Multidisciplinary evidence-based clinical management tools:
Nurse-coordinated initiatives transform health care
by Carolyn Dempsey, RN, MSN, ACNP, CDE, Jeannette Goguen, MD, MEd,
FRCPC, Alan Berger, MD, FRCSC and Ramona Cook, RN, BScN
ABSTRACT
Multidisciplinary evidence-based clinical management tools most often are
nurse-coordinated initiatives that transform health care. One such tool is a clinical pathway which makes explicit the usual patient problems and activities that must occur to facilitate achievement of expected patient outcomes in a defined time (Durham Region Path Work Group).
An Accreditation Review in 1999 targeting Ophthalmology and the Diabetes Comprehensive Care Program’s decision to decrease its cost per weighted case by 5% or greater for one of its highest case mix groupings, retinal procedures, precipitated the project. Moreover, to be in line with the Ontario Hospital Association’s (OHA’s) Hospital Report Card and the Achieved Improvement Measurement (AIM) Accreditation Framework, other reasons to embark on this corporate work were improving length of stay, addressing patient satisfaction and follow-up concerns. In addition, facilitating migration to the electronic patient care record represented another reason.
Evidence-based clinical management tools can be automated and serve as an effective and innovative informatic solution. The tools that were developed included: preprinted physician orders, retinal surgery pathways with and without diabetes, pictogram outlining processes and decisions, preprinted prescriptions, nausea, pain and activity guideline scales, and a questionnaire to evaluate patient satisfaction. These tools will be demonstrated.
It is hoped that efforts to standardize the pre- and post-op retinal surgical day care experience for persons living with diabetes will result in improvements in clinical care delivery, safety, and outcomes. These anticipated improvements and challenges with the tools’ future implementation will be discussed.
ABOUT THE AUTHORS
Carolyn Dempsey, RN, MSN, ACNP, CDE
Carolyn Dempsey is an Advanced Practice Nurse who works in the multidisciplinary Progressive Renal Disease Clinic at St. Michael’s Hospital in Toronto, Ontario, Canada caring for persons living with end-stage renal disease and diabetes. She has 20 years of varied nursing experience which includes: critical care, teaching, women’s health, nursing informatics and diabetes. She has worked in academic teaching centers in both Toronto and London.
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