Clinical pathways help hospices improve care
Meet CoP requirements with outcome data
Change is difficult, but hospices have to change the way they approach patient care due to the requirements of the Conditions of Participation (CoPs) that became effective in December 2008. Collection of outcome and quality data is a new activity for many hospices, but one way to ensure that data are collected in a way that enables benchmarking and evaluation for improvement is to use clinical pathways.
"Clinical pathways have been used by health care providers for many years, but very few hospices use them," says Karen Baranowski, BSN, RN, CHPN, clinical nurse educator for hospice at Intermountain Homecare in Bountiful, UT. "Having a pathway enables you to document data and outcomes consistently," she says. Because hospice does not currently use OASIS [Outcome and Assessment Information Set] for initial assessments and documentation of the patient's status, outcome data are not always collected in a way that enables evaluation of trends, she explains.
There are not a lot of hospice-specific pathways available, says Baranowski. "A hospice pathway must address the different phases of the end of life, and pathways that are designed for patients who will recover or improve do not apply to hospice," she points out. Because existing pathways are scarce or might be costly for agencies, it is possible to create your own pathway, she says.
"The first step is to ask yourself what to expect on a regular visit," explains Baranowski. "Identify symptoms you typically see, and describe outcomes you expect to reach," she says. Within the pathway, offer steps to take to address symptoms and reach expected outcomes, she adds. "Look at best practices within the hospice industry to identify the proper steps to take within your pathway," Baranowski suggests.
Resources can help
Members of the National Hospice and Palliative Care Organization (NHPCO) have access to reports and tools that are useful in setting up clinical pathways, says Baranowski. In addition to free resources for members, NHPCO also sell publications, she adds. "Remember to check standards of care published by different disciplines such as social workers, chaplains, nurses, and different medical specialties," suggests Baranowski. "They often have chapters or sections on hospice."
Address all aspects of hospice care because you should have one multidisciplinary pathway for each patient, says Baranowski. "You want to collect information from all providers in the same manner," she says.
Be certain your pathway is designed to address the different stages of hospice care, says Lisa Van Dyck, BSN, RN, MS, vice president of product development and consulting services for Innovative Healthcare Solutions in Naperville, IL. "Our pathway addresses admission, which is the first phase of hospice care; plateau, where patients' conditions change slowly; decline, the point at which patients are actively dying; and death or discharge," she says.
As a subsidiary of VNA First, Innovative Healthcare Solutions focused on development of clinical pathways for home health and hospice many years ago. "Our hospice pathway was developed in 1994 and has been enhanced throughout the years," Van Dyck says. "The pathway is provided in an electronic format, but hospices are able to print it out if they don't have the ability to use electronic forms."
When evaluating a pathway, it is often easiest to start by using a paper form, suggests Baranowski. "If it won't work as a paper form, it won't be any easier to use in electronic form," she points out.
Introduction of a clinical pathway requires careful education and presentation, says Baranowski. "If you use an electronic form, there is no opportunity for free texting, and many clinicians feel that this is very restrictive," she says.
The key to a successful introduction is first to make sure that all members of the management team and board of directors are supportive, Baranowski suggests. "You need their support to hold clinicians accountable for completing the pathway for every patient," she says.
Explain how the pathway fits all aspects of care together, suggests Baranowski. "Let them see how the pathway clearly defines outcomes and goals and how it is a tool that gives them resources for identifying interventions," she adds. If clinicians can see how a pathway can help them improve patient care, they are more receptive, Baranowski says. "If they don't understand its value, they will just view it as an aggravation," she says.
Introducing clinical pathways into your hospice's daily practice can be overwhelming, admits Baranowski. "Just focus on the most useful aspects of a pathway if you're developing it from scratch or adapting it from another pathway," she says. "Plan to re-evaluate the pathway and how it is used on a regular basis. Don't be afraid to make changes, because you want the pathway to be realistic and helpful."
Change is difficult, but hospices have to change the way they approach patient care due to the requirements of the Conditions of Participation (CoPs) that became effective in December 2008.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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