . Education was completed prior to beginning the new protocol . IP attended nursing unit staff meetings, inpatient and outpatient . IP attend the hospitalist and ED physician staff meetings . C-Diff was a part of our 2018 Pillar Goal -BIG focus . The policy went into effect on October 1, 2017. Johnston Health C-Diff 16 9/1/2018 to 03/31/2019 14 12 Initiated Nurse Driven 10 Protocol 8 6 Rate per 10000 Patient Days Patient 10000 perRate 4 2 0 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 Johnston Health C-Diff 09/01/2017 to 10/31/2018 18 16 Oh no! Oh yeah!! 14 12 10 Initiated Nurse Driven 8 Protocol Rate per 10000 Patient Days Patient 10000 perRate 6 4 2 0 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Deep Dive!! We sat down and did a deep dive to look at what was going on. We did not believe all of these were true hospital acquired cases! Does that count as a stool or not?? . Things we found: . There were some true HO cases. Lack of stool documentation and what that documentation means. Inattention to the number of stools and the time period. Inappropriate samples sent to lab. Conflicting/inconsistent documentation, sometimes from the patient. Patient received something that stimulated bowel movements but did not flag as a laxative in EPIC, i.e. GoLYTELY, Kayexalate . Patient received a laxative and continued with order. Patient had no stool and order failed to be deleted. Specimen was not collected timely. Majority of the time the fall out was with the algorithm. Not only from nurses but also the physicians. Managers re-educated staff, flyers redistributed . Our NEW nurse educators were able to help get the word out. IP attended unit staff meetings for inpatient and both EDs . IP attended Hospitalist and ED physician staff meetings . Began including Pharmacist on notifications to look at antibiotics . Sent out CDI event tool from DICON to unit managers and clinical coordinators to help them drill down on each case. Spoke with our lab director to make sure inappropriate specimens were not being tested . New pocket cards were made and distributed to physicians on treatment guidelines . Changes to our algorithm, staff educated Laboratory staff will call Dr. Cieza/Dr. Adams prior to processing C-Diff specimens for patients that have been in-house two midnights or greater. (Call the hospital operator to connect you with Dr. Cieza/Dr. Adams.) Monday through Friday 8:00a.m. – 5:00p.m., contact Dr. Cieza. If Dr. Cieza is unavailable, contact Dr. Adams. Saturday/Sunday 8:00a.m – 5:00p.m., contact Dr. Adams. Only specimens approved by Dr. Cieza/Dr. Adams will be processed. If the specimen is not approved then the order will be cancelled by Dr. Cieza, Dr. Adams, or nursing staff via verbal order from Dr. Cieza. Dr. Cieza or Dr. Adams may need to be transferred to the patient’s unit if not on campus. If Dr. Cieza/Dr. Adams does not respond within one hour of notification, then the C-Diff specimen will be processed to avoid further delays. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed The picture can't be displayed. The picture can't be displayed. Shoot the Poo!! The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. Dodge the doodie! The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. Bob for Poo! The picture can't be displayed. The picture can't be displayed. The picture can't be displayed. A total of 191 JH staff members were reached, including EVS/ED/QA/MD/Admin. 89 total IP nurses, 39 CNAs The picture can't be displayed..