Clinical Care Pathways (CCCP): Magic or Maze? Norah Bostock Operations Manager: Governance

CCCP’s-Magic or Maze?

Pathways: What does the literature say? The literature reveals CCCP’s as: Powerful clinical tools: proven across the world to organise & provide EB care Providing effective predictable trajectories of care with clinical outcomes Ensuring the 8 rights Facilitators of clinical indicator data Providers of: - Formal care guide supporting decision making - Mechanisms to co-ordinate client & healthcare provider resources - Legal record with minimal documentation - Basis for continuous improvement

Pathways: What does the literature say? Capture and support data on the care journey by being time specific Include client education and discharge planning Identified clinical tests are attended Designed to collaboratively involve both staff and client in the care journey

Clinical Pathways: The right person in the right place with the right outcome

Pathway applications: Is every clinical situation appropriate for a CCCP? Considered beneficial in the following areas: High cost e.g. non-healing venous leg ulcers High risk e.g. medication management High volume e.g. catheter management High interest e.g. diabetes/post-acute care Considered suitable for a high % of the population

Pathway solutions: Working together across the spectrum

Pathway solutions: What does the evidence say? Client outcomes underpinned by best practice leading to: Consistent pathway implementation and reduced clinical practice variation Reduced length of stay to deliver outcomes Returning clients to self management as soon as practicable Support hospital avoidance by being the “hospital in the home” Reliable multi-disciplinary collaborative partnership with other care professionals delivering shared care

Pathway solutions: What does the evidence say? Staff able to access best practice framework: Consistent referrer, nurse, client and carer education Delivers on evidence from National and International benchmarks Staff can express confidence in the care they deliver even in areas where knowledge is limited Pathways provide consistency to every staff member Provides consistency in when and where to report clinical risk and incidents Individualises care via the variance tracking

Pathway solutions Business Improvement: Collection of the right clinical outcome and variance evidence (through RDNS Mobility solutions and reporting) as a platform for Continuous Improvement Reduction in unnecessary documentation Pathways proven by clinical evidence with predictable costs demonstrating value for money to our funders (reducing overall burden on health system) We have a better record of care to follow up if a client complains

RDNS: Checklist for development Identify need Obtain commitment from clinicians Form group with relevant stakeholders Pathway Establish aims and outcomes for evaluation Evidence Draft pathway Review draft Costings Education to staff Trial pathway Evaluate results and act/adjust accordingly Implementation Establish ongoing review process

RDNS: Current Pathways VLU Urinary Catheter Management EOL Diabetes Self-Management Medication Streaming

RDNS: Pathways in development Urinary assessment & management Bowel assessment & management Insulin Management Palliative Symptom Management COPD Asthma Stage 3/4 Pressure Ulcer

Translating Evidence into Practice or Pitfalls & Perils or Critical steps and challenges Staff engagement – how do we achieve this Uptake – why use this when a care plan is easier Registration of the clinical care indicator Variance tracking – how to improve uptake & registration for audit & evaluation Changing the culture (too busy, too hard etc.) Evaluation – how and when Platforms for monitoring clinical indicator information – the value of this information to inform future services Audit processes Changes to client health status – how do we measure

Evaluation of pathways Identified through clinical indicators developed from: Client/staff uptake of pathways (client care indicator is registered when the pathway is commenced) LOS data Healing rates Health outcomes achieved Discharge rates Meeting or improving on benchmark standards

Summary Brief overview of the importance of developing and implementing care pathways to improve care delivery and health outcomes and support a new model of care. Piloting the pathway is as important as the development Evaluation is the final step in ensuring success Ongoing pathway uptake and monitoring of variances relevant to individual Clinical Specialties Committing to business as usual