title: A multifaceted intervention to implement guidelines improved treatment of nursing home-acquired pneumonia in a state veterans home.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Pre-posttest with untreated control group.
  
  
  METHODS
  Two Colorado State Veterans Homes (SVHs) during two influenza seasons.
  
  
  METHODS
  Eighty-six residents with two or more signs of lower respiratory tract infection.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado 80220, USA. Evelyn.Hutt@uchsc.edu
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hutt
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ruscin
authors.forename: Kitty
authors.initials: K
authors.lastname: Corbett
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Radcliff
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kramer
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Williams
authors.forename: Debra
authors.initials: D
authors.lastname: Liebrecht
authors.forename: William
authors.initials: W
authors.lastname: Klenke
authors.forename: Sheryl
authors.initials: S
authors.lastname: Hartmann
mesh_terms: D000369:Aged, 80 and over; D003428:Cross Infection / Q000451:nursing*; D005260:Female; D019983:Guideline Adherence; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000209:etiology / Q000451:nursing*; D017410:Practice Guidelines as Topic