The recurrent Clostridium difficile infection (RCDI) is an issue associated with numerous detrimental health and economic effects. The current consensus holds that fecal bacteriotherapy is among the most feasible solutions to the problem (O’Horo, Jindai, Kunzer, & Safdar, 2014). The following paper outlines a nursing plan intended expected to decrease the rate of RCDI in the clinical setting and, by extension, improve patients’ health outcomes, increase patient satisfaction, and alleviate the related financial burden.
Change Model Overview
The model of change selected for the project at hand is the ACE star model of knowledge transformation. The model consists of five elements, each of which represents a stage of knowledge acquisition. The first point is discovery research, during which the data necessary for the project is gathered. Depending on the approach chosen by the research team, the data is based either on the findings of a study or a review of the information from the academic literature. During the evidence summary stage, the collected data is converted into a meaningful statement. The next stage, translation to guidelines, requires the conversion of evidence into a set of useful recommendations. At the stage of integration, the guidelines are implemented in healthcare practice through the adjustments of organizational practices. Finally, at the evaluation stage, the outcomes of the innovation are assessed and compared to the predetermined criteria of success. The model is recommended for nurses to facilitate change due to its clarity and reliance on rigorous adherence to evidence-based practice, which ensures reliability and replicability of the achieved outcomes.
Define the Scope of the EBP
The identified issue of recurrent CDI is a problem that has several far-reaching implications. In the current healthcare setting, it adds to the rate of patient readmissions and thus contributes to the increased workload at the organizational level. Also, the high morbidity and mortality associated with the condition undermine the overall state of public health in the area (Gupta & Khanna, 2014). It should also be noted that the additional care necessitated by the RCDI creates a considerable financial burden for the impacted providers. On a broader scale, these factors translate into an inefficient distribution of resources within the field and undermine the overall effectiveness of the treatment of admitted patients.
Stakeholders
The successful implementation of the project would require several key stakeholders. First, it would be necessary to employ two consultant microbiologists to obtain relevant data on the issue. Next, at least one medical scientist would be recruited. It would also be beneficial to acquire the support of the food safety specialist. Finally, at least one nurse administrator should be involved.
Determine Responsibility of Team Members
The chosen members will cover the key components of the project. The consultant microbiologists will provide the necessary information regarding the clinical aspects of the issue and the underlying physiological processes. The food safety specialist’s assistance will improve the project team’s understanding of the role of intestinal microbiota in the CDI recurrence. The medical scientist is expected to oversee the research process and provide insights at stages one through three of the ACE star model. Finally, the nurse administrator will facilitate support for the project and establish communication with the staff on the organizational level.
Evidence
In addition to the evidence summary highlighted in the previous milestone, numerous pieces of evidence could be located that are consistent with the problem statement. Specifically, both the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America provides an update on their clinical practice guidelines that address the increased severity of the cases of CDI development due to the emergence of a more virulent strain of the pathogen (Barlam et al., 2016). The healthcare organizations provide position statements that emphasize the priority of CDI prevention and control, suggest the integration of surveillance, advocate the minimization of the use and duration of antibiotic use, and education of healthcare staff and patients (Fehér & Mensa, 2016; Moayyedi, Marshall, Yuan, & Hunt, 2014). All of the mentioned sources of evidence are responsibly supported by data and can be considered strong evidence in favor of the project.
Summarize the Evidence
The systematic review by O’Horo et al. (2014) provides an overview of common approaches to the treatment of recurrent CDI. The article studies the relative efficiency of several evidence-based interventions including, vancomycin, fecal bacteriotherapy, immunoglobulins, probiotics, fidaxomicin, metronidazole, and rifampin (O’Horo et al., 2014). Since some interventions, such as fecal bacteriotherapy, fidaxomicin, and vancomycin, were shown to be more effective than the others, they are recommended for use in the project at hand (O’Horo et al., 2014).
Develop Recommendations for change based on Evidence
Based on the research, it would be reasonable to recommend fecal microbiota transplantation as a primary intervention for successful reduction of the rate of recurrent CDI as well as, in the long run, the decrease of first-time CDI occurrence. The compliance with disinfection requirements, reduction of duration and use of antibiotics, and consistent education of patients and the organization’s staff should also be implemented and maintained to facilitate long-term improvement.
Translation
Action Plan
By the ACE star model, the first step of the planned pilot study is the facilitation of the study aimed at measuring the effects of the suggested interventions used in combination. Specifically, a sample would be identified that would be subject to treatment using fecal bacteriotherapy in combination with antibiotic medications. Preferably, a control group would be identified that will be treated with traditional antibiotic intervention without the use of fecal bacteriotherapy. The data will be collected at a baseline as well as after the termination of treatment. The data will then be analyzed using appropriate statistical tools and translated into meaningful conclusions with respective recommendations. The success of the project will be determined by matching the obtained results to the projected outcomes. Due to the time limitations, only the changes in patient health outcomes will be included in the assessment.
Process, Outcomes Evaluation, and Reporting
The desired outcome directly related to the project is the decreased rate of CDI recurrence among patients. This indicator can be measured by studying the health records of the patients admitted to the clinical setting based on the said diagnosis and analyzing the trend associated with the intervention. The findings will then be converted to the accessible graphical format and accompanied by clarifications regarding the validity of data during a report to the stakeholders.
Identify Next Steps
Once the project confirms the efficiency of the identified intervention, it would be necessary to implement it on a larger scale by institutionalizing the effective practices in other units. It would also be necessary to introduce staff training sessions to ensure proficiency. Finally, organizational culture adjustments may be necessary to facilitate the longevity of innovation.
Disseminate Findings
The findings will be communicated internally through a series of dedicated events. Also, a report will be issued containing the concise summary and details of the research procedure. In this way, the data can be verified externally and adopted for EBP solutions by interested parties.
Conclusion
The recurrent CDI is a serious clinical issue associated with significant health and economic effects. The suggested project is expected to provide a long-term solution by measuring the effectiveness of the interventions and facilitating a robust improvement. The adherence to the ACE Star change model is expected to ensure consistency of the innovation and clarity of the process for the involved stakeholders.
References
Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J.,… Hamilton, C. W. (2016). Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, 62(10), 51-77.
Fehér, C., & Mensa, J. (2016). A comparison of current guidelines of five international societies on Clostridium difficile infection management. Infectious Diseases and Therapy, 5(3), 207-230.
Gupta, A., & Khanna, S. (2014). Community-acquired Clostridium difficile infection: An increasing public health threat. Infection and Drug Resistance, 7, 63-72.
Moayyedi, P., Marshall, J. K., Yuan, Y., & Hunt, R. (2014). Canadian Association of Gastroenterology position statement: Fecal microbiota transplant therapy. Canadian Journal of Gastroenterology and Hepatology, 28(2), 66-68.
O’Horo, J. C., Jindai, K., Kunzer, B., & Safdar, N. (2014). Treatment of recurrent Clostridium difficile infection: A systematic review. Infection, 42(1), 43-59.