HOW TO USE THE CLINICAL PATHWAY

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Arlene Stewart
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1 LINIAL PATHWAY Patients diagnosed with Febrile Neutropenia. INLUSION RITERIA All patients who are admitted to hospital and diagnosed with hronic Obstructive Pulmonary Disease (OPD). EXLUSION RITERIA HOW TO USE THE LINIAL PATHWAY This is a proactive tool to avoid delays in treatment and discharge, and communicate best practice guidelines. These are not orders, but reflect the practitioner orders and include standardized guidelines for care. Place the linical Pathway in the nurses clinical area for charting. Initial the bottom of the column that applies to your shift of work. Addressograph/sticker each page of the pathway. HEALTH ARE PROFESSIONALS: Place appropriate symbol in space provided: i.e. done / not done or symbol provided and relevant. Place N/A in any box where the task is not applicable to the patient. Additional tasks due to patient individuality can be added. Departmental consults are signed off on consult sheet. PATIENT TRANSFERS: If patient is transferred to another hospital in Grey-Bruce or to A, send a copy of the following to the receiving site/agency and place a copy in the patients Blue OPD Folder: Discharge hecklist Teaching hecklist Medicine Reconciliation Form - opy in patient's Blue OPD Folder - Original to stay on patient chart - opy in patient's Blue OPD Folder - Original to stay on patient chart - Original to patient's Blue OPD Folder - opy to stay on patient chart Grey Bruce Health Network 1

2 LINIAL PATHWAY HEKLIST PROESS ASSESSMENT ER DISHARGE/ADMISSION HEKLIST /TIME /TIME = Done/Yes = Not Done/No N/A = Not Applicable * requires descriptive charting in progress notes INITIAL VITAL SIGNS INLUDE O 2 SATS & TEMPERATURE BEFORE LEAVING DEPARTMENT * HEST ASSESSMENT - RATE, OUGH, PRODUTIVE (OLOUR NOTED), EFFORT & HYPOVENTILATION * BRONHODILATOR EFFET PRE & POST DOSE(S) DOUMENTED If patient O 2 retainer, consider compressed air for nebulization. SATS ORDERED TO BE MAINTAINED: > 92% 88% - 92% Notify physician if oxygen requirement exceeds 50% DOUMENT NOTIFIATION TIME OF PHYSIIAN FOR DYSPNEA SALE > 7, TEMPERATURE > 38.5 SIGNS OF HYPO/HYPERTENSION, SATS < 88% ER DISHARGE REPORTED TO INPUT UNIT VOIDED AM TOOL OMPLETED ABNORMAL BLOOD WORK RESULTS REPORTED (B, ELETROLYTES, UREA, REATININE, GLUOSE) LABORATORY / DIAGNOSTIS ULTURE SPUTUM: XR ABG's EG ANTIBIOTI GIVEN WITHIN ONE HOUR OF PRESENTATION MEDIATIONS MOBILITY/ ATIVITY VTE ASSESSMENT OMPLETED FOR ADMISSION BEST MEDIINE REONILIATON BEFORE DISHARGE TO ASSESS FOR PATIENT ADMINISTRATION KNOWLEDGE ABLE TO MOBILIZE SHORT DISTANE BEFORE DISHARE (e.g.. 6 MINUTE WALK TEST) TO ONSIDER FOR DISHARGED PATIENTS DISUSSION BEGUN RE: ODE STATUS OR LIMITS TO INTERVENTIONS DISHARGE FROM ER DISHARGED PATIENT HAS BLUE OPD FOLDER WHIH INLUDES THE PLAN OF ATION ON WHEN TO RETURN TO ER IF NEESSARY DISHARGED PATIENT UNDERSTANDS TO FOLLOW-UP WITH PRIMARY PRATITIONER WITHIN 1 WEEK DISHARGED PATIENT UNDERSTANDS THE NEED FOR SPIROMETRY APPOINTMENT FOR FOLLOW-UP, IF NO PREVIOUS RESULTS DISHARGED PATIENT HAS A REFERRAL, WITH PERMISSION ER ADMISSION SIGNATURE: ER TRANSFER SIGNATURE: Grey Bruce Health Network 2

3 LINIAL PATHWAY PROESS PHASE 1 - ADMISSION/AUTE PHASE (Approximately 3 days) = Done/Yes = Not Done/No N/A = Not Applicable * requires descriptive charting in progress notes Performance Indicators Once all Performance Indicators are achieved move to Phase 2. RESPIRATORY RATE < 26 x 48 HOURS TEMPERATURE < 37.5 ' x 48 HOURS DYSPNEA SALE SORE IMPROVING OXYGEN REQUIREMENTS APPROAHING PRE-ADMIT BASELINE VS Q4H X 24H; QID X 24H, INLUDING O 2 SATS THEN BID & PRN ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) HEST ASSESSMENT Q4H - BREATH SOUNDS, PRODUTIVE OUGH (OLOUR), USE OF AESSORY MUSLES, EFFORT, ET * BRONHODILATOR EFFET PRE & POST DOSE(S) DOUMENTED If patient O 2 retainer, consider compressed air for nebulization. PATIENT HAS BEEN TAUGHT AND INDIATES UNDERSTANDING OF DYSPNEA SORE DYSPNEA SALE WITH ATIVITY (Indicate highest score) DYSPNEA SALE AT REST (Indicate highest score) MENTAL STATUS (TIME, PLAE, PERSON) AM TOOL OMPLETED ISOLATION: DROPLET/ONTAT PREAUTIONS (For initiation and discontinuation, erner order entered) MONITOR PO FOR DIABETIS REEIVING STEROID THERAPY MONITOR INTAKE / OUTPUT DIAGNOSTIS/ LABORATORY MEDIATIONS BLOOD WORK DONE EG WITH HEST PAIN AND NOTIFY PHYSIIAN INTERMITTENT SET / IV (monitored hourly) AS ORDERED, REASSESS DAY 2 VTE PROPHYLAXIS REASSESSED Q48H INITIALS PROGRESS NOTES: Grey Bruce Health Network 3

4 LINIAL PATHWAY PHASE 1 - ADMISSION/AUTE PHASE (Approximately 3 days) PROESS = Done/Yes = Not Done/No N/A = Not Applicable * requires descriptive charting in progress notes NUTRITION REGULAR DIET OR SPEIAL DIET, NUTRITION INTAKE A - Adequate IN - INadequate ENOURAGE FLUIDS 2-3 LITRES/DAY ASSIST PERSONAL HYGIENE MOBILITY/ATIVITY PSYHOSOIAL SUPPORT BRPs WITH ASSISTANE, INREASE TO AAT WALK IN HALLWAY DAILY WITH GOAL OF 9 METERS QSHIFT BEFORE DISHARGE ASSESS ANXIETY AND INTERVENE DNR WISHES DISUSSION ADDRESSED AND REORDED REVIEW PATIENT PATHWAY EDUATION START AND ONTINUE WITH TEAHING HEKLIST DISHARGE PLANNING ASSESS DISHARGE RITERIA DAILY A REFERRAL ON ALL OPD DIAGNOSED PATIENTS, WITH PERMISSION INITIALS PROGRESS NOTES: Grey Bruce Health Network 4

5 LINIAL PATHWAY MULTIDIIPLINARY ONSULTS ASSESS SUPPORT SYSTEMS FOR PATIEN (FAMILY, FRIENDS, FINANES, ET) AND ENGAGE MULTIDISIPLINARY TEAM AS NEEDED (PHYSIIAN ORDER REQUIRED FOR TREATMENT) OF ONSULT OF ASSESSMENT / SIGNATURE A ONSULT LINIAL NUTRITION ONSULE OUPATIONAL THERAPY ONSULT PHARMAY ONSULT PHYSIOTHERAPY ONSULT RESPIRATORY ONSULT SOIAL WORK ONSULT SPEEH THERAPY / SWALLOWING ONSULT WOUND LINIIAN ONSULT PROGRESS NOTES: Grey Bruce Health Network 5

HEST ASSESSMENT DOUMENTATION PAGE : TIME: INITIAL: DYSPNEA SORE: Activity Rest PATIENT ID : TIME: INITIAL: DYSPNEA SORE: Activity Rest : TIME: INITIAL: DYSPNEA SORE: Activity

6 HEST ASSESSMENT DOUMENTATION PAGE : TIME: INITIAL: DYSPNEA SORE: Activity Rest PATIENT ID : TIME: INITIAL: DYSPNEA SORE: Activity Rest : TIME: INITIAL: DYSPNEA SORE: Activity Rest : TIME: INITIAL: DYSPNEA SORE: Activity Rest : TIME: INITIAL: DYSPNEA SORE: Activity Rest : TIME: INITIAL: DYSPNEA SORE: Activity Rest Grey Bruce Health Network 6

7 INSTRUTIONS FOR HEST ASSESSMENT DOUMENTATION PAGE: On the diagram, record the various lung sounds heard using a series of legend-identified symbols. SAMPLE POSTERIOR VIEW (LEFT/RIGHT) L R W W LEGEND: W - WHEEZES - RAKLES A - ABSENT BREATH SOUNDS DYSPNEA SALE Baseline Oxygen Requirements: Maintain Sats Between: 0 - Nothing at all NOTIFY PHYSIIAN IF NOT RESOLVED WITH BRONHODILATOR: 1 - Very slight 7 - Very severe 2 - Slight Moderate NOTIFY PHYSIIAN IMMEDIATELY IF: 4 - Somewhat severe 9 - Very, very severe (almost maximal) 5 - Severe 10 - Maximal 6 - All rights reserved. No part of this document may be reproduced or transmitted, in any form or by any means, without the prior permission of the copyright owner Grey Bruce Health Network

8 LINIAL PATHWAY PHASE 2 - MAINTENANE PHASE (Approximately 2 days) PROESS = Done/Yes = Not Done/No N/A = Not Applicable * requires descriptive charting in progress notes OFF SUPPLEMENTAL OXYGEN OR ON USUAL HOME O 2 PERFORMANE INDIATORS (DISHARGE READINESS) ATIVITY LEVEL AS PER PREADMISSION USUAL MENTAL STATUS TEMPERATURE LESS THAN 37.5 DYSPNEA SALE SORE < 5 PATIENT INDIATES KNOWLEDGE OF HRONI DISEASE MANAGEMENT AND DISHARGE PLAN VS BID ONE STABLE & PRN, INLUDING O 2 SATS ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) HEST ASSESSMENT (BREATH SOUNDS, PRODUTIVE OUGH) DYSPNEA SALE WITH ATIVITY DYSPNEA SALE AT REST AM TOOL ISOLATION DISONTINUED & ORDER ENTERED IN ERNER ONSULTS LABORATORY / DIAGNOSTI HOME O 2 THERAPY AS NEEDED XR IF NOT IMPROVING ABG s (ABG RESULTS REQUIRED) INITIALS PROGRESS NOTES: Grey Bruce Health Network 8

9 PROESS GREY BRUE HEALTH NETWORK LINIAL PATHWAY PHASE 2 - MAINTENANE PHASE (Approximately 2 days) = Done/Yes = Not Done/No N/A = Not Applicable * requires descriptive charting in progress notes ASSESS PROPER USE OF INHALERS EDUATION REVIEW PATIENT PATHWAY START AND ONTINUE WITH TEAHING HEKLIST TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY / ATIVITY DISHARGE READINESS BRONHODILATOR TREATMENT EFFETIVE AND ASSESSED QSHIFT ADEQUATE DIET INTAKE AND ENOURAGE FLUIDS 2-3 LITRES/DAY DIET SUPPLEMENTS IF INADEQUATE NUTRITION PATIENT ABLE TO OMPLETE ADL'S WITH MINIMAL ASSISTANE PATIENT ABLE TO AMBULATE AS TOLERATED A ENGAGED AND EQUIPMENT AND SUPPORTS IDENTIFIED PRE- DISHARGE REVIEW DISHARGE PLANS WITH PATIENT TRANSPORTATION ARRANGED FOR PENDING DISHARGE PATIENT OWNED PORTABLE OXYGEN AVAILABLE FOR DISHARGE INITIALS PROGRESS NOTES: Grey Bruce Health Network 9

10 LINIAL PATHWAY PROESS PHASE 3 - DISHARGE HEKLIST INITIAL DYSPNEA SALE NORMAL FOR PATIENT AND < 5 ASSESSMENTS MENTAL STATUS NORMAL FOR PATIENT O 2 SATS >90% OR AS ORDERED - WITHIN PATIENT'S NORM X 48 HOURS STABLE OMORBID ILLNESS DIAGNOSTIS/ LABORATORY FOLLOW UP HEST X-RAY DISHARGE MEDIATION REONILIATION LIST REVIEWED AND PLAED IN PATIENT'S BLUE OPD FOLDER MEDIATIONS PATIENT DEMONSTRATES AURATE USE OF METERED DOSE INHALER SRIPT GIVEN BLUD OPD FOLDER AND PATIENT PATHWAY HOME WITH PATIENT PSYHOSOIAL SUPPORT/ EDUATION PATIENT DEMONSTRATES KNOWLEDGE OF OPD EXAERBATION WARNING SIGNS - PLAN OF ATION TEAHING HEKLIST OMPLETE - OPY TO BLUE OPD FOLDER SMOKING ESSATION INFORMATION OFFERED PATIENT/FAMILY QUESTIONS ANSWERED PATIENT ADVISED TO FOLLOW UP WITH INFLUENZA AND PNEUMOOAL VAINE DISHARGE PLANNING A AWARE OF DISHARGE FOLLOW-UP APPOINTMENT WITHIN 1 WEEK OF DISHARGE Grey Bruce Health Network 10

PREADMISSION CLINIC (PAC) BEST POSSIBLE MEDICATION HISTORY (BPMH) MEDICATION INSTRUCTIONS PRE-PROCEDURE MEDICATION INSTRUCTIONS

PREADMISSION CLINIC (PAC) BEST POSSIBLE MEDICATION HISTORY (BPMH) AND PRE-PROCEDURE MEDICATION INSTRUCTIONS BALL POINT PEN, PRESS FIRMLY DO NOT DO NOT DO NOT D/C disharge or disontinue > or < greater than