Arterial Leg Ulcer Outcome-Based Pathway
Transcription
Arterial Leg Ulcer Outcome-Based Pathway
Arterial Leg Ulcer Outcome-Based Pathway 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 Arterial Leg Ulcer Outcome-Based Pathway 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 Arterial Leg Ulcer Outcome-Based Pathway 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 Arterial Leg Ulcer Outcome-Based Pathway 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 © 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. 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Page 4 of 6 Arterial Leg Ulcer Outcome-Based Pathway 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 © 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 5 of 6 Arterial Leg Ulcer Outcome-Based Pathway 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 © 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 6 of 6