Great Expectations turning dreams into reality Adrienne Johnston

Great Expectations turning dreams into reality Adrienne Johnston Project Leader, Care Pathways Ulster Community & Hospitals Trust 028 90484511 x 3245 adrienne. johnston@ucht. n-i. nhs. uk A

Trust Profile • Merger Community & Acute Trust. H • Services include- primary, secondary and community care • Community services -pop. 140, 000 • Acute services -pop. 260, 000 • 2 community hospitals 40 beds total • 1 acute hospital – 600 beds • 5500 staff (3304 WTE) A

What is a Care Pathways? “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. ” National Pathway Association 1998 A

“A patient’s experience of an episode of care is sometimes likened to a journey. But the patient as traveller may feel more like an intrepid explorer continually coming up against the unknown rather than a modern traveller whose journey has been planned with a travel agent. . Planned journeys carry less risk than unplanned ones, and knowledge of the journey’s steps and stages reduces anxiety and fear. Our patients should expect at least the same amount of planning for and information about their health care as they get from travel agents. ” Layton et al 1998 A

Pathways & electronic notes Pathways Electronic notes • Whole note • Multi-professional • Accessible by all • Evidence based • Structure format • Stored centrally • Treatment plans • Future plans • Demographic details • Past histories • Examinations • Results • Referrals • Whole note • Multi-professional • Access on need to know basis • Evidence based - built in alerts • Structure format • Accessible all locations • Treatment plans • Future plans • Demographic details • Past histories • Examinations • Results • Referrals A

“A mess computerised is a computerised mess” Draft RCP record keeping standards – inpatients Royal College Phys. 2003 A

“The right information at the right time is nine tenths of any battle” Napoleon Bonaparte A

Hospice Services Clinical Trials Team Community Pharmacy Alternative Practitioners Surgeon Secretary Acute Palliative Care Database Co-ordinator District Nursing Out Patient Community Palliative Care Others Radiologist Specialist Nurse GP Audit Cancer patient Junior Docs Social Worker Surgeon Anaesthetist Pharmacy Haematologist Treatment Radiographer Radiologist Chemo Oncologist Nurse Counsellor Labs In Patient Allied Health Professionals Surgeon Specialist Nurse Clinical Radiologist Pharmacy Ward Nurses Specialist Nurse Labs Radiologist A

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What staff want • Access specific information • Access to ALL information A

What staff want • Access specific information • Access to ALL information • Aware of patient understanding & wishes • Access to evidence A

What staff want • Access specific information • Access to ALL information • Aware of patient understanding & wishes • Access to evidence • Alert to risks • Use professional judgement • Access for review & audit A

“Since computers entered office systems, paper utilization has increased six-fold” A

• Identify goal • Agree ALL information required • Agree who needs access & when • Policies & procedures off shelves • Develop ONE system – no mix & match • Computerise • Review information & improve care A

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