Purpose: Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.
Design and methods: Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.
Results: Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.
Implications: This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.