Advanced

Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia : a descriptive cross-sectional study

Eekholm, Signe LU ; Ahlström, Gerd LU ; Kristensson, Jimmie LU and Lindhardt, Tove LU (2020) In BMC Infectious Diseases 20(1).
Abstract

BACKGROUND: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. METHODS: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. RESULTS: Thirty... (More)

BACKGROUND: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. METHODS: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. RESULTS: Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. CONCLUSIONS: Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.

(Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adherence, Community acquired pneumonia, Diagnosis, Evidence-based guidelines, Treatment, Nursing care
in
BMC Infectious Diseases
volume
20
issue
1
article number
73
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85078302022
  • pmid:31973742
ISSN
1471-2334
DOI
10.1186/s12879-019-4742-4
language
English
LU publication?
yes
id
2e74e695-e11d-4443-a818-2c78b4d2ddc2
date added to LUP
2020-02-05 09:52:17
date last changed
2021-05-11 04:38:54
@article{2e74e695-e11d-4443-a818-2c78b4d2ddc2,
  abstract     = {<p>BACKGROUND: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (&gt; 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. METHODS: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. RESULTS: Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. CONCLUSIONS: Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.</p>},
  author       = {Eekholm, Signe and Ahlström, Gerd and Kristensson, Jimmie and Lindhardt, Tove},
  issn         = {1471-2334},
  language     = {eng},
  month        = {01},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Infectious Diseases},
  title        = {Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia : a descriptive cross-sectional study},
  url          = {http://dx.doi.org/10.1186/s12879-019-4742-4},
  doi          = {10.1186/s12879-019-4742-4},
  volume       = {20},
  year         = {2020},
}