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Clinical Practice Guidelines in the Nursing Home

Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass and Section of General Internal Medicine, Boston Medical Center, Boston, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass, dberlow{at}bu.edu

Gary J. Young, JD, PhD

Management Decision and Research Center, Boston VAMC, Boston, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Elaine C. Hickey, RN, MS

Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Julie Joseph, MPH

Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Jennifer J. Anderson, PhD

Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Arlene S. Ash, PhD

Section of General Internal Medicine, Boston Medical Center, Boston, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Mark A. Moskowitz, MD

Section of General Internal Medicine, Boston Medical Center, Boston, Mass and Boston University Schools of Medicine and Public Health, Boston, Mass

Clinical practice guidelines are an important tool for improving quality of care. This study determined whether and how guidelines are being used in nursing homes. We surveyed staff at 36 Department of Veterans Affairs (VA) nursing homes. Employees were asked whether they were familiar with guidelines as well as whether 5 specific guidelines had been read, were available, and had been adopted. Among 1065 respondents (60% of those surveyed), 79% reported familiarity with guidelines. The proportion of staff at a facility reporting adoption was generally less than 50%. Those nursing homes in which a high percentage of the staff reported adoption of one guideline were more likely to have adopted other guidelines. However, staff were not more likely to report adoption of a specific guideline when the nurse manager stated that it was adopted. We conclude that staff at VA nursing homes are familiar with guidelines. Guideline adoption at individual nursing homes, however, is not a systematic process involving the entire staff.

Key Words: Decubitus ulcers • nursing homes • practice guide-lines • quality assessment • urinary incontinence

American Journal of Medical Quality, Vol. 16, No. 6, 189-195 (2001)
DOI: 10.1177/106286060101600602


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