Downloaded from http://journals.lww.com/cns-journal by /r1JlJ0cDNg0GM4RSzEaIvLUPmCGrPiZVzYwKwfS092RByf7a6vrBaB4X2imrFcs1RDd1agJNFY5LfEDcOIrFYne9qrhf2rV3qvfJEqeJcxcIL+CwFqbWy/M2Lmfv945zu5cIcGb0GM= on 06/07/2019 Fecal Occult Blood Tests Valuable for Screening, Wasteful for Diagnostics Valerie Danesh, PhD, RN, CCRP, CCRN-K n Brittany Gisi, BSN, RN n Maitreyi Narayan, BS n Linda Yoder, PhD, MBA, RN, AOCN, FAAN n Omid Zad, MD Purpose/Objectives The purpose of this program was to deimplement the use of fecal occult blood tests (FOBTs) for hospitalized patients. Description of the Project/Program We used a multipronged multidisciplinary approach to deimplement the use of FOBT, including physician-nurse collaborations, data-based poster displays, and a review of test utilization and patient cost throughout all facilities. Outcome Despite a downward trend in FOBT orders for hospitalized patients over 3 years, the inappropriate use of FOBTremains a cause of unnecessary delays of diagnostic workups and patient care and excess costs ranging from US $22 000 to $41 000 annually for each hospital. Conclusion Clinical nurse specialists can question the empirical origin and patient outcomes associated with clinical practice and are positioned to assess and champion deimplementation processes. KEY WORDS clinical nurse specialist, deimplementation, evidence-based practice, fecal occult blood tests (FOBTs), gastrointestinal bleeding, redesign F ecal occult blood tests (FOBTs) have been validat- ed for colorectal cancer screenings to detect early- stage colorectal cancer or adenomas since 1967. 1,2 The American Cancer Society recommends FOBT annually for colorectal cancer starting at age 50 years in asymptom- atic individuals at average risk 3 and the US Preventive Services Task Force recommends FOBT screening every 1 to 3 years, depending on the test used. 4 Fecal occult blood tests are used to identify, in asymp- tomatic individuals at risk of a condition, those who have an increased likelihood of that condition. The use of the FOBT as a screening test can promote early detection of colorectal cancer and may reduce mortality in at-risk populations. 5 Screening with FOBTs to guide early detection of colorectal cancer is associated with a 16% decrease in relative colorectal cancer mortality. 5 The FOBT is used as a ‘‘risk refinement’’ strategy to prioritize colonoscopies for colorectal cancer screening in asymptomatic patients. If pa- tients are symptomatic with the suspicion of rectal blood loss, melena, and/or abdominal pain, then endoscopic evaluation is recommended. 2 PURPOSE The purpose of this article is to describe the deimplementation process of using FOBTs for hospitalized patients. BACKGROUND The FOBT is a guaiac (chemical) test to detect pseudo peroxidase activity of the heme component in stool. Sen- sitivities of FOBTs vary based on the test characteristics, sampling, and concomitant factors (eg, dietary intake, medications). Two tests are currently used as screening tests for occult blood in stool samples for detection of colorectal cancer: the guaiac FOBT and the fecal immu- noassay testing. The guaiac FOBT (gFOBT) detects heme in stool via a reaction that is dependent on the peroxidase activity of hemoglobin. This is not specific to human hemoglobin, or hemoglobin itself; animal hemoglobin and plant per- oxidases can cause false-positive results. Therefore, dietary and concomitant medication restrictions are required to minimize false-positive results for gFOBT. An overview of false results 3,6Y11 in gFOBT testing is provided in Author Affiliations: Assistant Professor (Dr Danesh), Undergraduate Student (Ms Narayan), and Professor (Dr Yoder) University of Texas at Austin; Assistant Investigator (Dr Danesh), Baylor Scott & White Health, Dallas, Texas; Medical Student (Ms Gisi), University of Pittsburgh School of Medicine, Pennsylvania; and ICU Medical Director (Dr Zad), Dr. P. Phillips Hospital, Orlando Health, Florida. The authors report no conflicts of interest. Correspondence: Valerie Danesh, PhD, RN, CCRP, CCRN-K, 1710 Red River St, Mail Code D0100, Austin, TX 78712 (vdanesh@nursing.utexas.edu). DOI: 10.1097/NUR.0000000000000460 Clinical Nurse Specialist A www.cns-journal.com 191 Clinical Nurse Specialist A Copyright B 2019 Wolters Kluwer Health, Inc. All rights reserved. Feature Article Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.