HOW TO USE THE CLINICAL PATHWAY

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Gervais Mosley
7 years ago
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1 QEH/HH PCH KCMH Souris Western Stewart Memorial O'Leary INCLUSION CRITERIA All patients who are admitted to hospital and diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Patients under 18 years of age EXCLUSION CRITERIA Patients diagnosed with Febrile Neutropenia or admitted to Critical Care HOW TO USE THE This is a proactive tool to avoid delays in treatment and discharge. These are not orders, only a guide to usual orders. Place the Clinical Pathway in the nurses clinical area of the chart. All health care professionals should fill in the master signature sheet at the front of the Pathway. Addressograph/sticker each page of the Pathway. HEALTH CARE PROFESSIONALS: Initial tasks as completed. Bulleted and shaded sections do not need to be signed for on the pathway, but are to serve as a remider for consideration and to be completed as required. Additional tasks due to patient individuality can be added to the pathway in OTHER boxes and/or Progress Notes. PATIENT TRANSFERS: If patient is transferred to another hospital in PEI or to home care or long-term care facility, send a copy of the following to the receiving site/agency: Discharge Criteria Teaching Checklist - Original to stay on patient chart - Copy with patient in education packet - Original to stay on patient chart

2 NAME (Please Print) SIGNATURE TITLE

3 Admitting Date / Time _ COMORBID CONDITIONS: PHASE 1 (Approximately 2 s) ADMITTING VITALS MET PATIENT OUTCOMES ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) Respiratory rate < admitting rate Heart rate < admitting rate Temperature < admitting rate Dyspnea scale score < admitting rate Saturations achieved with less oxygen (flow or %) VS Q4H & PRN X 24H, including SpO 2 VS QID X 24H, including SpO 2 Chest assessment Q4H (breath sounds, productive cough) Dyspnea scale with activity Dyspnea scale at rest Monitor intake / output Mental status (time, place, person) Isolation: Droplet / Contact Precautions (if necessary) Immunization History: - Pneumococcal - Influenza Once all Patient Outcomes are achieved, move to Phase 2 Yes No Unknown Yes No Unknown CONSULTS Contact Physio Re: Breathing Exercises Yes No Instructions for Dyspnea Scale: For Patients: "This is a scale that asks you to rate the difficulty of your breathing. It starts at 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?" 0 Nothing at all Very, very slight breathlessness 6 1 Very slight breathlessness 7 2 Slight breathlessness 8 3 Moderate breathlessness 9 4 Somewhat severe 10 Severe breathlessness Very severe breathlessness Very, very severe breathlessness Maximal breathlessness

4 PHASE 1 (Approximately 2 s) ADMISSION - ACUTE DIAGNOSTICS/ LABORATORY MEDICATIONS TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION Bedside spirometry, if ordered Sputum for C&S if ordered CXR, PA & lateral ABGs ECG if ordered ECG with chest pain, notify physician Blood work as ordered Blood culture X2 if ordered Intermittent set / IV as ordered, reassess 2 Assess proper use of inhalers Medication Reconciliation Oxygen to keep SpO or as ordered Assist personal hygeine Regular diet or special diet, Encourage fluids 2-3 litres/ BRPs with assistance, increase to AAT Walk in hallway Review Patient Pathway Start Teaching Checklist Assess anxiety and intervene Assess Discharge Criteria daily Yes No Yes No Yes No DISCHARGE PLANNING Assess for additional supports: Other: <4 hospital stay >70 years old Unstable secondary DX Social situation Medication compliance

5 PHASE 2 (Approximately 3 s) MET Off supplemental oxygen or on usual O 2 if on chronic home oxygen PATIENT OUTCOMES Activity level as per preadmission Usual mental status Temp less than 38 c Dyspnea scale score improving On PO meds X 24 hours Once all Patient Outcomes are achieved, move to Discharge Criteria Understands diagnosis and discharge plan VS BID once stable, including SpO2 ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) CONSULTS DIAGNOSTICS/ LABORATORY MEDICATIONS Chest assessement Q4H (Breath sounds, Productive cough) Dyspnea scale with activity Dyspnea scale at rest Mental status (time, place, person) Monitor intake / output Isolation: Droplet / Contact Precautions (if necessary) Smoking cessation referral made, if necessary Home O 2 therapy referral, as needed Repeat CXR if patient is not improving from Phase 1 Blood work as ordered ABG S if new home O 2 patient Re-assess patient's proper use of inhalers Review discharge medications Intermittent set / IV as ordered Yes No Updated April 20, 2011 Adapted from Grey Bruce Health Review November 1, 2011

6 PHASE 2 (Approximately 3 s) MAINTENANCE TREATMENTS/ INTERVENTIONS O 2 if indicated - discontinue if SpO2 in ordered range at rest and with activity Physio: Breathing Exercises Assist with personal hygeine,as necessary Yes No Date:_ NUTRITION Regular diet, or special diet encourage fluids 2-3 litres/ If tolerating diet, encourage snacks to meet increased nutritional needs from illness MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION DISCHARGE PLANNING Increase activity as tolerated Review Patient Pathway Continue Teaching Checklist Review handouts Assess patient knowledge Assess Discharge Criteria daily Equipment and supports arranged Book follow-up appointment post-discharge Review discharge plans with patient Updated April 20, 2011 Adapted from Grey Bruce Health Review November 1, 2011

7 DISCHARGE CRITERIA N/A Decreased sputum production and purulence from onset ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) Resp <24/MIN for hours Temp <38 for hours Pulse <100 BPM for hours Dyspnea scale normal for patient Usual mental status SpO2 >90% or as ordered - within patient's norm CONSULTS Follow up chest x-ray Smoking cessation referral made, if necessary DIAGNOSTICS/ LABORATORY Stable comorbid illness Spirometry if ordered Patient demonstrates accurate use of metered dose inhaler Inhaled beta 2 agonist therapy required no more than Q4H MEDICATIONS No antipyretics for 24 hours Determine if patient is able to pay for necessary medications post-discharge Discharge medication list reviewed and copy to patient TREATMENTS/ INTERVENTIONS Influenza vaccine (Follow-up if appropriate) Pneumococcal vaccine (Follow-up if appropriate) NUTRITION Tolerating diet as ordered MOBILITY/ACTIVITY Patient's normal activity PSYCHOSOCIAL SUPPORT/ EDUCATION Education materials and Patient Pathway home with patient Teaching Checklist complete Patient questions answered DISCHARGE PLANNING Home care if necessary Follow up appointment within 2 weeks of discharge

REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as "Stroke Service" in Cerner.

REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as Stroke Service in Cerner. ACUTE STROKE CLINICAL PATHWAY QEH/HH PCH KCMH Souris Western Stewart Memorial O'Leary PATIENT ID INCLUSION CRITERIA* All patients admitted to hosptial with a suspected diagnosis of acute ischemic stroke