Dr Zoe Aslanpour Head of Pharmacy & Public Health Practice

December 2010 UH

Learning objectives
Definition of integrated clinical pathway,

incorporating national guidance and clinical governance How are they are constructed The role of different healthcare professionals and multidisciplinary issues Professional accountability

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.

Background ........
In 1990 teams from the UK visited the USA to investigate 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

Integrated Clinical Pathway

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

Integrated Care Pathway:

Describes the care process within and across: primary, secondary and tertiary care Various health care settings Health and social care It also collects variations between planned and actual care

Aims of Integrated Clinical Pathways:

Facilitate introduction of guidelines & audit Improve multidisciplinary communication &

care planning Improve quality of care Reduce unwanted practice variation Improve clinician-patient communication Increase patients satisfaction Identify research & development questions

Integrated Care Pathway includes:

The right people

Doing the right things

In the right order At the right time In the right place With the right outcome

And most importantly focusing on the patients

& their experiences

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

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 flourish.

Integrated Care Pathways contain:

Multi-disciplinary, multi-agency, clinical and

administrative activities Evidence based, locally agreed, best practice Local and national standards Variance tracking Tests, charts, assessments, diagrams, letters, forms, information leaflets, satisfaction questionnaires etc Scales for measurement of clinical effectiveness

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

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

Skills required for ICP facilitator:

Facilitation & negotiation skills

Project management
Managing diverse and complex teams Conflict management Assertiveness skills Communication and public relations

Designing ICP Documentation

It should be quick and easy to complete Intuitive

Accessible
Meaningful Part of the routine of clinical/administrative

record keeping Clearly linked with the relevant activity by a unique identifier

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

What are the characteristics of an ICP?

Systematic action for consistent best practice and continuous improvements in patient care with attention to the patient experience Patient centred - built into packages of care for

identified groupings Provides continuous feedback via variance tracking and analysis Multidisciplinary Maps and models clinical and non-clinical care processes Incorporates guidelines and protocols includes standards and outcomes

Example of using ICP to improve services in diabetes care:

Map the current patient

care pathway Design a patient focused services Steps from current to optimal services Plan for resource implications

Diabetes Care
Level of provision of patients education varies considerably

Patients are mainly seen in primary care

GPs level of knowledge and competency in managing diabetes varies significantly

Complicated patients are sent to diabetic clinics in hospital to be seen by consultants and diabetes specialist nurses Diabetes checks including eyes and feet may not be performed regularly

Diabetes Clinics in secondary care (Consultants, DSNs)

GPs at Beacon practices All Type II, most Type I and some complicated patients Referrals

GPs with interest in diabetes

All Type II,

GPs with no diabetic services Most Type II

No Type I

Interim Solution / Outreach Clinic

GP / Practice Nurse

Specialist Nurse The GPs & Practice nurses get training

Trained GPs can treat

Non complicated
diabetics patients Trained GPs can Patients who are/ can not be seen by their GPs come to this clinic (Ist One Stop Shop is designated to house bounds) Diabetes clinics refer complicated diabetic patients to clinic

Retinopathy Screening Chiropodist

Transport

Dieticians

Educated patient

1. Look at the SLIPS (Southwark and Lambeth Integrated Care Pathway for

Older People with Falls) and complete the gaps in the following forms: a: Client information form b: General Falls assessment (Drug History) 2. Look at the Rheumatoid arthritis NICE guideline and identify pharmacist role in this ICP.