Barriers to and facilitators of clinical practice guideline use in nursing homes.
OBJECTIVE
To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs).


METHODS
Qualitative analysis.


METHODS
Four randomly selected community nursing homes.


METHODS
NH staff, including physicians, nurse practitioners, administrative staff, nurses, and certified nursing assistants (CNAs).


METHODS
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.


CONCLUSIONS
Clinicians and researchers wishing to increase CPG use in NHs should consider these barriers and facilitators in their quality improvement and intervention development processes.
Colón-Emeric
Cathleen S
CS
Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. colon001@mc.duke.edu
Lekan
Deborah
D
Utley-Smith
Queen
Q
Ammarell
Natalie
N
Bailey
Donald
D
Corazzini
Kirsten
K
Piven
Mary L
ML
Anderson
Ruth A
RA
D001291:Attitude of Health Personnel; D002985:Clinical Protocols / Q000592:standards*; D019983:Guideline Adherence; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D009657:North Carolina; D009735:Nursing Homes / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011361:Professional Competence / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care