Surgical Wound Outcome-Based Care Pathway

Surgical Wound 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 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
Surgical Wound
Surgical Wound (Post-Surgical Wound): is a wound caused by a surgical
incision that is intentionally left to heal by secondary intention or when
primary wound closure with staples or stitches is unsuccessful with
subsequent dehiscence.
Surgical wounds are made in optimal conditions but failure to heal may be a
result of infection. These wounds may be referred to as surgical site
infections (SSI).
o Closed surgical wounds with our without a drain
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 4
Surgical Wound 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 4
Surgical Wound Outcome-Based Pathway
Interval
(Can be
timeframe, #
visits or #
visits within
timeframe
Best Practice
Guideline
(include hyperlinks
at bottom)
Outcome
o
0 to 7 Days
Holistic client &
wound assessment
completed
Reporting
o
SPO initial
report
(standardized)
o
Outcome
Evaluation
Barriers to Outcome
Achievement
Outcome not
met
o
o
o
Date:
o
CAWC: Best
Practice
Recommendations
for the Prevention
and Management
of Open Surgical
Wounds
Correct outcomebased pathway
confirmed
Date:
o
SPO initial
report
(standardized)
Date:
o
Outcome not
met
Date:
o
o
o
o
Date:
o
Wound therapy
initiated
Date:
o
SPO initial
report
(standardized)
Date:
o
Outcome not
met
Inaccurate
diagnosis on
referral
Incomplete SPO
report
Unknown etiology
Other:
Date:
o
o
o
o
Date:
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
Client
contraindication
Resource barriers
o Client
o SPO
o CCAC
o System
Client declined
Other:
Date:
Follow-up Actions
o
o
o
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:
Date:
o
o
o
o
Inter-professional
referrals to address
contraindications
CC system navigation to
address resource
barriers
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 3 of 4
Surgical Wound Outcome-Based Pathway
Date:
o
Client discharge
planning initiated for
client independence
and prevention
o
SPO initial
report
(standardized)
Date:
o
Outcome not
met
o
o
o
Non-adherence
to BPG
o Client
o SPO
o CCAC
Client declined
Other:
o
o
o
o
o
Date:
21 to 28
days
CAWC: Best
Practice
Recommendations
for the Prevention
and Management
of Open Surgical
Wounds
o
20 – 30 % reduction in
wound size
Date:
o
SPO interim
report
(standardized)
Date:
o
Outcome not
met
Date:
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
Date
53 to 60
days
Or Upon
Discharge
CAWC: Best
Practice
Recommendations
for the Prevention
and Management
of Open Surgical
Wounds
o
Date:
Wound is closed by 8
weeks
o
SPO
discharge
report
(standardized)
Date:
o
Outcome not
met
Date:
o
o
o
Causative factors
o Internal
o External
Non-adherence
to BPG
o Client
o SPO
o CCAC
Other
Date:
Date:
Date:
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
Date
Consult with SPO / ET /
Wound Care Specialist
Inter-professional
referrals as required
CC system navigation as
required
Contact client/caregiver
re: rationale
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:
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 4 of 4