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A multifaceted intervention to implement guidelines improved treatment of nursing home-acquired pneumonia in a state
Evelyn Hutt1, J Mark Ruscin, Kitty Corbett
1Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado 80220, USA. Evelyn.Hutt@uchsc.edu
Objectives:
To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home-acquired pneumonia (NHAP) into practice using a small intervention trial.
Design:
Pre-posttest with untreated control group.
Setting:
Two Colorado State Veterans Homes (SVHs) during two influenza seasons.
Participants:
Eighty-six residents with two or more signs of lower respiratory tract infection.
Intervention:
Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing.
Measurements:
Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test.
Results:
At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year.
Conclusion:
Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents.
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