protocols be disease based problem based client based
protocols • be disease based, problem based, client based or treatment based • care pathways may include clinical guidelines or care protocols but that each are distinct entities • They describe care pathways as being like care protocols or clinical guidelines in so far as they aim to identify who should do what, when and in what order
8 STEPS TO DEVELOPING INTEGRATED CARE PATHWAY • • 1 Review the evidence 2 Collect data 3 Review current practice 4 Identify key indicators 5 Draft an integrated care pathway 6 Review and revise draft 7 Develop client version of care pathway 8 Monitor indicators
protocols • protocols are therefore more likely to be seen as non-negotiable requirements, and assumed to be, from their name, prescriptive of what must be done. • A document being described as a care protocol does not guarantee that it is of high quality or that using it will produce safe or high-quality care
protocols • Protocol documents tend to be shorter than clinical guidelines, with less detail of how and by whom they were developed, the types of evidence used and the hierarchies into which these were placed, evaluating them may be less easy to achieve. • the intention of protocols is that they are succinct documents which can be followed rapidly and step-by-step in practice
protocols • despite being more prescriptive, they may be more useful in acute situations where a busy practitioner is confronted with clinical need and wishes to know, swiftly, what is thought to be the best thing to do and how to do this. • By providing easily usable, staged, instructions, care protocols may contribute to the reduction of errors and increase the efficacy and safety of care
protocols • care protocols are likely to be especially useful in situations where all staff members may not be aware of the composite current best evidence and for staff who are relatively inexperienced in a particular field of practice or aspect of care.
protocols • There also situations where patients will be cared for in a ward or department outside the speciality to which they ‘belong’. This may be because an individual has a disease with multisystem involvement or because they are awaiting transfer or bed availability.
protocols • The time and effort which it can take to achieve changes in practice should not be underestimated. • For guidelines to be appropriately used, practitioners must be aware of their existence and be able to access these, and they must be presented in a clear, user-friendly format
protocols • Evaluation strategies should accompany guideline implementation, and feedback mechanisms should be put in place so that staff can determine whether the time and effort which they are expending in adopting new guidance is worthwhile • open discussion between all staff is needed so that the needs and priorities of each and how actions and decisions taken by each impact on the others can be understood and common aims reached.
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