Kristy Maracle

Posted Date

Jun 16, 2022, 4:05 PM

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I have not yet been involved in the implementation of a new evidence-based practice intervention however, there is an intervention that would be useful in my workplace in distinguishing between viral and bacterial infectious etiologies while aiding in antibiotic stewardship, which is the use of procalcitonin testing. It has been estimated that 30%-85% of antibiotic prescriptions are unnecessary or inappropriate and even when indicated, often exceed recommended durations, leading to ever increasing antibiotic resistance. 

Procalcitonin testing has been proven to be approximately 70% accurate in distinguishing bacterial from viral pathogen and when used in adjunct to algorithms and clinical judgement, has been shown to reduce unnecessary antibiotic use by up to 50% without increasing mortality or morbidity (Rhee and Mansour, 2022). A scenario where this may be useful is adding procalcitonin testing to ED order set that may be applied to presentations where there is high variability between viral vs bacterial etiologies, such as respiratory illnesses. 

The implementation of evidence-based practice (EBP) follows a process that includes cultivating a spirit of inquiry, asking a clinical question, searching for evidence, appraising, and applying the evidence, and evaluating its application in clinical practice (Abu-Baker et al, 2021). The initiation of the use of procalcitonin would follow a process that includes modifying the implementation for the available resources such as initially using the testing in the ED to establish type of infection but not in the guidance of antibiotic use as part of a multiphase “rollout” process, establishing EHR order sets, and keeping patient centered goals in the forefront, which may include anticipating shorter hospital stays with reduced risk of hospital acquired infections. The most difficult stage is the implementation stage, which may be accomplished by time-intensive strategies, various models, staff education, computerized decision support, performance feedback, multiprofessional collaboration, media campaigns, and resources, which are often minimal (Tucker & Gallagher-Ford, 2019). Education and proving cost-effectiveness would be key in the implementation of procalcitonin testing in small hospitals such as the one at which I am employed, and thus, I would add a thorough cost analysis with projected savings both immediately and in the future. 

References

Abu-Baker, N.N., Abualrub, S., Obeidat, R.F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: A cross-

sectional study among undergraduate nursing students. BMJ Nursing, 20:13. https://doi.org/10.1186/s12912-020-00522

Rhee, C., & Mansour, M.K. (2022). Procalcitonin use in lower respiratory tract infections. Retrieved on June 16, 2022, from, 

https://www.uptodate.com/contents/procalcitonin-use-in-lower-respiratory-tract-infections#

Tucker, S., & Gallagher-Ford, L. (2019). EBP: From strategy to implementation. American Journal of Nursing, 119(4), 50-52. 

https://doi:10.1097/01.NAJ0000554549.01028.af