title: Barriers to and facilitators of clinical practice guideline use in nursing homes.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. colon001@mc.duke.edu
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.forename: Deborah
authors.initials: D
authors.lastname: Lekan
authors.forename: Queen
authors.initials: Q
authors.lastname: Utley-Smith
authors.forename: Natalie
authors.initials: N
authors.lastname: Ammarell
authors.forename: Donald
authors.initials: D
authors.lastname: Bailey
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
authors.forename: Mary L
authors.initials: ML
authors.lastname: Piven
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: 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