Major Article
Health care worker perceptions toward computerized clinical decision support tools for Clostridium difficile infection reduction: A qualitative study at 2 hospitals

https://doi.org/10.1016/j.ajic.2018.04.204Get rights and content

Highlights

  • The impact of an electronic Clostridium difficile infection reduction bundle was assessed.

  • Gaps in knowledge and communication between health care workers were observed.

  • A perceived loss of autonomy and clinical judgment was identified.

  • Standardization and automation were perceived benefits.

  • End users agreed the tools could help them to improve the quality of patient care.

Background

Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. Computerized clinical decision support (CCDS) tools can aid process improvement in infection prevention and antibiotic stewardship, but implementation and health care workers (HCWs) uptake of these tools is often variable. The objective of this study was to describe HCWs' perceptions of barriers and facilitators related to uptake of CCDS tools as part of a CDI reduction bundle.

Methods

We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland. Semi-structured interviews and structured surveys were completed by HCWs to evaluate their perception to CCDS tools at 2 different stages: predevelopment and preimplementation. Emergent themes and patterns in the data were identified and condensed.

Results

Gaps in CDI-related knowledge and in communication between HCWs were identified throughout the evaluation. HCWs agreed on the potential of the tools to improve CDI diagnosis, prevention, and control. An important barrier for uptake was the perceived loss of autonomy and clinical judgment, whereas standardization and error reduction were perceived advantages.

Conclusions

These observations shaped the development and implementation of the CDI reduction bundle. Qualitative findings can provide valuable contextual information during the development stages of CCDS tools in infection prevention and antibiotic stewardship.

Section snippets

Background

Despite prevention efforts, Clostridium difficile infection (CDI) rates have remained high across the United States, suggesting that new interventions are needed.1 Electronic health record–based computerized clinical decision support (CCDS), a technology that uses patient-specific data to provide relevant pieces of knowledge at the point of care, has been used to optimize infection control and antibiotic stewardship activities.2, 3, 4, 5, 6 However, the use of CCDS specifically for CDI

Materials and methods

We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland to explore the perceived barriers and facilitators related to the uptake of a CDI reduction bundle.

CDI-related knowledge among HCWs

Of the 34 HCWs (17 from each hospital) who participated in the structured interviews, 11 were nurses, 9 were physicians, 3 were pharmacists, 4 were radiology technicians, and 7 were EVS workers. All EVS workers correctly responded to their CDI knowledge assessment. All interviewed HCWs (EVS excluded) agreed on the association between antibiotics and CDI development (n = 23; 100%); however, the same was not observed for the association between proton-pump inhibitors (PPIs) and CDI (n = 16; 70%).

Discussion

We identified important gaps in CDI-related knowledge and communication between HCWs. HCWs agreed on the potential of the evaluated CCDS tools to improve CDI prevention, control, and diagnosis. They expressed concern regarding a perceived loss of autonomy and clinical judgment, but also conveyed an appreciation for the perceived benefits associated with CCDS tools such as standardization and automation. Previous work on non-CDI CCDS tools confirmed our observations of perceived threats to

References (30)

  • S. Van de Velde et al.

    Tailoring implementation strategies for evidence-based recommendations using computerised clinical decision support systems: protocol for the development of the GUIDES tools

    Implement Sci

    (2016)
  • T.J. Bright et al.

    Effect of clinical decision-support systems: a systematic review

    Ann Intern Med

    (2012)
  • C.M. Dewart et al.

    Electronic Clostridium difficile infection bundle reduces time to initiation of contact precautions

    Infect Control Hosp Epidemiol

    (2017)
  • P.E. Brumley et al.

    Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection

    J Antimicrob Chemother

    (2016)
  • QuanK.A. et al.

    Computerized Physician Order Entry (CPOE) to Enforce Clinically Appropriate C. difficile Testing

    (2017)
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    Funding/support: Supported by the Centers for Disease Control and Prevention through a Broad Agency Announcement (contract no. 200-2016-91943).

    Conflicts of interest: N.B. reports grants from Centers for Disease Control and Prevention, during the conduct of the study; S.L. reports grants from Centers for Disease Control and Prevention, during the conduct of the study; D.J.M. reports grants from CDC, NIH, AHRQ, VA HSRD, IDSA, other from ASM, Lown and SHEA for expenses to organize or present at national meetings,other from Springer Inc, outside the submitted work; C.B. reports grants from Centers for Disease Control, during the conduct of the study; G.L.R. reports grants from Centers for Disease Control, during the conduct of the study; J.B. reports grants from Centers for Disease Control, during the conduct of the study; L.M.O reports grants from Centers for Disease Control and Prevention, during the conduct of the study; E.H. reports grants from ALK-ABELLO, outside the submitted work; there are no other conflicts to disclose.

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