Great Expectations turning dreams into reality

1. Great Expectationsturning dreams into reality Adrienne Johnston Project Leader, Care Pathways Ulster Community & Hospitals Trust 028 90484511 x3245 adrienne.johnston@ucht.n-i.nhs.uk

2. Trust Profile • Merger Community & Acute Trust. • 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) H

3. 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

4. “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

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

6. “A mess computerised is a computerised mess” Draft RCP record keepingstandards – inpatientsRoyal College Phys. 2003

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

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

10. What staff want • Access specific information • Access to ALL information

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

12. 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

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

14. 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