Cdiff and med A- would you skill?

[TigerxLiLy]

Patient admitted after her qualifying hosp stay for Dx. Of ankle fracture and cdiff in on 10/23

PT deferred gait training on day one due to NWB status for 6 weeks.

Resident was on flagyl in hospital for 1 week, still tested positive so they put her on vanc for 2 weeks and sent her to us.

12/12 therapy was plateauing, f/u ortho appt resulted in additional 6 weeks of NWB(1/8/15 f/u date). resident still required more assistance with ADLs then family able to provide..so family decided to keep LTC until weight bearing changes and requires less assistance.

We did RNP with last tx day 12/18. During that time resident was treated for mild uti and was retested for the cdiff = still positive. So MD placed on abt for uti and back on flagyl for cdiff a week.

Antibiotic therapy for both ended 12/19. No nurses documentation of any complications. Continued loose stool,but no s/s dehydration,n/v, poor pointake,lethargy,gi pain or distress.

F/u cdiff test today= still positive. Orders for 2 weeks of vanc q6hrs then 2 weeks of vanc bid.

Resident has had cdiff per MD over 4 months, same back n forth treatment. Resident has not needed IV fluids, has not c/o nausea in over 2 months, actually denies loose stools but she has a bit of STM , with cnas and nursing says she has loose BMs everyday. They state the BMs do not affect daily activities and resident continues to eat/drink the same every day.

MD does not want f/u is as the culture did not indicate it per MD and nursing does not report the s/s.

Would you continue to skill the resident for the cdiff and vanc observation? Is the Dx of cdiff and contact isolation(res. Leaves room due to loose stools are controlled per Risk manager) orders strong enough to justify skilled daily services? Nursing is always documenting "no s/s n/v,no adverse reactions,adequate po intake, no c/o abd pain, vitals WNL, and etc"

[TigerxLiLy]

** dates are not accurate... Heh.. I'm to tired to be THAT accurate :)

[Loo17]

Is the patient actually having multiple loose stools daily? The cdiff spores slough off for months after cdiff infection causing false positive samples. This is why it is not recommended to retest when patient is no longer symptomatic.

[TigerxLiLy]

According to the cnas and nurses she does...they say it's putty like

[JustBeachyNurse, LPN]

I had a patient (pedi) colonized with HAI c. Diff. Now on daily culturelle as published research shows effective for the body to eradicate c diff and reduce loose stools without additional abx wreaking havoc on the gut.

[Raviepoo]

When oh, when is fecal transplant going to become the standard of care for C. Diff?

[Talino]

Resident has had cdiff per MD over 4 months, same back n forth treatment. Resident has not needed IV fluids, has not c/o nausea in over 2 months, actually denies loose stools but she has a bit of STM , with cnas and nursing says she has loose BMs everyday. They state the BMs do not affect daily activities and resident continues to eat/drink the same every day.

Would you continue to skill the resident for the cdiff and vanc observation? Is the Dx of cdiff and contact isolation(res. Leaves room due to loose stools are controlled per Risk manager) orders strong enough to justify skilled daily services? Nursing is always documenting "no s/s n/v,no adverse reactions,adequate po intake, no c/o abd pain, vitals WNL, and etc"

Resident presents with a mild symptom of the disease. The services provided do not meet a skilled level of care.

[TigerxLiLy]

Exactly what I feel..because we have had cdiff needing way more nursing interventions... Just wish the MD/NP would consider stopping abt and seeing if stool starts to form...kinda like the other person says.. The stools are going to remain positive as long as it's sloughing out/Colonized

[CapeCodMermaid, RN]

We wouldn't skill this resident. PO antibiotics aren't enough to skill someone. We had one resident have CDiff for 6 months. She had the GIFT....first 2 times it didn't work. Finally the 3rd time it worked. She's thrilled...and back home.

[TigerxLiLy]

May I ask what the GIFT is?

[CapeCodMermaid, RN]

It's a Fecal Transplant. People donate their poop which is then placed inside someone who has CDiff that hasn't responded to medications. The GI docs around here are having good success with the procedure. The newest procedure is easy...the feces are placed in a capsule which doesn't dissolve until it gets into the GI tract.

[silverbat]

Also you can't put isolation if they come out of their room at all.