Implementation of Clinical Practice Guidelines in Long-Term Care Facilities

Newswise — Clinical practice guidelines are a promising way to enhance the quality of care for nursing home residents, although nursing homes may need additional support as they attempt to put the recommendations into practice, according to a study and editorial in the January Journal of the American Medical Directors Association.

Barbara Resnick, Ph.D., C.R.N.P., and colleagues of University of Maryland School of Nursing analyzed the experience of 23 long-term care facilities implementing two clinical practice guidelines. The guidelines, developed by the AMDA, addressed two of the major problems facing elderly people in nursing homes: falls and pain.

Based on specific process indicators—for example, whether each resident had been evaluated for risk of falling and had received adequate assessment and treatment for pain—the guidelines had a significant impact on nursing home care. From six months before to six months implementation of the falls guideline, the percentage of care process indicators increased from 46 to 62 percent. For the pain guideline, the percentage increased from 38 to 48 percent.

Interviews with Directors of Nursing at the nursing homes facilities identified staff education as a major challenge to implementing the guidelines. Getting staff to "buy in" and take responsibility for carrying out the guidelines was sometimes difficult, especially because of the increased workload entailed.

At the same time, the Directors of Nursing felt the guidelines were having a positive impact on the problems of pain and falls at their facilities. They recommended a more deliberate approach to implementing practice guidelines: implementing one guideline at a time, including staff in the process, and making future guidelines more "user-friendly."

Falls and pain are frequent problems for elderly nursing home residents, and rates of these problems are key indicators of the quality of care. Clinical practice guidelines such as those being developed by AMDA— based on research evidence and expert opinion—are seen as an important step toward ensuring high-quality nursing home care.

The new study shows that clinical practice guidelines can be implemented at nursing homes and produce at least some positive changes in care. At the same time, it illustrates the considerable challenges of integrating guideline recommendations into daily care.

An editorial by John F. Schnelle, Ph.D., and Sandra F. Simmons, Ph.D., of University of California, Los Angeles, emphasizes that nursing homes need ongoing support during the difficult process of guideline implementation. Expert consultants can play an important role, especially during the start-up phase. Later in the process, new information technologies could be used to monitor and provide feedback on efforts to translate the guidelines into everyday care.

The American Medical Directors Association is the national professional association for medical directors and other physicians practicing in long-term care. With more than 7,200 members, the AMDA is committed to the continuous improvement of the quality of patient care through education, advocacy, information, and professional development for both medical directors and attending physicians.

"Testing the Feasibility of Implementation of Clinical Practice Guidelines in Long-Term Care Facilities" byBarbara Resnick, PhD,CRNP,FAAN,FAANPJournal of the American Medical Directors AssociationJan/Feb2004