Non-Healing Wound Outcome-Based Pathway

Transcription

Pathway Identification
Pathway Name
Presenting Issue or Condition
Defined
Exclusion Criteria
Overall Pathway Outcome
Reason for Stoppage
Non-Healing Wound
A wound in which the patient does not have the physical capacity to heal 1.
o
o
o
o
o
o
o
New referrals (except in long-stay populations)
Malignant wounds
Maintenance wounds
Prevention of wound deterioration
Wound closed
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 > 30 days
o Patient refuses care
Other:
1
Norton, L., Coutts, P. & Sibbald, G.R. (2011). Choosing between a healable, non-healable and maintenance wound. Wound Care:
www.rehabmaganzine.ca, Fall 2011.
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
Date of Endorsement by
Provincial Patient Services
Frequency of Review
Next Review Date
What triggers a special condition
review of pathway
April 24, 2012
N/A
Based on Ontario Home Care Association & Ontario Community Support
Association (OHCA-OCSA), Nursing Practice Council (NPC) feedback
June 29, 2012
TBD based on RNAO and CAWC guidelines
May 2014
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
Best Practice
Guideline
Interval
Outcome
o
0 to 7 Days
(from start of
Non-Healing
Wound
pathway)
o
CAWC Best
Practice
Recommendation
s for Preparing the
Wound Bed
o
Holistic patient and
wound assessment
completed
Outcome
Evaluation
Reporting
o
Correct outcomebased pathway
confirmed
o
Wound therapy
initiated/reassessed
o
SPO
SPO
SPO
o
o
o
Outcome
not met
Outcome
not met
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
o
o
o
o
o
o
o
Stanford SelfManagement
Program
o
Discharge planning
initiated for patient
independence
o
SPO
o
Outcome
not met
o
o
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
Patient capacity
Resource barriers for
purchase of supplies
o Patient
o SPO
o CCAC
o System
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
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:
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
Best Practice
Guideline
Interval
Outcome
o
0 to 7 Days
Chronic disease
self-management
plan initiated
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
o
8 to 21 days
o
Q3 months
o
CAWC Best
Practice
Recommendation
s for Preparing the
Wound Bed
Assessment and
Identification of
resource/system
barriers –
intervention
initiated
No change in wound
o
CCAC
o
Outcome
not met
o
o
o
o
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:
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Patient capacity
Other:
o Patient
o SPO
o CCAC
Resource barriers
o Patient
o SPO
o CCAC
o System
Causative factors
o Internal
o External
Patient declined
Other
Follow up Actions
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Validate use of BPG
Consult with SPO
Inter-professional
CC system navigation
as required
Contact patient /
Other:
address resource
barriers
Contact
rationale
Inter-professional
referral as required
Escalation to manager
Other:
Validate use of BPG
Inter-professional
address resource
barriers
Consult with SPO ET /
Wound Care Consultant
Contact
rationale
Case conference
Other
1v5 - 20130913
Page 4 of 5
Interval
Q3 months
Best Practice
Guideline
Outcome
o
Resource/system
barriers addressed
Outcome
Evaluation
Reporting
o
CCAC
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Patient capacity
Other
Follow up Actions
o
o
o
o
o
address resource
barriers
Contact
rationale
Inter-professional
referral as required
Escalation to Manager
Other
1v5 - 20130913
Page 5 of 5

Non-Healing Wound Outcome-Based Pathway

Transcription

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