Analysis of adherence to national nosocomial pneumonia treatment guidelines
Authors Edward H Eiland III, Kurt A Wargo, Wayne Hamm, Ali AM Hassoun
Published 15 January 2008 Volume 2007:3(6) Pages 983—988
Edward H Eiland III1, Kurt A Wargo2, Wayne Hamm3, Ali AM Hassoun1,4
1Huntsville Hospital, Huntsville, AL, USA; 2Auburn University Harrison School of Pharmacy, Auburn, AL, USA; 3Pfizer Inc; 4Alabama Infectious Disease Center, Huntsville, AL, USA
Background: Guidelines for the management of adults with hospital-acquired (HAP), ventilatorassociated (VAP), and healthcare-associated (HCAP) pneumonia were recently updated. These evidence-based guidelines emphasize early, appropriate antimicrobials, as well as, de-escalation of initial therapy based upon microbiologic cultures and clinical response of the patient, and to shorten duration of therapy to a minimum effective period.
Objective: To evaluate adherence to the nosocomial pneumonia guidelines before and after a multifaceted educational intervention in conjunction with the implementation of an adult pneumonia order set.
Methods: A three phase, retrospective, observational analysis was performed among patients with nosocomial pneumonia in a tertiary care facility. The phases consisted of an analysis of medical charts to identify empiric antimicrobial therapy for patients with nosocomial pneumonia; education of physicians on the guidelines; and repeat review of medical charts of patients with nosocomial pneumonia to observe for guideline adherence. An adult pneumonia order set was introduced to the medical staff prior to the initiation of the observational analysis and provided a modality for prescribers to be most compliant with the current recommendations for treating pneumonia. Order set utilization was tracked throughout the observational analysis to determine if various educational interventions increased compliance.
Results: Thirty-three patients were evaluated pre-education: 5 transferred, 16 discharged, and 12 died. Thirty-one patients were evaluated post-education: 6 transferred, 21 discharged, and 4 died. The combined sixty-seven patients received two hundred forty-eight orders for forty-four unique antimicrobial agents from five different services. Appropriateness of antimicrobial prescribing, designated by adherence to the clinical practice guidelines, did not improve following an educational intervention. However, the adult pneumonia order set was utilized in forty-eight percent of the post-education group while only being implemented in nine percent of the preeducation group. The prescribing of single or additional antimicrobials, while utilizing the adult pneumonia order set, commonly resulted in overall noncompliance with the consensus guidelines.
Conclusion: This analysis showed that educational efforts alone were not effective in improving the appropriateness of prescribing empiric antimicrobial therapy in accordance with the guidelines. Prescribing compliance with pre-printed orders, in addition to periodic interactive educational interventions, should be addressed when introducing and maintaining adherence to new clinical practice guidelines.
Keywords: nosocomial pneumonia, clinical practice guidelines, educational intervention, pneumonia order set
Readers of this article also read:
Cai Y, Zhang W, Chen Z, Shi Z, He C, Chen M
Published Date: 5 January 2016
The gastroprotective effects of hydroalcoholic extract of Monolluma quadrangula against ethanol-induced gastric mucosal injuries in Sprague Dawley rats
Ibrahim IAA, Abdulla MA, Hajrezaie M, Bader A, Shahzad N, Al-Ghamdi SS, Gushash AS, Hasanpourghadi M
Published Date: 30 December 2015
Improving cytotoxicity against cancer cells by chemo-photodynamic combined modalities using silver-graphene quantum dots nanocomposites
Habiba K, Encarnacion-Rosado J, Garcia-Pabon K, Villalobos-Santos JC, Makarov VI, Avalos JA, Weiner BR, Morell G
Published Date: 24 December 2015
Lopez-Campos JL, Fernandez-Villar A, Calero-Acuña C, Represas-Represas C, Lopez-Ramírez C, Fernández VL, Soler-Cataluña JJ, Casamor R
Published Date: 27 May 2015
Transcutaneous spinal stimulation as a therapeutic strategy for spinal cord injury: state of the art
Grecco LH, Li S, Michel S, Castillo-Saavedra L, Mourdoukoutas A, Bikson M, Fregni F
Published Date: 23 March 2015
Das M, Yi DK, An SSA
Published Date: 20 February 2015
Cardiovascular and respiratory dysfunction in chronic obstructive pulmonary disease complicated by impaired peripheral oxygenation
Chuang ML, Huang SF, Su CH
Published Date: 11 February 2015
Reversal of corticosteroid insensitivity by p38 MAPK inhibition in peripheral blood mononuclear cells from COPD
Khorasani N, Baker J, Johnson M, Chung KF, Bhavsar PK
Published Date: 4 February 2015
Effect of triiodothyronine (T3) augmentation of acute milnacipran administration on monoamine levels: an in vivo microdialysis study in rats
Kitaichi Y, Inoue T, Nakagawa S, Boku S, Kato A, Kusumi I, Koyama T
Published Date: 30 October 2012
Angiopoietin-1-expressing adipose stem cells genetically modified with baculovirus nanocomplex: investigation in rat heart with acute infarction
Paul A, Nayan M, Khan AA, Shum-Tim D, Prakash S
Published Date: 8 February 2012