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Clinical Pathways Integrated with Evidence-Based Decisions: Part 1

Hess, Cathy Thomas BSN, RN, CWOCN

Advances in Skin & Wound Care: February 2013 - Volume 26 - Issue 2 - p 96
doi: 10.1097/01.ASW.0000426720.44078.44
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:

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).

Figure 1

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.

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          © 2013 Lippincott Williams & Wilkins, Inc.