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

<jats:sec id="S0899823X17000162_abs1" sec-type="general"><jats:title>BACKGROUND</jats:title><jats:p>Infants and young children are frequently colonized with <jats:italic>C. difficile</jats:italic> but rarely have symptomatic disease. However, <jats:italic>C. difficile</jats:italic> testing remains prevalent in this age group.</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs2" sec-type="general"><jats:title>OBJECTIVE</jats:title><jats:p>To design a computerized provider order entry (CPOE) alert to decrease testing for <jats:italic>C. difficile</jats:italic> in young children and infants.</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs3" sec-type="general"><jats:title>DESIGN</jats:title><jats:p>An interventional age-targeted before-after trial with comparison group</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs4" sec-type="general"><jats:title>SETTING</jats:title><jats:p>Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs5" sec-type="general"><jats:title>PATIENTS</jats:title><jats:p>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)</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs6" sec-type="general"><jats:title>INTERVENTION</jats:title><jats:p>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 <jats:italic>C. difficile</jats:italic> testing.</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs7" sec-type="results"><jats:title>RESULTS</jats:title><jats:p>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; <jats:italic>P</jats:italic><.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; <jats:italic>P</jats:italic><.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; <jats:italic>P</jats:italic>=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for <jats:italic>C. difficile</jats:italic>.</jats:p></jats:sec><jats:sec id="S0899823X17000162_abs8" sec-type="conclusions"><jats:title>CONCLUSIONS</jats:title><jats:p>The average monthly testing rate for <jats:italic>C. difficile</jats:italic> for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for <jats:italic>C. difficile.</jats:italic></jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol</jats:italic> 2017;38:542–546</jats:p></jats:sec>