Clinical Pathways Integrated with Evidence-Based Decisions: Part 1
Advances in Skin & Wound Care:
Departments: Practice Points
Cathy Thomas Hess, BSN, RN, CWOCN, is Vice President and Chief Clinical Officer, Net Health Systems, Inc. Please address correspondence to: Cathy Thomas Hess, BSN, RN, CWOCN, via e-mail: firstname.lastname@example.org.
In my last column, “Value of a Specialty Wound Care Electronic Medical Record,” we discussed utilizing a specialty wound care electronic medical record as a key to drive process efficiencies, manage volume, and support outcomes. One effective tool for supporting outcomes is the clinical pathway, which provides direction in a stepwise fashion for the team to follow when performing a comprehensive patient assessment. The assessment details the patient’s medical history, inclusive of the wound’s status. To complete each step, consider appropriate personnel through a clinical and operational workflow synchronization model. The pathway should provide information regarding an initial assessment. Follow-up visits will be predicated on the department’s clinical and operational workflow, policies and procedures, and the necessary medical/clinical direction based on the patient and his/her wound presentation. Such a pathway can serve as a guideline for the healthcare team to follow for a specific diagnosis (Figure 1).
In this column, we will look at the diabetic etiology evidence-based pathway, specifically week 1, and weeks 4 and 20 will be presented in subsequent columns. Key decision points are provided based on research that combines healing rates at 4 weeks with expected outcomes. If the patient does not meet a given healing rate, closure objective research suggests that they may experience delayed healing in the weeks to come. The provider may, at this point, act on further evidence-based adjunctive therapy recommendations altering the patient’s expected negative outcome. Selected references offer further considerations when developing pathways for your facility.
Source: Hess CT. Clinical Guide: Skin and Wound Care. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
Frykberg RG, Zgonis T, Armstrong DG, et al.. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006; 45 (5 Suppl): S1–66.
Kantor J, Margolis DJ. Expected healing rates for chronic wounds. Wounds 2000; 12: 155–8.
Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care 2003; 26: 1879–82.
Snyder RJ, Kirsner RS, Warriner RA 3rd, Lavery LA, Hanft JR, Sheehan P. Recommendations on advancing the standard of care for treating neuropathic foot ulcers in patients with diabetes. Ostomy Wound Manage 2010; 56 (4 Suppl): S1–24.
© 2013 Lippincott Williams & Wilkins, Inc.
Steed DL, Attinger C, Colaizzi T, et al.. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen 2006; 14: 680–92.