The patient’s history is the most useful component when evaluating chest pain, as both normal and abnormal investigations (such as the ECG, cardiac biomarkers and chest radiograph (CXR)) must be interpreted in the context of the patient’s history. The mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac v. non-cardiac (respiratory, gastric or musculoskeletal) pain. Also, this wills the nurse gauge the emergence of the patient’s complaints of chest pain.
The goal of this assignment is to define the diverse forms of integrated care and to provide evidence on their impact both on the patient and also the future of the registered nurse. An integrated care pathway contains many elements in order to make it function. There must be a clear declaration of the aims, objectives and key elements of care founded by evidence, the best practice available and a consideration of patient expectations. The records, 24-hour care and assessment of changes and outcomes must be monitored. The assistance of communication, good organisation of people’s roles and sequencing the actions of the relatives, multidisciplinary team, and most importantly the patients. For an integrated care pathway to be truly multidisciplinary, it should never be developed by one staff group. At the outset, all staff groups involved in the patient journey should be identified. A typical working group should include doctors, nurses and allied health professionals, with input from administrative and managerial staff where it is necessary. If the pathway exceeds boundaries of care, such as, discharging patients to services outside the hospital or healthcare setting, reps of these groups should be involved with their integrated care plan. It is the integration of health care, social care, and other external agencies such as voluntary groups and private sectors that impact on the patients care and health professional’s quality of care giving. It does not need all
The process of using Evidence Based Practice in a patients care plan consists of five key stages. Asses the patient and formulate the problems from this you will then need to access the relevant clinical articles. Using this information you should then be able to assess which is the best method of treatment discarding any misleading or ambiguous articles. You then need to incorporate this knowledge into the patients care plan. Finally you need to evaluate and assess the patient during treatment to ensure effectiveness.
The problem in this scenario is the challenges faced with trying to implement a new clinical pathway. This particular clinical pathway trying to be implemented is concerning ventilator-dependent patients who are discharged to home with home health care needs. These patients tend to have multiple health care needs beyond the ventilator and the new clinical pathway will establish a smooth transition from hospital to home, allowing for all the patient’s needs to be met. The challenges arise when trying to get all areas of the health care team to get involved. This especially includes the physicians that seem reluctant to follow a nurse’s guidelines. Not only are the physicians reluctant, the home health care representative will not be available to attend team meetings for a while. The new clinical pathway is due to be started in one month, so there is little time to get all parties on board.
Evidence Based Practice is a principle that is centered on the improvement of patient care and outcomes, by introducing and researching current based evidence when making decisions for that patient. According to Johnston (2016), “Health-care practitioners are increasingly being encouraged to implement research evidence into practice in order to ensure optimal patient outcomes and provide safe, high-quality care”. Throughout the course of this class, whether it be from researching about Evidence Based Practice, or the implementation of nursing care delivery models, patient care and the way we treat our patients is at the forefront of change. We know that change is necessary, now it is just a matter of how to implement that change into the healthcare
Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)
Facilities, performing coronary CTA, should develop and adhere to evidence based coronary CTA protocols for optimal, high quality, cost-effective, patient-centered care. A comprehensive review of the literature was performed using CINAHL, PubMed, MEDLINE, and Medscape search engines, and with the terms ?coronary CTA?, ?protocols?, ?guidelines?, ?radiation?, ?contrast?, ?beta-blockers?, and ?radiology nursing?.
Aveyard and Sharp (2013, citing Sackett et al. 2000) interpret evidence-based practice as the reliable and sensible use of the most recent evidence together with clinical knowledge and patient values to guide health care decisions. This suggests that we must use the best up-to-date evidence to make decisions about care delivery to patients, acknowledging individuals needs and preferences to optimised patient outcomes. By considering patient’s opinion and the clinician’s experience with the supporting significant evidence from research and expert report, we can give the best results for the patient () . However, nurses must always use their clinical judgement and decision making alongside with EBP as sometimes evidence may not applicable and
In both plans a physician advisor reviews cases but within HH the case manager compiles all the clinical data and reviews, seeking the advice of physician advisor if necessary. Equally, the plans provide for utilization review to be initiated within the first twenty-four hours of the patient’s admission, if not prior to admission. In addition, both plans provide opportunities for the admitting physician to provide proof or argument for discrepancies in treatments or length of stays. Although the UK HealthCare UR plan provides a single physician review of inadequate treatment or length of stay, HH UR plan stipulates a minimum of two physician members review additional information submitted via the admitting physician. Specifically, in the HH UR plan exists a component of a continuous medical care evaluation studies to provide provisions for the Continuous Quality Improvement Committee. In addition, physicians continually need to be educated on detail specific care in HH, as physicians occasionally do not want the prescribed orders challenged. Pre-printed patient progress notes with check boxes assist some of HH’s physicians in considering necessary or unnecessary treatments
Second is consistent approach in using evidence –based clinical practice guidelines for the ACS and AMI clientele. Thirdly is the collection and analysis of the four performance measures for chest pain patients. If a chest pain centers program meets all of these qualifications will be awarded certification for a two year period.
Also environmental risks, location, family members, risk to self, others and the general public. Many specific considerations have to taken before admission, capacity, gender issues, patient group dynamics, environmental factors, suitability, facilities/equipment required, age, ethnic/cultural requirements, safeguarding issues, costing and desired outcomes. Alongside the referral process is a Care and Treatment Review (CTR) these are in accordance with recommendations from NHS England (2015) and Clinical commissioning groups (CCGs). This admission assessment process is underpinned by NHS England’s Improving lives team and follows recommendations made in The Winterbourne view report (DH, Transforming care, 2012).
Effective implementation of process improvement is dependent on thorough and successful dissemination of evidence-based plans. Walsh (2010) explains the need for healthcare systems to be nimble and responsive to changes in clinical practice. Ensuring quality, safe care, requires health care providers to maintain high levels of knowledge and competency using evidence-based practice (EBP). Strategies to disseminate EBP must be clearly articulated to all relevant stakeholders in order to drive knowledgeable changes in behaviors (Agency for Healthcare Research and Quality, 2013). The Senior Vice President Health Partner Services as a clinical leader and direct link to community health partners provides what Titler (2008) describes
Clinical paths are good in many ways, but if not followed or changed appropriately, they can be used as ammunition for a plaintiff during trial. If a nurse, for some reason, deviates from the clinical path without good cause, this can be used against the nurse in trial. On the other hand, if the clinical path was followed when there should have been a change made to the clinical path to increase patient safety, outcomes, etc., a nurse can be found negligent. All changes to the clinical path need to be clearly documented with adequate justification for the change. Another downfall with clinical paths is that they may give patients certain expectations of outcomes and care, and if they are not progressing according to the clinical path, there could be an increased risk of liability. For this reason, patients need to be made aware that the clinical path is a guideline, and sometimes deviations are necessary to improve patient outcomes. Clinical paths have proven to be a great way to enhance communication and patient outcomes, and if for some reason a nurse gets brought to trial, the clinical path will be a clear and concise way to analyze the standard of care
To deliver better care and outcomes, there is a need for evidence-based policy to be implemented successfully (1). Policy change can achieve impacts and sustainability beyond what is possible through standalone services or projects (2). Designing a policy and then translating it into practice is “a messy business” and requiring understanding of the policy context, design processes, the underlying values and beliefs
Clinical practice guidelines (CPGs) are designed to improve the care and safety of patients in hospitals. This thesis explores the promoters and barriers for CPG adherence among nurses. The research is based on a combination of a systematic literature review, qualitative research and a quantitative study. The systematic literature review included searching three data bases, namely, the British Nursing Index (BNI), Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The qualitative research study included one-to-one interviews and focus groups. The quantitative study consisted of a questionnaire distributed to nurses to extend and check the findings of the qualitative studies. The systematic literature review revealed