care pathway development template by 46tqAwZv

VIEWS: 53 PAGES: 20

									               [Insert pathway name here]Care Pathway
                      Development/Review Tool




Author:
Position:
Lead:
Directorate:
Date (Revised):
Version:
Approved by:
Review date:
File Name and Pathway:
Target audience/staff
group:




Developed by: Afsaneh Motabar, Clinical Effectiveness & Quality Lead
Directorate: Public Health
Approved by: Clinical Effectiveness Group (CEG)
Date: July 2010
CONTENTS


1.  INTRODUCTION ............................................................................................... 3
2.  SCOPE .................................................................................................................. 3
3.  OBJECTIVES ...................................................................................................... 4
  3.1 Outcomes & Benefits ............................................................................. 4
4. CURRENT SITUATION .................................................................................... 4
  4.1 Current problems or issues ................................................................. 4
5. LITERATURE SEARCH .................................................................................... 5
6. CLINICAL ENGAGEMENT .............................................................................. 5
7. LOCALISATION ................................................................................................. 5
  7.1 Organisations involved ......................................................................... 5
  7.2 Key stakeholders & working group .................................................. 5
8. RISKS & ISSUES .............................................................................................. 6
9. IMPLEMENTATION .......................................................................................... 6
  9.1 Implementation Process ...................................................................... 6
  9.2 Policies & Procedures ............................................................................ 7
  9.3 Clinical Governance ................................................................................ 8
  9.4 Communication & Education............................................................... 8
  9.5 IT Support .................................................................................................. 8
  9.6 Cost Implications, Funding & contracting ..................................... 8
  9.7 Special Considerations .......................................................................... 9
10. AUDIT & REVIEW ........................................................................................ 9
  10.1   Key measurement criteria................................................................ 9
  10.2   Review ..................................................................................................... 9
11. REFERENCES ................................................................................................. 9
APPEENDICES ......................................................................................................... 10
  Appendix A- Process for development of Care Pathway .................... 10
  Appendix B- Current Care Pathway............................................................ 11
  Appendix C- Care Pathway Benefits Review Checklist ....................... 12
  Appendix D- Equality Impact Assessment Tool ..................................... 13
  Appendix E - Process Map .............................................................................. 14
  Appendix F- Clinical Governance Principals for Development of
  Care Pathways .................................................................................................. 15
  Appendix G – Operational Specification check list ............................... 18
  Appendix H - Resources .................................................................................. 20




                                                                                                                            2
1.      INTRODUCTION

This document is intended to be used as a planning tool for development of
[insert pathway name here].

Definition of care pathway:
A care pathway is a complex intervention for the mutual decision making and
organisation of care processes for a well-defined group of patients during a
well-defined period.

Defining characteristics of care pathways include:

(i)      An explicit statement of the goals and key elements of care based on
         evidence, best practice, and patients’ expectations and their
         characteristics;

(ii)     the facilitation of the communication among the team members and
         with patients and families;

(iii)    the coordination of the care process by coordinating the roles and
         sequencing the activities of the multidisciplinary care team, patients
         and their relatives;

(iv)     the documentation, monitoring, and evaluation of variances and
         outcomes; and

(v)      the identification of the appropriate resources.

The aim of a care pathway is to enhance the quality of care across the
continuum by improving risk-adjusted patient outcomes, promoting patient
safety, increasing patient satisfaction, and optimising the use of resources.1

2.      SCOPE

[Define start & end points of the care pathway and set the deliverables of the
work. Consider the contributions of multiple agencies and in particular the
contributions of the NHS organisations, social services, housing, patients
representatives etc.]




1
 Vanhaecht, K., De Witte, K. Sermeus, W. (2007). The impact of clinical pathways on the
organisation of care processes. PhD dissertation KULeuven, 154pp, Katholieke Universiteit
Leuven.



                                                                                            3
3.    OBJECTIVES

[Clearly define the objectives, which should be S.M.A.R.T (Specific,
Measurable, Action oriented, Realistic, Time related e.g. to reduce
inappropriate referrals by 10% by 31 Dec 2010) and within the characteristics
of care pathways as outlined above. It should aim at improving the quality of
care and bringing care closer to home].

Primary criteria
    Change is achievable over the next ?? years
    The current case for change is well made
    There is a significant evidence base and good links to demonstrable
      outcomes
    Reduces inefficiencies in patient journey

Secondary criteria
    Impacts on the largest number of people, or
    Impacts on a small group but realises the greatest benefit to the
      whole system
    Provides a solution that deals with health inequality issues particular
      to London/Haringey

     3.1    Outcomes & Benefits

[What are the expected outcomes from this activity? The outcomes should be
constructed around each objective stated above and include the case for
change?]


                            Direct outcome /          Indirect outcome /
                            benefit                   benefit
Patient-Centred
Benefits/Impacts/outcome
Organisational
Benefits/Impacts
System Benefits/Impacts




4.    CURRENT SITUATION

[Include national and local data analysis and London context]

      4.1    Current problems or issues




                                                                            4
[Highlight any current problems and consider key local and national priority
areas. What does not yet exist nationally, in London or locally to provide a
good care pathway? E.g. inappropriate referral to secondary care, waste of
specialist resources.]


5.   LITERATURE SEARCH

[A literature search for evidence, research, consensus statements, or
nationally agreed guidelines should be carried out to make sure that current
best practice is incorporated in the pathways. E.g. NICE, NSF, National
Strategies, Map of Medicine, etc.]


6.   CLINICAL ENGAGEMENT

[Initial conversation should be carried out with local clinicians e.g. Hospital
Consultants, General Practitioners, Specialist Nurses, Pharmacists, GP’s with
special interest etc]


7.   LOCALISATION

     7.1    Organisations involved


Geographic area
Primary Care Trusts/GP Consortia
Acute Trusts
Other organisations (e.g. local
authorities, voluntary sector groups,..)

     7.2    Key stakeholders & working group

[Patients and carers view should be considered. This can be achieved in the
form of focus groups, patient surveys or having a user or carer on the
pathway working group.]
     Name                     Position                   Contact details




                                                                                  5
      8.      RISKS & ISSUES
Risk Detail                        Probability     Impact      Mitigation




Issue Detail                                     Responsible          Timeframe




      9.      IMPLEMENTATION

           9.1 Implementation Process
        [Define implementation & pilot process]

           What barriers exist to implementing an improved pathway in terms of
                 o structures?
                 o organisations?
                 o other factors?
           What needs to happen to support implementation
                 o locally?
                 o nationally?

           Soft barriers:
                   Health professional knowledge
                   Health professional attitudes
                   External barriers (e.g., environmental / system level issues)
                   Patient characteristics (e.g., education, information, poor
                      communication with patients, preferences for treatment)
                   Patient / professional relationships which can make the
                      difference between collaboration or coercion


      In developing care pathway prototypes using a common chain to both
      articulate and further understand the dynamics of the pathway would be
      useful; an example chain is represented below. In practice it will be necessary
      to allow individuals to change between pathways relatively easily, and if



                                                                                    6
necessary to receive treatment and care along more than one pathway at any
one time.

A common care pathway chain



                                    Ongoing review and assessment: Constant
                                    tuning of care plan in partnership with patient
                                    and partner organisations




   Population:        Entry:                      Assessment /             T          Route 1   E
                                                  triage                   R                    X
   People             Telephone                                            E                    I
   known to the       entry                                                A                    T
   service                                                                 T
                      GP referral                                          M          Route 2
   People             entry                                                E
                                                  Diagnosis
   unknown to                                                              N
   the service        Consultant                                           T
                      referral entry                                                  Route 3




                               Exit: At each stage an ‘easy out easy in’
                               approach with direct access to clearly defined
                               alternative care pathways




Transfer/discharge

There is a need to make exit and re-entry arrangements clear and easy from
the perspective of patients. At present services often create barriers to re-
referral as methods of demand-management, i.e. to slow down the flow of
cases being referred to clinical teams. Rapid re-entry to care should not
require a full re-assessment if the person has already undergone an earlier
assessment and diagnosis. This approach is sometimes called ‘Easy in- easy
out’.


     9.2         Policies & Procedures

[List the policies and processes within the NHS Trusts/partner organisations
that will interface with this localisation activity]




                                                                                                    7
      9.3    Clinical Governance

 [What are the clinical governance arrangements within the care pathway and
 at entry/exit points? See appendix F for Clinical Governance Principals.]


      9.4    Communication & Education


Communication Plan: [Provide prompts re: who the communication plan
includes, who leads which parts of it, cost of implementation,
timeframes etc.]




Education Needs: [Provide prompts re: who the education needs refer to
(could be public, staff, patients, carers), who leads, cost of
implementation etc]




      9.5    IT Support

 [Amendment of referral forms to reflect revised pathways, e.g. choose & book
 options to include GPwSI service or specific consultant in the acute trust.]


      9.6    Cost Implications, Funding & contracting

 [Are there any cost implications in implementing care pathways, e.g. cost
 savings by preventing inappropriate referrals/initial investment in training and
 development of specialist skills?
 Information on current funding and contracting should be available.]




                                                                                8
     9.7   Special Considerations

 [Are there any special considerations to be made BEFORE or DURING the
localisation activity? If yes, please explain. Do you need to consider carer
support?]



10. AUDIT & REVIEW

     10.1 Key measurement criteria

How will you measure change? You need to include the:
-     Data element (e.g. reduced inappropriate referrals)
-     Measure (e.g. Reduction by x%)
-     Timeframe (e.g. by 31 Dec 2010)
-     Frequency of measurement (e.g. quarterly)
-     Qualitative elements and focus on outcomes for patients, e.g. patient
      satisfaction survey.]



       10.2 Review

[Define the review date and keep the pathway up to date in line with national
new evidence and best practice.]


11. REFERENCES




                                                                              9
APPEENDICES

 Appendix A- Process for development of Care Pathway


                  Identify the need for care pathway



         Obtain management support and ongoing commitment
                   from clinicians and management




         Form a multidisciplinary group with key stakeholders




           Gather relevant data (pre-test) prior to pathway
        development .Establish if there is an existing pathway.


        Establish aims, and outcome measures for evaluating
                              pathway


        Collect data/evidence for pathway clinical content and
                                design


           The pathway should be approved by the relevant
        committee or group where applicable and to send to the
              Clinical Effectiveness Group for sign off.



          Provide education to clinical staff who will be using
                               pathway



                   Commence use / trial of pathway




        Audit pathways to establish compliance and suitability of
                               pathways




            Update any deficits in the pathway and continue
                            implementation




                                                                    10
Appendix B- Current Care Pathway

[Include screen shots of existing pathway]




                                             11
       Appendix C- Care Pathway Benefits Review Checklist


                  Benefits review checklist
                                                                               Benefit
Improve patient decision making by:
    improved information (e.g. diabetes checklists at the right time)
    improved education (e.g. shared ownership of care pathways using the
    Map)
Improve patient experience by:
    better communications (e.g. provision of specific patient info. at the
    right right point in the pathway
    increased trust in the healthcare system (e.g cross-care setting
    pathways are increasingly transparent)
    care closer to home (e.g. required services in place)
    reduced admission into hospital (e.g. preventative measures in place)
    reduced procedural errors (e.g. 'smoothing out' the referral to
    treatment)
    improved clinician/patient dialogue (e.g. introduction to Expert Patient
    Network etc if available)
Reduced
    admissions (e.g. inappropriate admission to secondary care)
    unscheduled care (e.g. out of hours services/ambulance service included
    in pathways)
    treatment failure (e.g. inappropriate treatment)
    readmissions ( e.g. long term conditions management of acute
    exacerbations such as COPD)
    inappropriate referrals (e.g. referral criteria agree across the whole
    healthcare community)
    liabilities (e.g. improved access to the right pathway & clinical
    governance approval etc.)
    unnecessary tests
    length of stay (e.g. using National Guidance e.g. Hip/Knee replacements)
improved
    pathway design discipline (e.g. engagement of multi-disciplinary team,
    established governance process)
    communications across care settings
    improved quality of referrals (e.g. from a general practice & system
    perspective)
    consistency of care across the healthcare community
    capability to achieve national targets
Financial
     improved utilisation of services
     reduced direct costs of service provision
     reduced duplication of services
     workforce planning
     delivering care in the most appropriate setting
Other: Please specify




Adopted from Map of Medicine




                                                                                         12
     Appendix D- Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the
appropriate committee for consideration and approval.

                                                             Yes/No     Comments

1.   Does the document/guidance affect one
     group less or more favourably than another
     on the basis of:

        Race

        Ethnic origins (including gypsies and travellers)

        Nationality

        Gender

        Culture

        Religion or belief

        Sexual orientation including lesbian, gay and
         bisexual people

        Age

        Disability - learning disabilities, physical
         disability, sensory impairment and mental
         health problems

2.   Is there any evidence that some groups are
     affected differently?

3.   If     you     have     identified potential
     discrimination, are there any exceptions
     valid, legal and/or justifiable?

4.   Is the impact of the document/guidance
     likely to be negative?

5.   If so, can the impact be avoided?

6.   What alternative is there to achieving the
     document/guidance without the impact?

7.   Can we reduce the impact by taking different
     action?

If you have identified a potential discriminatory impact of this procedural document,
please refer it to Michele Daniels, Head of Diversity and Health
Michele.daniels@haringey.nhs.uk , together with any suggestions as to the action
required to avoid/reduce this impact.

For advice in respect of answering the above questions, please contact Yolanda
Rubner, Head of Governance Yolanda.rubner@haringey.nhs.uk .




                                                                                  13
      Appendix E - Process Map

(Include a process map with reference to evidence based guidelines at
relevant “nodes”).




                                                                        14
Appendix F- Clinical Governance Principals for Development of Care
Pathways 2

Pathways
Interfaces between organisations: management approach and mitigation:
I.e.: PCT interface, clinical interface, contractor interface, public interface.

Pathway mapping led by Pathway Clinical Lead with support from clinical and
non-clinical colleagues from all the organisations who will work within the
pathway.
Identify risks and critical control points at the interfaces between organisations/at
handoff and within each section of the Pathway.
Establish risk exposure
Establish mitigating actions
Monitor/audit

Accountability: responsibility for the quality of clinical care of the individual,
multidisciplinary
teams and organisations.

"Who is accountable" can be divided into two groups: individual healthcare
professionals and groups of professionals, such as primary care trusts. The legal
obligations for individual healthcare professionals to provide care of sufficiently
high quality to individual patients continue to exist in tandem with care delivered
via pathways. These are mainly dealt with by the law of negligence, under which
a patient can sue a health professional for failing to have provided care of a
reasonable standard. In addition, obligations imposed on individual professionals
by their professional bodies (such as the General Medical Council) to provide care
of adequate quality continue to exist.

Process accountability includes the need to show that appropriate systems
are being used to record to whom care is being delivered and the way in which it
is delivered and includes the quality of the activities undertaken. To fulfil the
requirements of process accountability, staff working within pathways will need
to show that they are delivering care in accordance with the standards set
nationally, and also that any locally developed standards are adhered to.

Indemnity: The starting point is that healthcare professionals who work for NHS
bodies under contracts of employment are entitled to NHS indemnity in relation
to their acts of negligence that arise out of an in course of their employment. The
employing body is vicariously liable for their employees' negligence. That
vicarious liability is covered by the Schemes managed by the NHSLA.

(1) Liability will usually rest with the employer of the healthcare professional
whose treatment is being criticised, e.g. acute trust for the surgeon, possibly PCT
for the physiotherapists and some others

(2) There will be some professionals who do not operate under contracts of
employment, most likely GPs but possibly also allied health professionals. They
are not entitled to NHS indemnity and are not covered by the Schemes. Their
indemnity will usually be covered by a Medical Defence Organisation (GPs) or
professional indemnity insurance

2
    Developed by Yolanda Rubner, Head of Governance.


                                                                                          15
(3) Where the pathway 'fails' (for want of a better description), it depends on the
reason for the failure. For example, if there is a failure in follow up from an
orthopaedic clinic, liability will lie with the acute trust and be covered by CNST or
RPST depending on circumstances. If a GP fails to refer, this will usually be a
matter for his/her MDO.

Patient focus: services need to be patient focused, involving patients as partners in
all choices and decisions about access, care and treatment.
Openness and Transparency in the planning, design, delivery and monitoring of
services with the involvement of services with the involvement of the patients
and the public.
Patient and carer involvement in chronic disease
Local Involvement Networks
Choice

Clinical Leadership: strong clinical leadership which drives high standards of quality
and a commitment to evidence based practice.
Engaging doctors and nurses in leadership
Clinical leadership competency framework (in development)
NHS Graduate Scheme continues to recruit high calibre graduates onto the award
winning scheme;
Gateway to Leadership attracts fresh talent into the NHS from other sectors by
recruiting on its programme;
Breaking Through Programme recruits NHS managers from black and minority
ethnic backgrounds

Risk Management/Patient Safety Direct: risk management processes are
implemented to minimise risk in delivery of effective clinical care to patients.
Incident reporting/trend analysis.
Clinical Risk profiling.
Non-clinical risk (health and safety: risk profiling, risk assessors, fire wardens, fire
marshals, fire drills, COSHH, RIDDOR etc)
Clinical complaint/claims handling/trend analysis

Resource Efficiency and Effectiveness:
finances,
staff and
building and infrastructure.

Audit
Pathway clinical audits (critical control points)

Research governance
Compliance with the Research Governance Framework for Health and Social Care
(RGFHSC)

Information Governance
Record keeping
Caldicott/confidentiality issues throughout the pathways
Information Governance Toolkit compliance

SOPs
addressing key components of the pathway that are audited at critical control
points for effectiveness.


                                                                                             16
Improvement and vfm:
Demonstrating quality improvement and transformational change/ outcomes
measurements/Scorecards

Safeguarding
Safeguarding vulnerable adults incorporated into pathway design
safeguarding children incorporated into pathway design

Pharmacy
Medicines use review
Medicines Management Services
Dispensing
 Prescribing

ICT
functioning clinical systems
digital imaging

Environment / Infection control
access/DDA
environment (e.g. PEAT)
signposting/way finding




                                                                            17
Appendix G – Operational Specification check list

Specifications

         Catering, Snack bar and Shop
         Building and Engineering Services Maintenance
         Building Fabric Maintenance
         Cleaning (output)
         Cleaning (input)
         Security Control System
         Reception PABX
         Security
         Fire Management
         Car Park Management
         Grounds Maintenance
         Mail and Porterage
         Printing and Reprographics
         Waste Management
         Internal Planting
         Way finding



Best Practice
          Performance Measurement System
          Business Continuity Planning



Health and Safety
         Health and Safety Policy Statement
         Health and Safety Checklist
         Health and Safety Procedures
         Emergency and Security Procedures
         Health, Safety and Emergency Procedures
         Guide for Workstation Assessments
         Workstation Risk Assessment Form
         Health and Safety Policy Statement
         Health and Safety Checklist



         Environmental Policy Statement
         Equal Opportunities Policy Statement
         Health and Safety Policy Statement
         Training Policy Statement
         User Guide to FM Services
         Fire Precautions Policy and Procedures
         Security Policy and Procedures


                                                         18
Legislation examples
          Health and Safety Checklist
          Information governance: Data Protection/Freedom of Information / Caldicott
          TUPE
          DDA


Recruitment, Retention, Training
         Recruitment policy
         Talent management policy
         Appraisal and Training Policy Statement
         Recruitment policy




                                                                                   19
Appendix H - Resources


       Guide to Carrying Out Clinical Audits on the Implementation of Care
        Pathways
      http://www.hqip.org.uk/assets/7-HQIP-CA-PD-031-Guide-to-carrying-
      out-clinical-audits-on-the-implementation-of-care-pathways-19-
        April.pdf

      Map of Medicine
       http://www.mapofmedicine.com/

      International Journal of Care Pathway
       http://ijcp.rsmjournals.com/current.dtl

      European Pathway Association
       http://www.e-p-a.org/index2.html

      Journal of Integrated Care Pathways
       http://www.rsmpress.co.uk/jicp.htm

      Institute of Innovation & Improvement
       http://www.institute.nhs.uk/




                                                                              20

								
To top