Clinical Care Pathways (CCCP): Magic or Maze?

Norah Bostock

Operations Manager: Governance

CCCP’s-Magic or Maze?

Pathways: What does the literature say?

The literature reveals CCCP’s as:• Powerful clinical tools: proven across the world to organise &

provide EB care• Providing effective predictable trajectories of care with clinical

outcomes• Ensuring the 8 rights• Facilitators of clinical indicator data• Providers of:

- Formal care guide supporting decision making

- Mechanisms to co-ordinate client & healthcare provider resources

- Legal record with minimal documentation

- Basis for continuous improvement

Pathways: What does the literature say?

• Capture and support data on the care journey by being time specific

• Include client education and discharge planning• Identified clinical tests are attended• Designed to collaboratively involve both staff and client in the

care journey

Clinical Pathways: The right person in the

right place with the right outcome

Pathway applications: Is every clinical

situation appropriate for a CCCP?

Considered beneficial in the following areas:• High cost e.g. non-healing venous leg ulcers• High risk e.g. medication management• High volume e.g. catheter management• High interest e.g. diabetes/post-acute care

Considered suitable for a high % of the population

Pathway solutions: Working together across the spectrum

Pathway solutions: What does the evidence

say?

Client outcomes underpinned by best practiceleading to:

• Consistent pathway implementation and reduced clinical practice variation

• Reduced length of stay to deliver outcomes • Returning clients to self management as soon as practicable • Support hospital avoidance by being the “hospital in the

home”• Reliable multi-disciplinary collaborative partnership with

other care professionals delivering shared care

Pathway solutions: What does the

evidence say?

Staff able to access best practice framework:

• Consistent referrer, nurse, client and carer education• Delivers on evidence from National and International

benchmarks• Staff can express confidence in the care they deliver even in

areas where knowledge is limited• Pathways provide consistency to every staff member• Provides consistency in when and where to report clinical

risk and incidents• Individualises care via the variance tracking

Pathway solutions

Business Improvement:

• Collection of the right clinical outcome and variance evidence (through RDNS Mobility solutions and reporting) as a platform for Continuous Improvement 

• Reduction in unnecessary documentation • Pathways proven by clinical evidence with predictable costs

demonstrating value for money to our funders (reducing overall burden on health system)

• We have a better record of care to follow up if a client complains

RDNS: Checklist for development

• Identify need• Obtain commitment from

clinicians• Form group with relevant

stakeholders• Pathway• Establish aims and

outcomes for evaluation• Evidence

• Draft pathway• Review draft• Costings• Education to staff• Trial pathway• Evaluate results and

act/adjust accordingly• Implementation• Establish ongoing review

process

RDNS: Current Pathways

• VLU• Urinary Catheter Management• EOL• Diabetes Self-Management• Medication Streaming

RDNS: Pathways in development

• Urinary assessment & management• Bowel assessment & management• Insulin Management• Palliative Symptom Management• COPD• Asthma• Stage 3/4 Pressure Ulcer

Translating Evidence into Practice or Pitfalls & Perils or Critical steps and challenges• Staff engagement – how do we achieve this• Uptake – why use this when a care plan is easier• Registration of the clinical care indicator • Variance tracking – how to improve uptake & registration for

audit & evaluation• Changing the culture (too busy, too hard etc.)• Evaluation – how and when• Platforms for monitoring clinical indicator information – the value

of this information to inform future services• Audit processes• Changes to client health status – how do we measure

Evaluation of pathways

Identified through clinical indicators developed from: • Client/staff uptake of pathways (client care indicator is

registered when the pathway is commenced)• LOS data• Healing rates• Health outcomes achieved• Discharge rates• Meeting or improving on benchmark standards

Summary • Brief overview of the importance of developing and

implementing care pathways to improve care delivery and health outcomes and support a new model of care.

• Piloting the pathway is as important as the development• Evaluation is the final step in ensuring success• Ongoing pathway uptake and monitoring of variances relevant

to individual Clinical Specialties• Committing to business as usual