title: Evidence-based clinical pathways to manage urinary tract infections in long-term care facilities: a qualitative case study describing administrator and nursing staff views.
abstract: OBJECTIVE
  This article examines the views of nursing staff and administrators in long-term care facilities (LTCFs) regarding a clinical pathway for managing urinary tract infections (UTIs) in LTCF residents.
  
  
  METHODS
  A qualitative (case study) design was used.
  
  
  METHODS
  Data were collected from 8 LTCFs in southern Ontario and 2 in Iowa enrolled in a larger randomized controlled trial of clinical pathway for managing UTIs in LTCF residents, conducted between September 2001 and March 2003. The clinical pathway, designed to more effectively identify, diagnose, and treat UTIs, and reduce inappropriate antibiotics use for asymptomatic UTIs, introduced 2 decision tools to determine when to order a urine culture and initiate antibiotic treatment for suspected UTIs.
  
  
  METHODS
  We conducted 19 individual interviews with administrators and 10 focus groups with 52 nurses.
  
  
  RESULTS
  Nurses generally thought that the pathways were well developed and easy to use, and administrators believed they were an important educational resource. Barriers to their use varied by group-initial lack of buy-in from nurses (medical directors), additional work (directors of nursing), and the need to change the protocol to exclude certain residents based on prior health conditions and/or pressure from physicians or families (nurses).
  
  
  CONCLUSIONS
  Both administrators and staff, once familiar with a new clinical protocol to improve UTI management in LTCFs, generally supported its use.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. lohfeld@mcmaster.ca
authors.forename: Lynne
authors.initials: L
authors.lastname: Lohfeld
authors.forename: Mark
authors.initials: M
authors.lastname: Loeb
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002170:Canada; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care; D009733:Nursing Diagnosis; D009735:Nursing Homes; D009740:Nursing Staff / Q000523:psychology*; D014481:United States; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents