Clinical Pathways

Clinical pathways evolved in the early 1990s as a means to standardize care for particular medical diagnoses. These pathways are multidisciplinary plans of care and can incorporate the possible nursing diagnoses that are most commonly found with a particular medical condition. When used appropriately, these pathways can drive the nursing process and contribute to the nursing care plan.

Clinical pathways provide a blueprint for multiple disciplines to coordinate care and achieve desired outcomes within a specified time frame. They include four main components: a timeline, a treatment plan of interventions, outcome criteria (measurable long-and short-term goals), and a variance record to allow for deviations to be recorded and analyzed.

Pathways are designed to standardize care and to improve the quality of care and outcomes. The concept was designed to help ensure that a patient entering hospital ABC with congestive heart failure (CHF) would receive the same level and quality of care as if he went to hospital XYZ. Or that patients being seen by a home health agency in New Hampshire would receive the same care as patients being seen by a home health agency in Texas.

The downside is that many physicians and other health care team members feel that pathways condone a cookbook style of medical care and that not all patients fit neatly into the pigeon holes that pathways expect.

Clinical pathways are set plans for the care of a patient with a specific diagnosis and as such, they are not easily individualized. It is important to select a pathway that fits the most pertinent needs of the patient.

These pathways allow for expected variances, but cannot possibly anticipate all combinations of factors. For example, a diabetic pathway would most likely include possible complications of neuropathy, retinopathy, and foot ulcers. It would not anticipate that the patient might also have comorbidities of cancer or HIV that would certainly skew the care and interventions this patient would need. In the same manner, clinical pathways often don't adapt well to unexpected changes in the patient's condition.

On the positive side, clinical pathways support continuity of care and coordinate care across the clinical disciplines by providing clinical guidelines for care. They help reduce risks and contain costs. Outcomes and documentation are usually improved significantly by the use of pathways.

One of the most beneficial aspects of clinical pathways is that they include the whole team in planning and implementing care. This includes the patient, who is a major partner and player in the entire process.

Your facility may or may not use clinical pathways. Some physicians may have their own pathways or variations of standard ones. Some refuse to subscribe to the cookbook nature of pathways. You may see any combination of issues with pathways. Be sure to acquaint yourself with the expectations in your particular situation and if you float to another area, don't assume the same rules apply.

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