ABCABC Great Expectations turning dreams into reality Adrienne Johnston Project Leader, Care Pathways Ulster Community & Hospitals Trust x3245

ABCABC Trust Profile Merger Community & Acute Trust. Services include- primary, secondary and community care Community services -pop. 140,000 Acute services -pop. 260,000 2 community hospitals 40 beds total 1 acute hospital – 600 beds 5500 staff (3304 WTE) H

ABCABC What is a Care Pathways? “An integrated Care Pathway determines locally agreed, multidisciplinary practice based on guidelines and evidence where available, for a specific patient/client group. It forms all or part of the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement.” National Pathway Association 1998

ABCABC “A patient’s experience of an episode of care is sometimes likened to a journey. But the patient as traveller may feel more like an intrepid explorer continually coming up against the unknown rather than a modern traveller whose journey has been planned with a travel agent.... Planned journeys carry less risk than unplanned ones, and knowledge of the journey’s steps and stages reduces anxiety and fear. Our patients should expect at least the same amount of planning for and information about their health care as they get from travel agents.” Layton et al 1998

ABCABC Pathways & electronic notes Whole note Multi-professional Accessible by all Evidence based Structure format Stored centrally Whole note Multi-professional Access on need to know basis Evidence based - built in alerts Structure format Accessible all locations PathwaysElectronic notes Treatment plans Future plans Demographic details Past histories Examinations Results Referrals Treatment plans Future plans Demographic details Past histories Examinations Results Referrals

ABCABC “A mess computerised is a computerised mess” Draft RCP record keeping standards – inpatients Royal College Phys. 2003

ABCABC “The right information at the right time is nine tenths of any battle” Napoleon Bonaparte

ABCABC Cancer patient Treatment Surgeon Radiologist Specialist Nurse Labs Pharmacy Haematologist Oncologist Clinical Radiologist Chemo Nurse Radiographer Counsellor Others Acute Palliative Care Community Pharmacy Community Palliative Care Clinical Trials Team Audit Database Co-ordinator Secretary District Nursing Hospice Services Alternative Practitioners GP Out Patient Surgeon Specialist Nurse Radiologist In Patient Surgeon Specialist Nurse Anaesthetist Radiologist Junior Docs Ward Nurses Allied Health Professionals Social Worker Labs Pharmacy

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ABCABC What staff want Access specific information Access to ALL information

ABCABC What staff want Aware of patient understanding & wishes Access to evidence Access specific information Access to ALL information

ABCABC What staff want Alert to risks Access for review & audit Access specific information Access to ALL information Aware of patient understanding & wishes Access to evidence Use professional judgement

ABCABC “Since computers entered office systems, paper utilization has increased six- fold”

ABCABC Identify goal Agree ALL information required Agree who needs access & when Policies & procedures off shelves Develop ONE system – no mix & match Computerise Review information & improve care

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