1. E-Pathways: What is the role for nursing? Alex Westbrook Lecturer Practitioner School of Cancer Nursing & Rehabilitation Royal Marsden Hospital, London

2. Overview Nursing Language, ICPs & EPR Nursing and e-pathways Some reflections from practice Recommendations for future development

3. Background The hospital At the time a new hospital building and Trust 500-bedded (approx) London teaching hospital Mixed specialities EPR ‘test-bed’ My role (then!)

4. The nursing Language Project 1997-2000 The need for change Nursing documentation Nursing terminology Feasibility study initiated: Translation of NANDA New care plan documentation New nursing assessment tool Project strategy & roll out throughout the hospital

5. Philosophy of nursing language development a more rounded picture of ‘sickness’ Medical diagnosis: represent sickness as a disease process (e.g. Cerebral Vascular Accident) Nursing diagnoses: represent sickness as the patients illness experience (e.g. Self care deficit-hygiene/toileting; Impaired physical mobility; Carer role strain)

6. How does this ‘fit’ with the concept of ICPs?

7. ICP development Multidisciplinary document Development & implementation led by Nursing & Quality Examples of ICPs: THR, TKR, TURP…

8. ICP development The concerns: Task/Process Focused Medical Model of Care Cookbook Medicine The benefits: Patients Clinicians Audit/Clinical Effectiveness Evidence Based Practice Collaborative Care

9. Nursing + e-pathways = a compromise! In considering the use of ICPs for nursing we: Identified the nursing contribution to care Used our common nursing language Paper and electronically ‘dove-tailed’ ICPs and nursing care plans to create an individualised plan of care

10. Translation to EPR – reflections from practice Multi or uni-disciplinary pathways? Where does the ownership lie? How do the pathways map to other clinical records? Are e-pathways accessible for all professions?

11. Recommendations for future practice All-Involving at all stages Each profession must identify their unique contribution to the care pathway Professions should already be documenting electronically to avoid duplication of records Use of a clear structure and agreed language is essential

12. So, what is the role for nursing in e-pathways…?