Arterial Leg Ulcer Outcome-Based Pathway

Transcription

Pathway Identification
Pathway Name
Presenting Issue or
Condition Defined
Exclusion Criteria
Overall Pathway Outcome
Reason for Stoppage
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 Intact skin (without visible injury or opening e.g. cellulitis)
o Wound closed
o Wound closed
o Supervening event:
o Transfer to other CCAC
o Admission to hospital >14 days
o Admission to a LTCH
o Death
o Vacation away from home >14 days
o Patient refuses care
o Moved to a different pathway
o List reason:
o New pathway:
o Other:
1v5 - 20130913
© 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, 2013. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 1 of 5
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
o
o
o
Date of Endorsement by
Provincial Patient Services
Committee
Frequency of Review
Next Review Date
What triggers a special
condition review of
pathway
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
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
May 2014
o Criteria for special condition review will be determined based upon
results obtained from the OBP/OBR pilot.
1v5 - 20130913
© 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, 2013. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 2 of 5
Interval
Best Practice
Guideline
0 to 7 Days
Outcome
o
Holistic patient and
wound assessment
completed
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
Lower limb
assessment
completed
o
SPO
o
Outcome
not met
o
o
o
Woundpedia Leg
Ulcer BPG
o
o
Correct outcomebased pathway
confirmed
o
Referral for
vascular
assessment
initiated/completed
o
SPO
SPO
o
o
Outcome
not met
Outcome
not met
o
o
o
o
o
o
o
o
Follow up Actions
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
o
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
o
Inaccurate diagnosis on
referral
Incomplete SPO Report
Unknown etiology
Other:
o
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
o
o
o
o
o
o
o
o
o
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
address resource
barriers
Contact patient /
Other:
Follow-up with SPO for
report completion
Discontinue pathway
Other:
address resource
barriers
Contact patient /
Other:
1v5 - 20130913
© 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, 2013. All rights reserved. Unauthorized distribution and duplication strictly prohibited.
Page 3 of 5
Interval
Best Practice
Guideline
0 to 7 Days
Outcome
o
Wound therapy
initiated
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
o
Patient discharge
planning initiated
for patient
independence and
prevention
o
SPO
o
Outcome
not met
o
o
o
Patient contraindication
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
Non-adherence to BPG
o Patient
o SPO
o CCAC
Patient declined
Other:
Follow up Actions
o
o
o
o
o
o
o
o
21 to 28 days
o
20-30% reduction
in wound size
o
SPO
o
Outcome
not met
o
o
Stanford SelfManagement
Program
o
Causative factors
o Internal
o External
o Patient
o SPO
o CCAC
Other:
o
o
o
o
o
o
Inter-professional
referrals to address
contraindications
address resource
barriers
Contact patient /
Other:
Consult with SPO / ET /
Wound Care Specialist
Inter-professional
referrals as required
CC system navigation
as required
Contact
patient/caregiver re:
rationale
Other:
Consult with SPO ET /
and review / update
care plan as required
Validate use of BPG
Inter-professional
Consider transfer to
another pathway
Other:
1v5 - 20130913
Page 4 of 5
Interval
21 to 28 days
Best Practice
Guideline
Outcome
o
Chronic disease
self-management
plan initiated
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
77 to 84 days
Or upon
discharge
o
Wound is closed
by 12 weeks
o
SPO
o
Outcome
not met
o
o
o
o
o
o Patient
o SPO
o CCAC
Patient / caregiver
appropriateness for selfmanagement
Already linked with
resource
Patient declined
Other:
Causative factors
o Internal
o External
o Patient
o SPO
o CCAC
Other:
Follow up Actions
o
o
o
o
o
o
o
o
o
o
Consult with SPO
Inter-professional
CC system navigation
as required
Contact patient /
Other:
Consult with SPO / ET /
and review / update
care as required
Validate use of BPG
Inter-professional
Consider transfer to
another pathway
Other:
1v5 - 20130913
Page 5 of 5

Arterial Leg Ulcer Outcome-Based Pathway

Transcription

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