Associations Among Nurse and Certified Nursing Assistant Hours per Resident per Day and Adherence to Guidelines for Treating Nursing Home-Acquired Pneumonia
Associations Among Nurse and Certified Nursing Assistant Hours per Resident per Day and Adherence to Guidelines for Treating Nursing Home-Acquired Pneumonia
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DOI：
10.1093/gerona/63.10.1105
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发表时间：
2008-10-01
影响因子：
5.1
通讯作者：
Kramer, Andrew M.
中科院分区：
文献类型：
--
作者：
Hutt, Evelyn;Radcliff, Tiffany A.;Kramer, Andrew M.
背景资料。疗养院(NH)-获得性肺炎(NHAP)导致过度死亡率、住院和功能衰退，部分原因是许多NH居民没有得到适当的护理。护理结构，如护士/住院医生的人员配置比例，可能会阻碍或教唆高质量的护理。这项研究考察了护士/住院医生的人员配置比例、人员流动率和遵循循证指南治疗NHAP之间的关系。一项前瞻性的图表回顾研究是在2004-2005年流感季节对三个有2种NHAP症状和体征的州的16个NHS的居民进行的。同时审查NH病历的功能状态、合并症、NHAP严重程度和指南的遵从性。护士署署长提供执业护士和执业护士助理的每人每天工作时数比率(Hrpd)，以及新聘用的护理人员/年与现有护理人员的比率。通过多元回归分析，调整病例组合、设施特征和机构内居民的聚集性，评估指南依从性、护士和CNA人力资源开发和人员流失率之间的关系。中等(1.7-2.0)和高(>；2.0)CNA hrpd与较好的肺炎球菌和流感疫苗接种率显著相关。超过1.2名持证护士HRPD与适当的住院(优势比[OR]12.4：95%可信区间[CI]，3.5-43.8)和指南推荐的抗生素(OR 3.8：95%CI，1.7-8.7)显著相关。A>；70%的营业额与及时通知医生呈负相关(OR 0.4：95%CI。合理住院率(OR0.09：95%CI，0.05~0.26)。NHAP治疗指南的遵守与rtursc和cna hr-ixl和稳定性相关。NI-I实施循证护理的能力可能取决于其人员配置比例和稳定性。
Background. Nursing home (NH)-acquired pneumonia (NHAP) causes excessive mortality, hospitalization, and functional decline, partly because many NH residents do not receive appropriate care. Care structures like nurse/resident staffing ratios can impede or abet quality care. This study examines the relationship between nurse/resident staffing ratios, turnover, and adherence to evidence-based guidelines for treating NHAP.Methods. A prospective, chart-review study was conducted among residents of 16 NHs in three states with >= 2 signs and symptoms of NHAP during the 2004-2005 influenza season. NH medical records were reviewed concurrently for functional status, comorbidity, NHAP severity, and guideline adherence. Ratio of licensed nurse and Certified Nursing Assistant (CNA) hours per resident per day (hrpd) and ratio of newly hired nursing staff/year to current nursing staff were provided by Directors of Nursing. Associations among guideline adherence, nurse and CNA hrpd, and turnover were assessed using multiple regression to adjust for case mix, facility characteristics, and clustering of residents in facilities.Results. Mid (1.7-2.0) and high (> 2.0) CNA hrpd were significantly associated with better pneumococcal and influenza vaccination rates. More than 1.2 licensed nurse hrpd was significantly associated with appropriate hospitalization (odds ratio [OR] 12.4: 95% confidence interval [CI], 3.5-43.8) and guideline-recommended antibiotics (OR 3.8: 95% CI, 1.7-8.7). A > 70% turnover was inversely related to timely physician notification (OR 0.4: 95% CI. 0.2-0.7) and appropriate hospitalization (OR 0.09: 95% CI, 0.05-0.26).Conclusions. NHAP treatment guideline adherence is associated with rtursc and CNA hr-Ixl and stability. An NI-I's ability to implement evidence-based care may depend on adeqtnnc staffing ratios and stability.