Adherence to Therapeutic Guidelines for Patients with Community-Acquired Pneumonia in Australian Hospitals

Abstract

Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, particularly in elderly patients, and is associated with a considerable economic burden on the healthcare system. The combination of high incidence and substantial financial costs necessitate accurate diagnosis and appropriate management of patients admitted with CAP. This article will discuss the rates of adherence to clinical guidelines, the use of severity scoring tools and the appropriateness of antimicrobial prescribing for patients diagnosed with CAP. The authors maintain that awareness of national and hospital guidelines is imperative to complement the physicians’ clinical judgment with evidence-based recommendations. Increased use of pneumonia severity assessment tools and greater adherence to therapeutic guidelines will enhance concordant antimicrobial prescribing for patients with CAP. A robust and multifaceted educational intervention, in combination with antimicrobial stewardship programs, may enhance compliance of CAP guidelines in clinical practice in Australia.

Heterogeneous emergency department management of published recommendation defined hypotension in patients with acute traumatic spinal cord injury: A multi‐centre overview

“…As an example, a survey of neurosurgical intensive care specialists across UK showed variable BP management in acute TSCI; 23% aiming for MAP >60 mmHg, 54% MAP >80 mmHg and 18% targeting ±20% normal BP . In Australia, poor adherence to guidelines for particular conditions has been previously demonstrated . There is little evidence describing ED hypotension management or adherence to internationally published guidelines post‐TSCI in Australia.…”

Enablers and barriers to the use of antibiotic guidelines in the assessment and treatment of community-acquired pneumonia-A qualitative study of clinicians’ perspectives

“…Even with positive attitudes towards guidelines all clinicians believed that clinical judgment was essential in modifying treatment of CAP. The prevailing attitude was that strict adherence to guidelines is unworkable as they do not account for all patient characteristics such as comorbidities, social circumstances and previously trialled or failed treatments . In this context, CAP guidelines may have reached their maximum applicability and utility in many clinical practice settings when considering patient comorbidities and complexity.…”

Audit of a multidisciplinary approach to improve management of community-acquired pneumonia

“…Some standards exhibited a significant improvement. For example, compliance with empirical antibiotic guidelines (standard 4), which is associated with an improved clinical outcome for CAP patients,8 increased from 56.3% to 85.5%, and other standards increased from 0% compliance to attain rates above the national average 9. An exception was the standard relating to documentation of vaccination plans, for which compliance remained at 0% for two consecutive years.…”