Comparison of 3 Techniques for Implementing a Guideline for Community-Acquired Pneumonia

• Objective: To compare 3 techniques used in implementing a community-acquired pneumonia (CAP) guideline: traditional educational sessions, academic detailing, and preprinted order forms. • Setting and participants: Patients with CAP receiving care at an academic medical center in central Massachusetts. • Methods: A retrospective analysis of medical records was performed to assess guideline adherence. • Results: 587 patients with CAP were identified; 71 were excluded because their primary diagnosis was not CAP. After traditional guideline education, 29% of patients were treated according to the guideline, with 75% treated with preferred formulary antibiotics. Following academic detailing, 24% of patients were treated according to the guideline, with 71% treated with formulary antibiotics. Following implementation of preprinted order forms, 38% of patients were treated according to the guideline, with 77% treated with formulary antibiotics. • Conclusion: Overall, guideline adherence was suboptimal for all interventions at both sites. Formulary adherence was better, with nearly three quarters of patients receiving formulary-designated antibiotics. Implementation of preprinted orders was associated with high utilization of appropriate antibiotic therapy.