Testing the feasibility of implementation of clinical practice guidelines in long-term care facilities

OBJECTIVES: The purpose of this study was to explore the feasibility of implementing two specific Clinical Practice Guidelines (CPGs), Pain Management and Falls and Fall Risk, developed by the American Medical Directors Association. DESIGN: This study used a combined quantitative and qualitative design using a single-group repeated-measures design for the quantitative component. SETTING: The study was done in 23 long-term care facilities in Maryland. PARTICIPANTS: Of 40 facilities that participated in a training program for CPG implementation, 32 were interested in implementing CPGs and 23 volunteered to participate in the study. Evaluation of the Falls CPG was based on 127 randomly selected cases preimplementation and 119 randomly selected cases postimplementation from the 23 facilities. Evaluation of the Pain CPG included 64 randomly selected cases preimplementation and 74 randomly selected cases postimplementation from the 23 facilities. Qualitative data was obtained from 20 of the directors of nursing. INTERVENTION: Thirteen of the facilities implement-ed the Falls CPG, 10 facilities implemented the Pain CPG, and eight facilities implemented both CPGs. MEASUREMENTS: Process indicators of CPG implementation were used in this study. Process indicators included five measurable items that were indicative of CPG implementation such as evidence of a pain assessment. RESULTS: Less than half (45%) of the original 40 facilities actually implemented at least one of the CPGs. Based on process indicators in those facilities that did implement the CPGs, there was evidence that the guidelines were being implemented. Qualitative data led to the development of four major themes: challenges to implementation, benefits of implementation, process recommendations, and recommendations for changes in the CPGs. CONCLUSION: The study provides some support for the feasibility of CPG implementation in facilities that voluntarily attempted to implement the guidelines. In addition, the findings provide some useful suggestions for how to facilitate the implementation process.