title: Impact of a multidisciplinary intervention on antibiotic use for nursing home-acquired pneumonia.
abstract: BACKGROUND
  Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home-acquired pneumonia (NHAP) guidelines related to use of antibiotics.
  
  
  METHODS
  This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP. Interventions took place in 8 NHs in Colorado; 8 NHs in Kansas and Missouri served as controls. Interventions included (1) educational sessions for nurses to improve recognition and timely treatment of NHAP symptoms and (2) academic detailing to clinicians by pharmacists regarding diagnostic and prescribing practices. Differences in antibiotic use between groups were compared after 2 intervention years relative to baseline.
  
  
  RESULTS
  A total of 549 episodes of NHAP were evaluated in the intervention group and 574 in the control group. Compared with baseline, 1 facility in the intervention group significantly improved in guideline adherence for optimal antibiotic use (P = 0.007), whereas no facilities in the control group improved. The mean adherence score for optimal antibiotic use in intervention NHs increased from 60% to 66%, whereas the control NHs increased from 32% to 39% (P = 0.3). Mean adherence to guidelines recommending antibiotic use within 4 hours of NHAP diagnosis increased from 57% to 75% in intervention NHs but decreased from 38% to 31% in control NHs (P = 0.0003 for difference). There was no difference between intervention and control NHs for guideline adherence regarding optimal duration of antibiotic use.
  
  
  CONCLUSIONS
  The ability of this multifaceted study to repeatedly remind nursing staff of the importance of timely antibiotic administration contrasts with its limited academic detailing interaction with clinicians. This difference within the intervention may explain the differential impact of the intervention on antibiotic guideline adherence.
authors: University of Colorado, Anschutz Medical Campus, Aurora, USA. sunny.linnebur@ucdenver.edu
authors: Sunny A
authors: SA
authors: Linnebur
authors: Douglas N
authors: DN
authors: Fish
authors: J Mark
authors: JM
authors: Ruscin
authors: Tiffany A
authors: TA
authors: Radcliff
authors: Kathy S
authors: KS
authors: Oman
authors: Regina
authors: R
authors: Fink
authors: Brent
authors: B
authors: Van Dorsten
authors: Debra
authors: D
authors: Liebrecht
authors: Ron
authors: R
authors: Fish
authors: Monica
authors: M
authors: McNulty
authors: Evelyn
authors: E
authors: Hutt
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004509:Education, Nursing, Continuing / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D019983:Guideline Adherence; D006801:Humans; D007615:Kansas; D008923:Missouri; D009735:Nursing Homes / Q000458:organization & administration*; D010348:Patient Care Team; D010595:Pharmacists / Q000458:organization & administration; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D024382:Professional Role; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents