Cutaneous bacterial infections. How to manage primary, secondary, and tertiary lesions.

Lesions of the threefold spectrum of bacterial infections usually can be diagnosed on the basis of the clinical picture, but sometimes laboratory studies and a therapeutic trial may be needed for confirmation. Fortunately, a number of effective antimicrobial agents and adjunctive measures are available for treatment.     

Development of an integrated care pathway for the management of hemiplegic shoulder pain

Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidence-based multidisciplinary integrated care pathway (ICP), and to use this to audit quality of care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of care offsets the substantial investment of staff time in ICP development.     

Development of an integrated care pathway for the management of hemiplegic shoulder pain

Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidence-based multidisciplinary integrated care pathway (ICP), and to use this to audit quality of care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of care offsets the substantial investment of staff time in ICP development.     

A pilot project to design, implement and evaluate an electronic integrated care pathway

The project focused on the design, implementation and evaluation of an electronic integrated care pathway (eICP), within a Mother and Baby Unit. Health care professionals and service users (stakeholders) were involved in the process in order to promote patient centred, co-constructed care. Questionnaire and discussion groups were used for data collection regarding the initial eICP development. Of 15 participants who took part in the design and development of the eICP, seven were able to take part in the evaluation process on the Unit. Results show that 100% (n = 7) of the participants were in agreement with the eICP and the format that was produced and implemented for trial on the Unit. Increased ownership of records, greater multi disciplinary involvement and enhanced patient experience were also reported. Recommendations for clinical practice include resource management, ownership of the research group, holism maintenance and the acquisition of computer skills.     

Developing a joined up approach to smoking cessation in primary and secondary care

Nurses are well placed to give patients help and advice on giving up smoking. This article describes how a groundbreaking nurse led project has increased referrals to smoking cessation services and encouraged thousands of patients to quit. It discusses the importance of healthcare professionals working together to support patients to stop smoking and the need for training to ensure staff are engaged with the "quit journey".     

Facilitating an integrated approach to primary health care in Saskatchewan

It is unlikely that truly integrated primary health care will become a reality unless health professionals actively strive to foster integration. Dialogue about integration barriers and opportunities has begun between the nursing, pharmacy, social work, emergency medical services, and medical professions. This dialogue should be expanded to include all of the professions with a potential role in an integrated system. The dialogue will also need to include government leaders as key public policy decisions will significantly influence the success or failure of integrated primary health service delivery strategies. As well, dialogue needs to occur with communities so that citizens can understand, value and help shape and maintain this kind of service delivery. Public education needs to emphasize that an integrated approach to primary health care in Saskatchewan is the best kind of service that can be provided. The Integrated Primary Health Care Working Group believes that the principles of primary health care require health professionals in Saskatchewan to develop an integrated approach to health services delivery in Saskatchewan. An exploration of possible barriers to this integrated approach is an important first step in eliminating barriers and facilitating effective health care service delivery to meet population health needs.     

The evaluation of an end-of-life integrated care pathway

AIM: this evaluation set out to examine the needs of staff as they adopted an end-of-life integrated Care Pathway (ICP), and its impact on both service users and providers. METHOD: semi-structured interviews were conducted with palliative care specialists, other health care professionals and bereaved carers. RESULTS: the challenges encountered revolved around the multitude of settings, and professionals involved; around the diagnosing of dying; communication with patients and the provision of emotional or spiritual support. Ongoing challenges at the end of the evaluation were those of addressing spirituality and some of the established practices. However, there was general consensus that the ICP facilitated greater consistency of care, improved continuity, and ensured a proactive rather than a reactive approach to care. All these were recognised and appreciated by bereaved carers. CONCLUSION: end of life is now every health care professional's business and this may have the potential to raise the place of palliative care in general on the professional agenda.     

An integrated care pathway for the management of low back pain

Low back pain is a disabling condition that is responsible for a considerable amount of health service expenditure [HMSO, London, 1994, p. 1; The Back Pain Revolution. Churchill Livingstone, London, 1999]. Following national recommendations from the Clinical Standards Advisory Group [HMSO, London, 1994, p. 1] and the Royal College of General Practitioner Guidelines [Royal College of General Practice, London, 1996, 1999], local initiatives have attempted to integrate this advice into care pathways for low back pain. This paper will detail the background development, construction and audit of an integrated care pathway for the management of patients with acute low back pain in North Staffordshire.     

Developing an economic IQ in primary care

PURPOSE: To describe elements of an economic intelligence quotient (IQ) that can be used to enhance the nurse practitioner's (NP) fiscal viability in a primary care setting. DATA SOURCES: Anecdotal data from providers and administrators; clinical experiences of the authors; scientific and government publications and guidelines. CONCLUSIONS: In the United States, managed care cost-containment initiatives have led to competition among physicians and NPs for patients and jobs. An understanding of the economic base of a practice is essential to fiscal viability in this market. PRACTICE IMPLICATIONS: When turf and job competition are the norm, it is essential that the NP develop an economic IQ. Knowledge of coding, billing, reimbursement, and documentation are critical to identifying the NP's value to the practice and promoting job retention. The challenge is for the NP to give high-quality, cost-effective, and safe patient care and to be a productive provider.     

Indwelling catheters: developing an integrated care pathway package

Urinary catheterisation is a common nursing procedure in hospital and in the community, yet there are risks associated with it. Complications include urethral trauma, urinary tract infection, strictures, urethral perforation, encrustation, bladder calculi and neoplastic changes (Lowthian, 1998). The procedure is also linked to nosocomial infection and, in some cases, these catheter-related infections can prove fatal (Pratt et al, 2001). Due to the risks, catheterisation is indicated as a last resort after all other interventions have failed.     

Developing an integrative therapies program in a tertiary care cardiovascular hospital

This article describes one hospital's approach to developing an inpatient integrative therapies program and the foundation for a broader integrative healthcare vision. Since the program's inception, additional evidence has accumulated in the literature supporting the impact of integrative therapies strategies on patients' quality of life during inpatient stays. These findings and our own evaluation processes have encouraged continued program growth. Several elements were critical to the program's success. Review of the literature and investigation of other programs served as preparation before the actual program started. It was necessary to have administrative, nursing, and physician champions who were able to envision the program and see the value of this approach for patients. We appreciated the need for evidence-based outcomes research and demonstrable patient outcomes. Finally, a program manager was hired who was able to understand the culture of the hospital and the organizational change process. Each of these basic steps, which called for interdisciplinary collaboration, allowed us to accomplish the goal of using integrative therapies as adjuncts to conventional medical care and thereby supported an integrative approach. Consistently linking the integrative vision to patient needs and requirements helped us to identify many new avenues to expand upon this work. The process of program development described may be useful to other inpatient cardiovascular programs inclusive of critical care settings. Adaptations of our experience to other populations in critical care and across other hospital settings may be possible.     

Developing an interprofessional learning culture in primary care

This paper discusses the concept of interprofessional learning based on empirical data from an evaluation of an interprofessional learning project that was set in a British primary health care centre. A process evaluation methodology was chosen to collect the data using semi-structured interviews and focus groups with stakeholders and staff to gather their experiences and views of the project and documentary data from records written over the lifetime of the project. The paper argues that an interprofessional learning culture requires time to become embedded in everyday practice and to achieve such a culture, shared values, aims and clear communication are essential. The data suggest that there is a need to recognize responsibility for one's own learning as individuals as well as learning as teams of work colleagues if interprofessional learning is to be successful. However, even when these pre-requisites of interprofessional learning are agreed and acknowledged openly in the workplace, participants in the development of a learning culture need to recognize that there are structural controls which influence and constrain such developments which are external to participants and beyond their immediate control.     

Developing an interprofessional learning culture in primary care

Summary

This paper discusses the concept of interprofessional learning based on empirical data from an evaluation of an interprofessional learning project that was set in a British primary health care centre. A process evaluation methodology was chosen to collect the data using semi-structured interviews and focus groups with stakeholders and staff to gather their experiences and views of the project and documentary data from records written over the lifetime of the project. The paper argues that an interprofessional learning culture requires time to become embedded in everyday practice and to achieve such a culture, shared values, aims and clear communication are essential. The data suggest that there is a need to recognize responsibility for one's own learning as individuals as well as learning as teams of work colleagues if interprofessional learning is to be successful. However, even when these pre-requisites of interprofessional learning are agreed and acknowledged openly in the workplace, participants in the development of a learning culture need to recognize that there are structural controls which influence and constrain such developments which are external to participants and beyond their immediate control.     

多学科协作癌痛整合门诊的实施与管理

目的 探讨专科医院多学科协作癌痛整合门诊的运营管理模式，为解决“看病难”问题提供参考。方法 同济大学附属上海市肺科医院于2013年起构建癌痛整合门诊一站式多学科协作诊疗模式，由肺内科医师、麻醉师、临床药师、疼痛专科护士兼国家二级心理咨询师组成，通过绿色通道实现癌痛问题的快速检查、诊断及解决；并建立个人档案，登记“疼痛筛查表”，由疼痛专科护士每周电话随访实施疼痛跟踪管理和延续护理。通过调查2018-2021年就诊于癌痛整合门诊的308例患者，了解其就医体验并评价癌痛门诊实施效果。结果 患者就医体验总体满意度为96.4%；认为一次性达到就医目的者占88.3%、认为诊治及时合理者占87.3%、认为居家康复护理指导及时者占78.6%;53.9%的患者认为门诊费用价格适中。结论 与目前分科精细化的诊疗模式相比，多学科癌痛整合门诊为患者提供了一站式的便捷快速诊疗服务，可有效解决看病难的问题，提升了患者的就医满意度，值得临床推广。