Pilonidal Sinus Outcome Based Pathway

Pilonidal Sinus Outcome-Based Pathway
Pathway Identification
Pathway Name
Presenting Issue or
Condition Defined
Exclusion Criteria
Overall Pathway Outcome
Reason for Stoppage
Pilonidal Sinus
Pilonidal sinus (cyst, Sacro-coccygeal Pilonidal Sinus): is an abscess
near or at the natal cleft of the buttocks in the midline of the
sacrococcygeal area of the back. This acquired condition is caused by
one or more factors: body hairs entering the natal cleft or previous incision
site causing a foreign-body reaction or keratin plugs in hair follicles
causing folliculitis/ abscess.
o Intact skin (without visible injury or opening e.g. cellulitis)
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 4
Pilonidal Sinus Outcome-Based Pathway
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 4
Pilonidal Sinus Outcome-Based Pathway
Interval
Best Practice
Guideline
Outcome
o
0 to 7 Days
Holistic patient
and wound
assessment
completed
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
o
Correct outcomebased pathway
confirmed
o
Wound therapy
initiated
o
SPO
SPO
o
o
Outcome
not met
Outcome
not met
o
o
o
o
o
o
o
o
o
Discharge
planning initiated
for patient
independence and
prevention
o
SPO
o
Outcome
not met
o
o
o
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
Inaccurate diagnosis on
referral
Incomplete SPO report
Unknown etiology
Other:
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
o
o
o
o
o
o
o
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
Follow-up with SPO for
report completion
Discontinue pathway
Other:
Inter-professional
referrals to address
contraindications
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
Consult with SPO / ET /
Wound Care Specialist
Inter-professional
referrals as required
CC system navigation
as required
Contact
patient/caregiver re:
rationale
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 4
Pilonidal Sinus Outcome-Based Pathway
Interval
21 to 28 days
Best Practice
Guideline
Outcome
o
20 – 30 %
reduction in
wound size
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
53 – 60 days
Or Upon
Discharge
o
Wound is closed
by 8 weeks
o
SPO
o
Outcome
not met
o
o
o
Causative factors
o Internal
o External
Non-adherence to BPG
o Patient
o SPO
o CCAC
Other:
Causative factors
o Internal
o External
Non-adherence to BPG
o Patient
o SPO
o CCAC
Other:
Follow up Actions
o
o
o
o
o
o
o
o
o
o
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:
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:
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 4 of 4