A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home–Acquired Pneumonia in a State Veterans Home

Hutt, Evelyn; Ruscin, J. Mark; Corbett, Kitty; Radcliff, Tiffany A.; Kramer, Andrew M.; Williams, Elizabeth M.; Liebrecht, Debra; Klenke, William; Hartmann, Sheryl

doi:10.1111/j.1532-5415.2006.00937.x

Cited by 44 publications

(47 citation statements)

References 30 publications

(36 reference statements)

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“…[14][15][16] Guidelines, care paths, and other tools for assessing changes in condition and for the most common conditions associated with hospital readmissions, including heart failure, pneumonia, renal failure/dehydration, and urinary tract infections, as well as strategies to enhance advance care planning, are available. [17][18][19][20][21][22][23][24][25][26][27] Although implementing clinical practice changes in the NH setting is challenging for many reasons, 20,28-31 use of some of these guidelines and tools has been associated with reduced hospitalizations in the NH population. [32][33][34][35] A CMS pilot study demonstrated a 50% reduction in hospitalizations in 3 NHs in Georgia with high hospitalization rates associated with a set of clinical practice tools that includes many of those mentioned previously (Interventions to Reduce Acute Care Transfers or ''INTERACT'').…”

Section: Discussionmentioning

confidence: 99%

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Ouslander

Díaz

Hain

et al. 2011

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 99%

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Ouslander

Díaz

Hain

et al. 2011

Journal of the American Medical Directors Association

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“…Only two studies, focusing on pneumonia, did not bring about an improvement in antibiotic prescribing [45,47], one possibly due to lack of power [47], and the other potentially because the academic detailing was performed by pharmacists [45]. Four out of 12 studies targeted only physicians [42,44,46] or nurses [43].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 97%

“…Table 2 summarizes all 12 published interventional studies that aimed to improve antibiotic use in LTCFs, of which all but one [43] had an educational component [29,32,[39][40][41][42][44][45][46][47][48].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 99%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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“…4 Although CPGs are increasingly available, they are not routinely used in NHs. [5][6][7][8] Programs that train NH staff to implement CPGs have had limited success. 9 Poor adoption in other healthcare settings has been attributed to physician attitudes and values, 10,11 conflicting patient goals and expectations, 12,13 and organizational characteristics.…”

Section: Introductionmentioning

confidence: 99%

Barriers to and Facilitators of Clinical Practice Guideline Use in Nursing Homes

Colón‐Emeric

Lekan

Utley-Smith

et al. 2007

J American Geriatrics Society

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OBJECTIVES-To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs). DESIGN-Qualitative analysis. SETTING-Four randomly selected community nursing homes.PARTICIPANTS-NH staff, including physicians, nurse practitioners, administrative staff, nurses, and certified nursing assistants (CNAs). MEASUREMENTS-Interviews(n = 35) probed the use of CPGs and clinical protocols. Qualitative analysis using Rogers' Diffusion of Innovation stages-of-change model was conducted to produce a conceptual and thematic description.RESULTS-None of the NHs systematically adopted CPGs, and only three of 35 providers were familiar with CPGs. Confusion with other documents and regulations was common. The most frequently cited barriers were provider concerns that CPGs were ''checklists'' to replace clinical judgment, perceived conflict with resident and family goals, limited facility resources, lack of communication between providers and across shifts, facility policies that overwhelm or conflict with CPGs, and Health Insurance Portability and Accountability Act regulations interpreted to limit CNA access to clinical information. Facilitators included incorporating CPG recommendations into training materials, standing orders, customizable data collection forms, and regulatory reporting activities.CONCLUSION-Clinicians and researchers wishing to increase CPG use in NHs should consider these barriers and facilitators in their quality improvement and intervention development processes.Address corresponding to Cathleen Colon-Emeric, MD,

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A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home–Acquired Pneumonia in a State Veterans Home

Cited by 44 publications

References 30 publications

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Barriers to and Facilitators of Clinical Practice Guideline Use in Nursing Homes

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