Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study

Abstract

Background: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. Methods: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. Results: Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. Conclusions: Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.

Adherence to Guidelines for Assessment and Empiric Antibiotics Recommendations for Community-Acquired Pneumonia at Ambo University Referral Hospital: Prospective Observational Study

“…Some studies revealed possible barriers and challenges for poor adherence of healthcare professionals to treatment guideline. 35 Models were developed to suggest that physicians fail to adhere to guidelines in the presence of an internal barrier that a cognitive (awareness or knowledge) or affective (attitude or motivation) component, or in the presence of an external barrier (patient, guideline and environmental factors) that restricts the professionals’ ability. 36–38 Implementation science indicates that factors determining healthcare professionals (HPs’) adherence to treatment guideline can be linked to both individual, team and organizational level and are related to the context where the treatment and care is performed.…”

‘Stolen Time’- Delivering Nursing at The Bottom of A Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing For Patients With Community Acquired Pneumonia.

“…To enhance awareness of the phenomenon under study, she expanded her preunderstanding by studying literature about EBGs recommendations for CAP [e.g. 10,11] and barriers and facilitators for HPs' adherence to EBGs [3,6]. The Theoretical Domain Framework (TDF) [26] (14 domains selected from 33 behaviour change theories and 128 constructs) was central in this process as it captures barriers and facilitators for HPs behaviour at individual, team, and organizational levels.…”

“…A group of patients who appear to be deprived of nursing care (NC) interventions according to EBGs are older patients with CAP [2,3,6], leading to fatal patient outcomes. CAP is an acute in ammatory lung disease and a signi cant cause of morbidity and mortality among older persons (>65 years) [7], thus representing a major cost and capacity challenge for hospitals and society [8,9].…”

“…The unsuccessful transfer of evidence into practice presented in previous studies [e.g. 4,6,18] raises the question of what hinders RNs in adhering to EBGs, particularly in light of the fatal consequences for patients and the economic and capacity burden for healthcare settings. According to implementation researchers [19,20], context-related barriers inhibiting the implementation and facilitators for the implementation of EBGs in clinical practice must be explored [21].…”

“…Studies have shown unsuccessful transfer of EBGs into routine clinical practice for patients with CAP regarding diagnostic procedures, medical treatment, and NC, of which NC appears to be the most neglected [6]. According to EBGs [e.g.…”