Arterial Leg Ulcer Outcome-Based Pathway

Transcription

Client Details
Name / Client ID
etc.
Date Pathway
Activated
Date Pathway
Discontinued
Reason for
Stoppage
Drop-down or radio button
o Wound closed
o Inoperable arterial disease
o Awaiting surgical intervention
o Moved to a different pathway
o List reason:
o New pathway:
o Admitted to hospital
o Deceased
o Other:
Pathway Identification
Pathway Name
Presenting Issue or
Condition Defined
Exclusion Criteria
Coding Requirements
(e.g. specific local referral
codes etc.)
Overall Pathway Outcome
Arterial Leg Ulcer
A wound caused by compromised or inadequate arterial blood flow from
the heart to the tissues in the leg and foot. Wound fails to heal due to
arterial insufficiency (Peripheral Arterial Disease).
o Inoperable arterial disease
o Gangrene (tissue ischemia)
o Mixed ulcer etiology
o
Wound closed
Pathway Evaluation
Date Created
Date Reviewed
(Subject Matter Experts)
Subject Matter Experts
December 7, 2011
January 10, 2012 – February 21, 2012
o
o
o
o
o
o
o
Ontario Home Care Association & Ontario Community Support
Association (OHCA-OCSA), Nursing Practice Council (NPC)
OHCA-OCSA, Therapy Advisory Group (TAG)
Catherine Harley, Canadian Association of Enterostomal Therapy
(CAET) Executive Director
Dr. Gary Sibbald, Women’s College Hospital (WCH), Director of
Wound Healing Clinic, Director of Medical Education
Dr. Kevin Woo, Advanced Wound Consultant, West Park Health
Centre
Heather McConnell, Registered Nurses Association of Ontario
(RNAO), International Affairs & Best Practice Guidelines (IABPG)
Associate Director
Mariam Botros, WCH, Chiropody
1v3-20121105
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access
Centres/Association des Centres d’accès aux soins communautaires de l’Ontario, 2012. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 1 of 6
o
o
o
Date of Endorsement by
Provincial Client Services
Committee
Frequency of Review
Next Review Date
What triggers a special
condition review of
pathway
Version
Patricia Coutts, WCH, Wound Healing Centre
Peggy Ahearn, Canadian Association of Wound Care (CAWC),
Executive Director
Rhona McGlasson, Sunnybrook Health Sciences Centre, Executive
Director
June 29, 2012
TBD based on RNAO and CAWC guidelines
TBD
o Criteria for special condition review will be determined based upon
results obtained from the OBP/OBR pilot starting in Fall 2012.
1v3 – November 5, 2012
1v3-20121105
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access
Centres/Association des Centres d’accès aux soins communautaires de l’Ontario, 2012. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 2 of 6
Interval
(Can be
timeframe, #
visits or # visits
within
timeframe
Best Practice
Guideline
(include hyperlinks)
0 to 7 Days
Outcome
o
Holistic client and
wound assessment
completed
Reporting
o
SPO initial report
(standardized)
Outcome Evaluation
o
Outcome not met
Barriers to Outcome
Achievement
o
o
o
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
Follow-up Actions
o
o
o
Date:
o
Lower limb
assessment
completed
Date:
o
SPO initial report
(standardized)
Date:
o
Date:
Outcome not met
o
Woundpedia Leg Ulcer
BPG
o
o
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
Date:
o
o
o
Date:
o
Correct outcomebased pathway
confirmed
Date
o
Date:
SPO initial report
(standardized)
o
Date:
Outcome not met
o
o
o
o
Inaccurate
diagnosis on
referral
Incomplete SPO
Report
Unknown etiology
Other:
CC system
navigation to
address resource
barriers
Contact client /
caregiver re:
rationale
Other:
CC system
navigation to
address resource
barriers
Contact client /
caregiver re:
rationale
Other:
Date:
o
o
o
Follow-up with SPO
for report
completion
Discontinue
pathway
Other:
1v3-20121105
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access Centres/Association des Centres d’accès aux soins
communautaires de l’Ontario, 2012. All rights reserved. Unauthorized distribution and duplication strictly prohibited.
Page 3 of 6
Date:
Date:
Date:
Date:
Date:
o
Referral for
vascular
assessment
initiated/completed
o
o
Initial referral
SPO initial report
(standardized)
o
Outcome not met
o
o
o
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
o
o
o
Date:
o
Wound therapy
initiated
Date:
o
SPO initial report
(standardized)
Date:
o
Date:
Outcome not met
o
o
o
o
Client
contraindication
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
Date:
o
o
o
o
Date:
o
Client discharge
planning initiated
for client
independence and
prevention
Date:
o
SPO initial report
(standardized)
Date:
o
Date:
Outcome not met
o
o
o
Non-adherence to
BPG
o Client
o SPO
o CCAC
Client declined
Other:
CC system
navigation to
address resource
barriers
Contact client /
caregiver re:
rationale
Other:
Inter-professional
referrals to address
contraindications
CC system
navigation to
address resource
barriers
Contact client /
caregiver re:
rationale
Other:
Date:
o
o
o
o
Consult with SPO /
ET / Wound Care
Specialist
Inter-professional
referrals as
required
CC system
navigation as
required
Contact
1v3-20121105
Page 4 of 6
o
Date:
21 to 28 days
o
20-30% reduction
in wound size
Date:
o
SPO interim report
(standardized)
Date:
o
Date:
Outcome not met
o
o
o
Causative factors
o Internal
o External
Non-adherence to
BPG
o Client
o SPO
o CCAC
Other:
Date:
o
o
o
o
o
Stanford SelfManagement Program
Date:
o
Chronic disease
self-management
plan initiated
Date:
o
SPO interim report
(standardized)
Date:
o
Date:
Outcome not met
o
o
o
o
o
Date:
Date:
Date:
Non-adherence to
BPG
o Client
o SPO
o CCAC
Client / caregiver
appropriateness for
self-management
Already linked with
resource
Client declined
Other
Date:
client/caregiver re:
rationale
Other:
Consult with SPO
ET / Wound Care
Specialist and
review / update
care plan as
required
Validate use of
BPG
Inter-professional
referrals as
required
Consider transfer to
another pathway
Other:
Date:
o
o
o
o
o
Consult with SPO
Inter-professional
referrals as
required
CC system
navigation as
required
Contact client /
caregiver re:
rationale
Other:
Date:
1v3-20121105
Page 5 of 6
77 to 84 days
Or upon
discharge
o
Wound is closed
by 12 weeks
o
SPO interim /
discharge report
(standardized)
o
Outcome not met
o
o
o
Causative factors
o Internal
o External
Non-adherence to
BPG
o Client
o SPO
o CCAC
Other
o
o
o
o
o
Date:
Date:
Date:
Date:
Consult with SPO /
ET / Wound Care
Specialist and
review / update
care as required
Validate use of
BPG
Inter-professional
referrals as
required
Consider transfer to
another pathway
Other:
Date
1v3-20121105
Page 6 of 6

Arterial Leg Ulcer Outcome-Based Pathway

Transcription

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