What is a Care Pathway? Ali El-Ghorr Implementation Advisor

Overview of presentation  Different types of care pathways  How to develop an ICP for BPD  Example mental health ICP

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Pathway Algorithm Referral Pathway Protocol Care Pathway Patient Pathway Triage Pathway Service Pathway Guideline Critical Pathway Integrated Care Pathway What’s in a name?

Algorithm Care Pathway Integrated Care Pathway

Algorithm  Decision aid  One page summary  Based on evidence  Layed out as a decision tree  Usually used by 1 professional in the care of 1 individual  Clinical judgement still important

Example: Alcohol Screening and Brief Interventions Algorithm

Care Pathway

 Diagrammatic representation of a journey of care  Multidisciplinary  High level map of care  Based on evidence and good practice  Includes all main referral routes & referral criteria  Describes who is responsible for what  Includes main comorbidities and complications  Applies to ~80% cases

What is an Integrated Care Pathway (ICP)?

Integrated Care Pathway A system of care that allows the comparison of planned care with care actually given

Integrated Care Pathways  Focus on the service user  Part of the care record  Map out the expected care (multidisciplinary/multi-agency)  Describe how care should be structured and co-ordinated  Set standards along the care journey based on the evidence & best practice  Facilitate the monitoring of these standards through VARIANCE tracking

Mental Health ICPs

Policy Context Delivering for Mental Health (Dec 2006) :  National policy to improve mental health services through development and implementation of Integrated Care Pathways

 Person-centred  Safe  Effective The Healthcare Quality Strategy for NHSScotland

QIS standards

ICP Standards

How do you develop an ICP for BPD?

Process Standards Stakeholder involvement Process mapping

Delivering together Psychologists Consultants Nurses AHPsSocial Work Improvement Support StaffService users and carers Local Teams Voluntary sector Managers GPs

Involving Primary Care

Possible incentives -ICP links to Quality Outcomes Framework: Mental health register Physical health checks Dementia review Depression screening Depression assessment using validated tool -ICPs linked to psychological therapies HEAT target

High level Increasing level of detail Process Mapping

Opportunity for Redesign

Content

 Service user at the centre of care planning  Comprehensive assessment  Risk management  A service user rated measure of needs (eg Avon)  Targeted inpatient admission  Measure outcome

 There is a record of medication for BPD

Example: NHS Tayside mental health admission and discharge ICP

Admission & Discharge ICP

Implementation

Local implementation  Part of local strategy  Identify local champions / leads  Embed ICP work within Care Governance  Conduct awareness raising & education  Repeat education programme  Audit, review & provide feedback

Support available  National ICP toolkit (  Network of National ICP Co-ordinators & ICP Team  BPD Network  Co-ordinated approach (Health Directorates, NHS Education Scotland, Social Work, Care Commission and others)

Incentives  Quality strategy (person centred, safe, effective)  Patient safety in mental health  HEAT targets in mental health  Quality Outcomes Framework  Partnership working (Social Work & Voluntary Sector  ICP accreditation

Conclusions  Different types of care pathways  ICPs are a system of care  ICPs are a tool for service redesign and continuous quality improvement  Focus on service user and meeting their needs  Support and help is available

SCOTTISH Personality Disorder NETWORK Welcome to the Scottish Personality Disorder Network Conference Thursday 17 th March 2011