Managed Care (MC) is a multidisciplinary model for health care delivery that organizes and sequences the caregiving process. Its objectives include: 1) to reduce length of stay and resource consumption, and 2) to measure, maintain or improve patient outcomes related to care received. Our tertiary care facility is the first Canadian hospital to implement MC. Patient care is directed through the use of a Care Map. Each map is specific to a pathological state and its treatment, i.e. Total Knee Replacement (TKR), and consists of a Patient Problem List, with related patient-centred outcomes, and a Critical Path. The Critical Path outlines the temporal sequence of the provision of care. Most key events on a Care Map are determined anecdotally. The purpose of this project was to collect outcome information in patients assigned to the Total Knee Replacement Care Map in an attempt to validate the existing Care Map or make recommendations for revisions. Inter-rater and intra-rater reliability of knee range of motion-was calculated using the Intra Class Correlation Coefficient (ICC). ICC values ranged from .64-.97. Seventeen patients were assessed. All patients were measured on Day 6 and 8 of the Care Map. This process has resulted in validation of certain range estimates and recommendations for revision of others.
This paper outlines the process of incorporating the "Guidelines For the Client-Centred Practice of Occupational Therapy" into the practice of occupational therapy in an out-patient rehabilitation facility serving young people with physical disabilities. Specifically, the areas of practice addressed are screening and assessment. The process started in 1987 with an identification of the need to find a holistic framework that meets the complex needs of clients with chronic physical disabilities. The conceptual model of occupational performance, as outlined in the Guidelines, provided such a framework. The process of incorporating the Guidelines into the screening and assessment practices of occupational therapists at Erinoak Serving Young People With Physical Disabilities is described, with examples of documents developed by the department. Suggestions are given to integrate the conceptual model of occupational performance into the practice of occupational therapists working with children and adolescents with physical disabilities.
Technological advances have tremendously altered the nature of health care delivered to the critically ill. High-technology care should be balanced with a humanistic approach to meet the needs of the "whole person". Humanistic care can be fostered by cultivating open dialogue among patients, families, physicians, nurses, and other involved staff.
We investigated how a clinical pharmacist can contribute to quality assurance of the use of drugs for inpatients in a respiratory ward.
Up to twice a week over two periods (43 meetings, 31 in the first and 12 in the second period), a clinical pharmacist sat in on the morning meetings regarding patients. Various drug-related problems were identified and discussed.
The clinical pharmacist took part in discussions of 232 (70%) of a total of 332 patients. On average, 0.71 drug-related problems per patient resulting in a prescription change were identified. This included 239 drug-related problems: lack of use of drugs (25), unnecessary use (18) or wrong use (1); too low dose (16), too high dose (30); adverse effects (29); compliance (10) and miscellaneous problems (110). The average number of prescription changes suggested by the clinical pharmacist went down from 0.81 per patient in the first period to 0.57 in the second (p
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Comment In: Tidsskr Nor Laegeforen. 2006 Nov 30;126(23):314817160128
This study abstracted nursing problems documented in cancer patients' nursing care plans to analyze (1) which nursing problems were documented and (2) the degree of congruence between the abstracted problems and NANDA nursing diagnoses. 236 unique nursing problems were identified and could be mapped to 32 NANDA nursing diagnoses. However, only 4.3% had a precise match with NANDA, Thirty-eight percent were classified as similar and the rest were broader, narrower or no match. Thus NANDA only partially covered problems written by nurses in the care plans for this group of patients.
This study developed and tested a chart audit tool to assess the implementation of evidence-based recommendations for vascular access nursing assessment and device selection. Chart audits of 71 patients were conducted in a home healthcare agency and a community hospital prior to guideline implementation. Observations of initial infusion therapy and chart audit documentation of 31 patients were also compared. Results from observations indicated that nurses provided care consistent with the recommendations, but findings from chart audits indicated that assessment and decisionmaking were poorly documented. Studies that use only precomparison and postcomparison by chart audit may miss changes in nursing practice.
