1. © 2004-2007 Grey Bruce Health Network EVIDENCE-BASED CARE PROGRAM General Pathways Education Workshop (click to go to the desired section) Introduction to Workshop/Instructions Evidence-Based Care Program General Pathways Workshop

2. © 2004-2007 Grey Bruce Health Network Evidence Based Care Program 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.underlined like this 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. Back to Start of Workshop NextBack

3. © 2004-2007 Grey Bruce Health Network Introduction These pathways have been developed as a part of the Evidence- Based Care Program, which is Schedule 6 in the agreement of the Grey Bruce Health Network. The intent is to develop regional pathways and other evidence- based 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: 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. Back to Start of Workshop NextBack

4. © 2004-2007 Grey Bruce Health Network All pathways developed for the Network have been developed using the same template. Each pathway package contains the following: Clinical Practice Guideline Pre-Printed Orders Clinical Pathway Patient Pathway Patient Education Materials Community Care Stage Clinical Pathway (if applicable) Back to Start of Workshop NextBack Components of a Pathway Package

5. © 2004-2007 Grey Bruce Health Network 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 www.gbhn.ca Back to Start of Workshop Back to Pathway Components NextBack Clinical Practice Guideline

6. © 2004-2007 Grey Bruce Health Network This is an order set to be used by physicians for the patients that fit the inclusion criteria for the pathway. (see sample)(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. Back to Start of Workshop Back to Pathway Components NextBack Pre-Printed Orders

7. © 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 Initiativeswww.gbhn.ca 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.first page 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. Back to Start of Workshop Back to Pathway Components NextBack

8. © 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.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. Back to Start of Workshop Back to Pathway Components NextBack

9. © 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. Back to Start of Workshop Back to Pathway Components NextBack

10. © 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 post- op care, if the patient requires care beyond the 5 days. See sample.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. Back to Start of Workshop Back to Pathway Components NextBack

11. © 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.Click here 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.www.gbhn.ca Back to Start of Workshop Back to Pathway Components NextBack

12. © 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. Back to Start of Workshop Back to Pathway Components NextBack

13. © 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.patient pathway It is on 8 ½ 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. Back to Start of Workshop Back to Pathway Components NextBack

14. © 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. Back to Start of Workshop Back to Pathway Components NextBack

15. © 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.teaching checklist 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. Back to Start of Workshop Back to Pathway Components NextBack

16. © 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)(see sample) Back to Pathway Components Back to Start of Workshop Begin Quiz Back

17. © 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? Back to Start of Workshop Answers Back

18. © 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 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.cawww.gbhn.ca 2. Where do I find the Clinical Pathway? This will be found as a package, including the pathway, the 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)www.gbhn.ca a) 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. b) 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. c) What are the Discharge Criteria? Discharge Criteria are the goals we would like the patient to achieve before being discharged home. d) 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. Back to Start of Workshop NextBack

19. © 2004-2007 Grey Bruce Health Network 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)www.gbhn.ca a) What do I do with them? Give them to the patient and refer to them while teaching the patient. Answers to General Pathway Quiz Back to Start of Workshop Back

20. © 2004-2007 Grey Bruce Health Network 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 websitewww.gbhn,ca 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.  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.cawww.gbhn.ca If you have any questions regarding this information contact your Site Champion or contact the Evidence-Based Care Program(519-364 2341) Answers to General Pathway Quiz Back to Start of Workshop Back