Elderly/Long-Term Care

Adequate staffing helps ensure patients in nursing homes receive proper treatment for pneumonia

Though guidelines exist to improve care and outcomes of nursing home-acquired pneumonia (NHAP), about 1 to 3 percent of nursing home residents suffer from this condition at any given time, and mortality averages 25 percent. In a recent study, Evelyn Hutt, M.D., of the Denver Veterans Administration Medical Center and University of Colorado, Denver, and colleagues reviewed charts to determine whether staff followed guidelines in detecting and treating pneumonia in 389 residents in 16 nursing homes in Colorado, Kansas, and Missouri.

Staffing and turnover rates were the best predictor of whether a patient received recommended care, the researchers found. This care includes vaccinations, antibiotics, hospitalizations, and rapid communication with a physician about a change in a patient's status. Staff turnover rates averaged 60 percent, and facilities with high turnover rates tended not to adhere to the guidelines.

Higher staffing levels were linked to compliance, with nursing home residents receiving vaccinations for pneumonia and influenza, which can be a precursor condition for pneumonia. Patients at nursing homes with high licensed nursing staff to patient ratios and low turnover rates were also more likely to be hospitalized when their conditions warranted it and not be hospitalized when they were well enough to be cared for in their nursing homes. This study was funded by the Agency for Healthcare Research and Quality (HS13618).

See "Associations among nurse and certified nursing assistant hours per resident per day and adherence to guidelines for treating nursing home-acquired pneumonia," by Dr. Hutt, Tiffany A. Radcliff, Ph.D., Debra Liebrecht, R.N., and others in the October 2008 The Journals of Gerontology 63A(10), pp. 1105-1111.

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