Planning for Implementation of a Universal Decolonization Process at a Large Healthcare System (Masters of Science in Biomedical Informatics Capstone)

Abstract

<h3>Background</h3> There is a growing body of literature to promote the use and highlight the effectiveness of universal decolonization (UD) over targeted decolonization (TD) to reduce the burden of methicillin-resistant Staphylococcus aureus (MRSA) on acute care patients. Infection preventionist (IP) leaders and stakeholders at a large urban healthcare system have supported implementing UD in adult intensive care units (ICUs) but have not yet identified a future state electronic health record (EHR) workflow due to technical, legal, and human factor constraints. This project served as a Masters capstone for an IP. <h3>Methods</h3> An IP with biomedical informatics experience identified constraints and requirements associated with UD at the implementation site, collaborated with clinical informaticists, and outlined pathways in the EHR, including triggering events, alerts, and order sets, to accomplish the UD process effectively. The target patient population will include adult ICU patients in 14 acute care hospitals. The IP identified three potential future state workflows in the EHR for effective UD implementation with strengths and weaknesses. <h3>Results</h3> Future state workflows were evaluated based on reliability that all UD components will be carried out to completion in each patient, the workflow will reach the target population, and there will be high compliance. IPs and stakeholders elected to pursue a partial hard-stop alert within the EHR with few override options in order to achieve high compliance, despite possible physician resistance as seen with total hard-stop alerts. In the coming months, this workflow will be built into the System's EHR and implemented. <h3>Conclusions</h3> A viable solution was identified for a future state MRSA UD workflow. The future state workflow successfully satisfied requirements and addressed constraints identified by IPs and stakeholders. This will ultimately lead to higher compliance with the UD process and a decrease in the burden of MRSA within the System is expected following implementation of the workflow.