ITS 99 - Quality Initiative to Improve the Electronic Health Record’s Best Practice Advisory for Targeted MRSA Screening Compliance

Background: Early identification of methicillin resistant Staphylococcus aureus (MRSA) colonized patients ensures prompt isolation and decolonization therapy to prevent MRSA transmission and infection. Our hospital currently uses an electronic health record (EHR) best practice advisory (BPA) to alert team members to collect MRSA nares screens for adult inpatients with MRSA risk factors. Infection prevention data suggested that MRSA screening compliance was low. This prompted a quality improvement initiative to increase MRSA screening compliance including assessing and revising the MRSA screening BPA.

Methods: This quality improvement initiative was performed between December 2022 and November 2023 at a 1,040 bed acute care academic medical center. Opportunities to increase MRSA screening compliance among adult inpatients were identified and resulted in BPA modifications. Phase 1 modifications included changes to BPA firing frequency and dismissal. Integration of discrete data fields was included in phase 2 modifications. Point prevalence surveys were conducted for MRSA nares screening compliance prior to (n= 56), and after phase 1 (n=30) and phase 2 (n=38) modifications. In addition, the number of MRSA screens collected, and MRSA positive patients identified in the 90 days before and after BPA modifications were compared.

Results: MRSA screening compliance was 38% and 89% before and after MRSA BPA modifications, respectively. The 30-day average for MRSA screen collection increased from 862 to 1,489 screens following BPA modifications. In addition, after BPA modifications the 30-day average identification of first time MRSA patients increased from 95 to 139.

Conclusions: This quality improvement project successfully identified MRSA screening BPA opportunities and ultimately increased our MRSA screening compliance by over 51%. In addition, on average this project resulted in the identification of 44 more MRSA patients every 30 days. Facilities that desire to increase MRSA screening compliance may consider using an EHR BPA and/or assessing and adjusting their current EHR BPAs.