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Care pathways are increasingly being used in the UK as a tool for managing clinical processes and patient outcomes. This article describes some of the key elements of care pathways, highlights factors in successful implementation and discusses some concerns about their use.
KEY
WORDS
NURSING CARE
NURSING PROCESS
NURSING CARE PlANS
These key words are based upon work undertaken by the RCN Library.
Care pathways are multidisciplinary plans which predict the course of events in the treatment of patients with similar problems. These events must be specified on a timeline, and all incidents, actions and interventions must be identified, as must the resources required to achieve the expected outcomes (Reinhart 1995).
This article uses the term 'care pathways' throughout, although, as Box 1 illustrates, there are many other terms that may be used to describe the management of clinical care processes. Definitions of care pathways include:
A multidisciplinary plan of care written by teams looking after particular case types, a management tool, a process approach (Riches et al 1994) A set of proposed rather than prescribed activities (Heymann 1994)
Agreed multidisciplinary interventions for a given diagnosis, symptom or procedure within a given time limit (Layton 1993).
The National Pathway Association (NPA), formerly known as the National Pathway User Group, was founded in 1994 to act as a national resource for organisations developing care pathways in England and Wales, and uses the following definition of care pathways based on a consensus view of its membership: `An integrated care pathway determines locally agreed, multidisciplinary practice based on guidelines and evidence where available, for a specific patient/client group. It forms all, or part of, the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement.'
FORMAT
The format of the care pathway documentation varies. However the care pathway is described, it should include basic information expressed chronologically.
Events will typically be grouped under key headings, and will be organised by day, by hour, by week, in stages or in phases. For example, patients in intensive care may be sequenced hourly, while care pathways for patients undergoing rehabilitation following a hip replacement may be sequenced on a daily basis. Care pathways for mentally ill patients may be sequenced weekly,...