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General Pathway Education

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EVIDENCE-BASED CARE PROGRAM
В© 2004-2007 Grey Bruce Health Network
General Pathways
Education Workshop
(click to go to the desired section)
Introduction to Workshop/Instructions
Evidence-Based Care Program
General Pathways Workshop
Evidence Based Care Program
В© 2004-2007 Grey Bruce Health Network
Introduction to Workshop/Instructions
This is a web-based workshop, and thus has links throughout
each page to enable you to move throughout the workshop.
Whenever you see words underlined like this, you can click on
that area to go to another section or to find more information
on a topic.
At the bottom of each page are navigational buttons to help you
move through the workshop.
You can go through as much or as little of the workshop as you
like at a time.
If you have any questions about how to use this workshop or
the individual pathways, feel free to ask your Site Champion.
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В© 2004-2007 Grey Bruce Health Network
Introduction
These pathways have been developed as a part of the EvidenceBased Care Program, which is Schedule 6 in the agreement of the
Grey Bruce Health Network.
The intent is to develop regional pathways and other evidencebased tools that flow across all hospitals and community services
in Grey and Bruce (including Grey Bruce Health Services, Hanover
and District Hospital, South Bruce Grey Health Centre, the
Community Care Access Centre and Grey Bruce Health Unit).
It is hoped that these pathways will improve:
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Coordination of care through more communication across professions;
Continuity of care, through increased linkages among hospitals and the
CCAC;
Clinical outcomes, through increased usage of best practices; and
Patient satisfaction, through linked expectations and increased patient
teaching at our agencies.
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В© 2004-2007 Grey Bruce Health Network
Components of a Pathway Package
All pathways developed for the Network have been
developed using the same template. Each pathway
package contains the following:
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Clinical Practice Guideline
Pre-Printed Orders
Clinical Pathway
Patient Pathway
Patient Education Materials
Community Care Stage Clinical Pathway (if applicable)
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В© 2004-2007 Grey Bruce Health Network
Clinical Practice Guideline
The Clinical Practice Guideline is a collection of the
evidence used in the development of the pathway
It can be used as a reference if you have any
questions about the content of the pathway
It can be found on the GBHN website at
www.gbhn.ca
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Components
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В© 2004-2007 Grey Bruce Health Network
Pre-Printed Orders
This is an order set to be used by physicians for the patients
that fit the inclusion criteria for the pathway. (see sample)
It should be located in an easy to find place for physicians to fill
out where they assess this patient population (i.e. emergency,
doctor’s office, unit, etc.).
Pre-printed orders are found at the GBHN website
Physicians should cross out any orders that do not apply to the
patient due to patient complications, individuality, etc; and add
any orders that are not on the sheet, either on the same sheet,
or using an additional order sheet. Each order sheet needs to be
dated and signed by the physician.
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Components
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В© 2004-2007 Grey Bruce Health Network
Clinical Pathway
This is the in-hospital multi-disciplinary documentation tool used by all
health care professionals who care for the patient on the pathway.
It can be found on your unit and should be placed on the chart and
used in place of other charting forms (i.e. flow sheets, see your Site
Champion for details) while documenting care for the patient.
Select the Evidence-Based Care Icon on your desktop to access your
pathway materials or go to the www.gbhn.ca and select Current
Initiatives
Each pathway template looks and works the same. The first page
contains instructions for use, on transfer of patients and a master
signature sheet for all professionals to sign (unless you have one for
your facility, then this portion will not be there) if they are using the
pathway.
There are two types of formats of pathways – a day format and a
phase format. The Total Hip Replacement is a day format, and the
Community-Acquired Pneumonia pathway is a phase format. Each looks
similar, but works a little differently.
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Components
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В© 2004-2007 Grey Bruce Health Network
Day – Type Clinical Pathway
The Total Hip Replacement pathway is formatted as a
day-type pathway. On the Day format pathway, each
page of the pathway corresponds to a day. See
sample.
On each pathway, we track “Performance Indicators”.
Performance Indicators are goals we are hoping we
as health care providers will achieve in a day.
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Components
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В© 2004-2007 Grey Bruce Health Network
Day – Type Clinical Pathway
The additional rows below the indicators are tasks to be
done for the day. They have been separated into different
types of tasks, i.e. assessments, treatments, etc.
On the right hand side are columns – they correspond to the
number of shifts in a day. Each day starts at the beginning of
your day shift.
Be sure you write in the time frame that you are working.
As each task is complete, initial in the time frame you did it.
If a task does not apply to that patient, or has already been
done and does not need to be done again that day, indicate
“N/A” and initial the box.
At the end of your shift, no boxes should be left blank.
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Components
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В© 2004-2007 Grey Bruce Health Network
Day - Type Clinical Pathway
The Total Hip Replacement pathway has a recommended length of stay
of five days post-op. Thus, there are five pages, one for each day, to
document tasks.
After the fourth day on the pathway, there is a page for ongoing postop care, if the patient requires care beyond the 5 days. See sample.
Following this, you will find a page of Discharge Criteria.
This page is a list of goals the patient needs to achieve before going
home. Thus, if the patient has achieved all the Discharge Criteria,
he/she should be able to be discharged. If not, he/she should stay until
the Discharge Criteria have been met.
If the patient is transferred refer to the first page of the clinical
pathway for information to forward on transfer or if discharge with
CCAC.
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Components
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В© 2004-2007 Grey Bruce Health Network
Phase - Type Clinical Pathway
The other type of clinical pathway is a Phase-Type clinical
pathway. Click here to see the Congestive Heart Failure
pathway. It has two phases. The first phase is anticipated to be
two days.
The patient moves from one phase to the next by achieving the
Patient Outcomes at the top of the page. Once these are
achieved, the patient can move to the next phase. If the
outcome is not achievable due to patient complications or we
are not able to resolve move the patient to the next phase of
the pathway. If the outcome will need more time to achieve
continue in the same phase with a new blank page that can be
printed from www.gbhn.ca .
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Components
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В© 2004-2007 Grey Bruce Health Network
Phase - Type Clinical Pathway
Throughout each of the Phases refer and complete the
Discharge Criteria page.
This page is a list of goals the patient needs to achieve before
going home. Thus, if the patient has achieved all the Discharge
Criteria, he/she should be able to be discharged. If not, he/she
should stay until the Discharge Criteria have been met.
When the Discharge Criteria have been met, the patient is ready
for discharge regardless of which phase they are in.
If the patient is transferred refer to the first page of the clinical
pathway for information to forward on transfer or if discharge
with CCAC.
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Components
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В© 2004-2007 Grey Bruce Health Network
Patient Pathway
Each pathway package will include a patient pathway,
which mirrors the clinical pathway but is worded in
lay terms.
It is on 8 ВЅ x 11 paper in 14 font, that covers each
day or phase of the pathway.
It should be given to the patient or family on
admission and referred to throughout the stay to help
the patient understand what to expect and what the
plan is during this admission.
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Components
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В© 2004-2007 Grey Bruce Health Network
Patient Education Materials
Each pathway will include materials for the patient
that include information about his/her condition or
procedure. These should be given to the patient or
family on admission.
These can be used as a guide by healthcare
professionals when teaching to ensure consistent
teaching.
The patient can take these materials home with
him/her to aid in self care and to be used by any
community or outpatient providers in continuing care.
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Components
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В© 2004-2007 Grey Bruce Health Network
Teaching Checklist
The teaching checklist is used by the healthcare team
to aid in patient teaching. It will provide a guideline
for teaching, and has references to the patient
education materials.
It should be placed on the chart and referred to
when teaching to reduce redundancies in teaching
and ensure all topics are covered before discharge.
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Components
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В© 2004-2007 Grey Bruce Health Network
Community Care Stage Pathway
In some cases, care for a patient often flows into
either outpatient services or CCAC home care
services.
In order to aid in continuity of care and ensure
transfer of appropriate information, in these cases we
will develop a Community Care Stage of a pathway.
This stage is for staff caring for patients in an
outpatient or CCAC provider setting, and will help
provide a guideline for care as well as allow us to
evaluate care in those settings. (see sample)
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Components
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В© 2004-2007 Grey Bruce Health Network
General Pathway Information Quiz
1.
What is the Clinical Practice Guideline?
a) What is it used for?
b) Where can I find it?
2.
Where do I find the Clinical Pathway?
a) Where does it go on the chart?
b) What is the difference between a Day-type pathway and a Phase-type pathway?
c) What are patient outcome indicators? What are performance indicators?
d) What are the Discharge Criteria?
3.
Where do I find the patient pathway?
a) What do I do with it?
4.
Where do I find the patient education materials?
a) What do I do with them?
5.
Where do I find Pre-Printed Orders?
6.
Where do I find the teaching checklist?
a) What do I do with it?
7.
Where do I find the electronic pathway package and education materials on my unit?
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Answers
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В© 2004-2007 Grey Bruce Health Network
Answers to General Pathway Quiz
1.
What is the Clinical Practice Guideline? This is a summary of the evidence used in the development of
2.
Where do I find the Clinical Pathway? This will be found as a package, including the pathway, the
the pathway.
a)
What is it used for? It is used for reference if you have questions about the content of the
pathway.
b)
Where can I find it? It is found on the GBHN website at www.gbhn.ca
patient pathway, the patient education materials, and the teaching checklist at www.gbhn.ca
Where does it go on the chart? Each unit may be different (ask your site champion)
a)
b)
c)
d)
What is the difference between a Day-type pathway and a Phase-type pathway? A Day-type
pathway has only one day per page. A phase-type pathway may have less than a day, or more
than a day, but a patient moves from one phase to the next by achieving the patient outcomes.
What are performance indicators? Performance indicators are goals we would like to achieve as
health care providers within the time period specified on the pathway page.
What are the Discharge Criteria? Discharge Criteria are the goals we would like the patient to
achieve before being discharged home.
What do I do with the Discharge Criteria? Each day, you should be checking the Discharge
Criteria to see if any of the criteria have been met. Once all the criteria have been met, the
patient should be ready to go home.
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of Workshop
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В© 2004-2007 Grey Bruce Health Network
Answers to General Pathway Quiz
3.
Where do I find the patient pathway? It should be found in the pathway package.
a)
What do I do with it? Give it to the patient and refer to it throughout the hospital
stay to help the patient understand what is happening each day or phase of the
pathway.
4. Where do I find the patient education materials? These should be found in the pathway
package or the www.gbhn.ca website (select Evidence-Based Care icon on your
desktop)
a)
What do I do with them? Give them to the patient and refer to them while teaching
the patient.
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В© 2004-2007 Grey Bruce Health Network
Answers to General Pathway Quiz
5.
Where do I find Pre-Printed Orders? There may be 5 printed copies on your unit (ask
your site champion) otherwise print from the www.gbhn,ca website
6. Where do I find the teaching checklist? It should be found in the pathway package.
a) What do I do with it? Put it on the chart in __(ask your site champion)
section, indicate on it when any of the topics have been covered to allow other
health care professionals to know what has been taught and what is left to
teach, along with any comments you have.
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Where do I find the electronic version of the pathways and education materials on my
unit? This is found on the GBHN website at www.gbhn.ca
If you have any questions regarding this information contact your Site Champion or contact the Evidence-Based Care
Program(519-364 2341)
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