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Learning objectivesDefinition of integrated clinical pathway,
incorporating national guidance and clinical
governance
How are they are constructed
The role of different healthcare professionalsand multidisciplinary issues
Professional accountability
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Background
In the 1980s, USA began to develop the integrated clinical
pathway tool to:
Focus on the patient rather than the system
Re-defined the delivery of care
To identify measurable outcomes.
To measure efficiency of the health care processes in order
to fulfil the requirements of the insurance industry.
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Background ........
In 1990 teams from the UK visited the USA toinvestigate the use of integrated clinical pathway
In 1991 the first integrated clinical pathway was
established in North West London
Integrated clinical pathways were clinician led with
patients and locally agreed best practice at their
heart.
In 2002 the electronic Pathways Database was
launched on National Health Library to enable free
sharing of integrated clinical pathway across UK
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Integrated Clinical Pathway
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Definition
An integrated care pathway is a multidisciplinary
outline of anticipated care, placed in an
appropriate timeframe, to help a patient with a
specific condition move progressively through a
clinical experience to positive outcomes.
www.evidence-based-medicine.co.uk
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Integrated Care Pathway:Describes the care process
within and across:
primary, secondary and tertiary care
Various health care settings
Health and social careIt also collects variations between
planned and actual care
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Aims of Integrated Clinical Pathways:
Facilitate introduction of guidelines & audit Improve multidisciplinary communication &
care planning
Improve quality of careReduce unwanted practice variation
Improve clinician-patient communication
Increase patients satisfaction
Identify research & development questions
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Integrated Care Pathway includes:
The right people
Doing the right things
In the right orderAt the right time
In the right place
With the right outcome
And most importantly focusing on the patients& their experiences
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Why were they developed
To reduce unnecessary variations in patient care Support partnerships in delivery of care
Empower patients and their carers.
To incorporate local and national guidelines into
everyday practice
Manage clinical risk
Meet the requirements of clinical governance
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Clinical Governance:A framework through which NHS
organisations are accountable for
continuously improving the quality of their
services and safeguarding high standards of
care by creating an environment in which
excellence in clinical care will f lourish.
http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515 -
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Integrated Care Pathways contain:Multi-disciplinary, multi-agency, clinical and
administrative activitiesEvidence based, locally agreed, best practice
Local and national standardsVariance trackingTests, charts, assessments, diagrams, letters,
forms, information leaflets, satisfactionquestionnaires etcScales for measurement of
clinical effectiveness
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Requirements for successful ICPs?
Select an important area of practice Gather support for the project from relevant people
Form a multidisciplinary group
Identify established guidelines e.g. NICE, NPSA Review practice, both current and past
Involve local staff from all disciplines
Identify service improvements and set goals
Prepare paperwork, Educate staff, pilot
Analyse & discuss variances regularly
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The role of the ICP Facilitator
leadership and marketing
project management including:
planning and evaluation
implementation skills including trouble-shooting communication, chasing, motivating, negotiating
facilitation especially process mapping & ICP
writing training, mentoring, support
feedback mechanisms
delivery of the goods
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Skills required for ICP facilitator:
Facilitation & negotiation skills
Project management
Managing diverse and complex teams
Conflict management
Assertiveness skills
Communication and public relations
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Designing ICP Documentation
It should be quick and easy to complete Intuitive
Accessible
Meaningful
Part of the routine of clinical/administrativerecord keeping
Clearly linked with the relevant activity by aunique identifier
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Other terms used for ICP
Anticipated Recovery Pathways (ARPs)
Multidisciplinary Pathways of Care (MPCs)
Care Protocols
Critical Care Pathways Pathways of Care
Care Packages
Collaborative Care Pathways Care Profiles
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What are the characteristics of an ICP?
Systematic action for consistent best practice andcontinuous improvements in patient care withattention to the patient experience
Patient centred - built into packages of care for
identified groupings Provides continuous feedback via variance tracking
and analysisMultidisciplinary
Maps and models clinical and non-clinical careprocesses Incorporates guidelines and protocols includes standards and outcomes
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Example of using ICP to
improve services in
diabetes care:
Map the current patientcare pathway
Design a patient
focused services Steps from current to optimal services
Plan for resource implications
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Diabetes Care Level of provision of patients education varies
considerably
Patients are mainly seen in primary care
GPslevel of knowledge and competency in
managing diabetes varies significantly
Complicated patients are sent to diabetic clinics inhospital to be seen by consultants and diabetesspecialist nurses
Diabetes checks including eyes and feet may notbe performed regularly
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Diabetes Clinics in secondary
care (Consultants, DSNs)
GPs at
Beacon
practices
All Type II,
most Type I
and some
complicated
patients
GPs with
interest in
diabetes
All Type II,
No Type I
GPs with
no diabetic
servicesMost Type II
Referrals
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Interim Solution / Outreach Clinic
Specialist Nurse
Diabetes clinics
GP / Practice Nurse
The GPs & Practice nurses get training
Patients who are/ can not be seen
by their GPs come to this clinic
(Ist One Stop Shop is designated
to house bounds)
Trained GPs can treat
Non complicated
diabetics patients
Retinopathy Screening Chiropodist
Trained GPs can
refer complicated
diabetic patients to clinic
DieticiansEducated patient
Transport
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1. Look at the SLIPS (Southwark and
Lambeth Integrated Care Pathway forOlder People with Falls) and complete
the gaps in the following forms:
a: Client information formb: General Falls assessment (Drug History)
2. Look at theRheumatoid arthritis NICEguideline and identify pharmacist role in this ICP.
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