Critical Pathways of Care

CRITICAL
PATHWAYS
OF CARE
Presented by:
Nivedita Kochar
2040982204
INTRODUCTION
Critical pathway refers to the expected outcomes and

care strategies developed by collaborative practice
team
They provide detailed guidance for each stage in the

management of a patient (treatment, intervention ,
etc.) with a specific condition over a given time
period and include progress and out come details.
DEFINITION
• A care pathway is anticipated care placed in an

appropriate time frame, written and agreed by a multi
disciplinary team-Welsh National Leadership and
Innovation Agency for Health care(2005)
• A critical pathway is a type of abbreviated plan of care

that provides outcome-based guidelines for goal
achievement within a designated length of stay.
CHARACTERISTICS OF
CRITACAL PATHWAYS OF
CARE
– Pathway is a projection of the client’s entire length of
treatment .
– Includes detailing of interdisciplinary intervention or

processes and client outcomes each day from
admission to discharge.
– Pathway may be extended to include transfer to home

care or another treatment facility.
CRITICAL PATHWAYS OF
CARE TEAM INCLUDES
– Nurse case manager
– Clinical nurse specialist
– Social worker
– Psychiatrist
– Psychologist
– Dietician
– Occupational therapist
– Chaplain and others
HOW CRITICAL PATHWAYS
OF CARE IS CARRIED OUT
– The team decides what categories of care are to be

performed, by what date and whom.
– Each member of the team is then expected to carry out

his or her functions according to the time line
designated on the CPC.
– The nurse as case manager is ultimately responsible for

ensuring that each day of assignments is carried out.
Cont…
– If variations occur at any time in any of the categories

of care, rationale must be documented in the progress
notes .
– The nurse contacts psychiatrists to inform him or her

of the admission.
– The psychiatrist performs additional assessments to

determine if other consultations are required.
Cont…
– Within 24 hours, the interdisciplinary team meets to

decide on other categories of care.
– Completion of the CPC, and make individual care

assignments from the CPC .
– Each member of the team stays in contact with the nurse

case manger regarding individual assignments.
– Ideally team meetings are held daily or every other day.

Cont…
– CPCs can be standardized because they are intended

to be used with uncomplicated cases.
– A CPC can be viewed as protocol for various clients

with problems for which a designated outcome can be
predicted.
EXAMPLE
• For example, with the sample CPC presented, the nurse

case manager may admit the client into the detoxification
center.
• The nurse contacts the psychiatrist to inform him or her

of the admission.
• The psychiatrist performs additional assessments to

determine if other consults are required.
Cont…
• The psychiatrist also writes the orders for the initial

diagnostic work-up and medication regimen. Within 24
hours, the interdisciplinary team meets to decide on
other categories of care, to complete the CPC, and to
make individual care assignments from the CPC
• This particular sample CPC relies heavily on nursing

care of the client through the critical withdrawal period.
Cont…
• However, other problems for the same client, such as

imbalanced nutrition, impaired physical mobility, or
spiritual distress, may involve other members of the team
to a greater degree.
• Each member of the team stays in contact with the nurse

case manager regarding individual assignments.
• Ideally, team meetings are held daily or every other day

to review progress and modify the plan as required
Nursing Diagnoses Time Goals and /or Time Goals and /or Time Goals and /or
and Categories of actions actions actions
care dimension dimension dimensio
n
Risk for injury related Day 7 Client shows no

to CNS agitation evidence of injury
obtained during
ETOH
withdrawal
Referrals Day 1 Psychiatrist Day 7 Discharge with

Assess need for: follow-up
appointments as
Neurologist required.
Cardiologist
Internist
Diagnostic Studies Day 1 Blood alcohol Day 4 Repeat of selected

level diagnostic studies
Drug screen as necessary
(urine and
blood)
Chemistry
Profile
Urinalysis
Chest x-ray
ECG
Additional Day 1 VS (4th hr) Day 2–3 VS (8th hr) Day 4–7 VS (B.D. if
assessments Day 1–5 I&O Day 6 I&O remain stable)
Ongoing Restraints
Ongoing Assess withdrawal Day 4 Marked Day 7 Discharge;
symptoms: decrease in absence of
tremors, objective objective
nausea/ vomiting, withdrawal withdrawal
tachycardia, sweating, symptoms symptoms
high blood pressure,
seizures,
insomnia,
hallucinations
Medications Day 1 *Librium 200 mg in Day 3 Librium 120 mg Day 5 Librium 40 mg

divided doses in divided doses
Day 2 Librium 160 mg in Day 6 DC Librium

divided doses
Librium 80 mg Day 7 Discharge; no
Day 1–6 Librium(as needed) Day 4 in divided doses withdrawal
symptoms
Day 1–7 Maalox ( After Food &
hs)
*NOTE: Some
physicians may elect to
use Serax or Tegretol in
the detoxification
process
Cont…
Client education Day 5 Discuss goals Day 7 Discharge with

of AA and information
need for regarding AA
outpatient attendance or
therapy outpatient
treatment
ADVANTAGES
– Help improve clinical outcomes
– Help improve and even reduce patient documentation
– Support training
– Optimize the management of resources
 Can help ensure quality of care

– Help empower patients
– Help manage clinical risk
– Sense of satisfaction
DISADVANTAGES
 Differences between unique patients

– One more paper work
– Overburdened with administrative cost
– Problems of introduction of new technology
– Require commitment from staff and establishment of an

adequate organizational structure
– May take time to be accepted in the workplace
CONCLUSION
A Critical Pathway is thus a road map for a patient as

well as for the treatment team, which supports an
Effective In-patient Care.

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CRITICAL

Critical pathway refers to the expected outcomes and

They provide detailed guidance for each stage in the

• A care pathway is anticipated care placed in an

• A critical pathway is a type of abbreviated plan of care

– Includes detailing of interdisciplinary intervention or

– Pathway may be extended to include transfer to home

– The team decides what categories of care are to be

– Each member of the team is then expected to carry out

– The nurse as case manager is ultimately responsible for

– If variations occur at any time in any of the categories

– The nurse contacts psychiatrists to inform him or her

– The psychiatrist performs additional assessments to

– Within 24 hours, the interdisciplinary team meets to

– Completion of the CPC, and make individual care

– Each member of the team stays in contact with the nurse

– Ideally team meetings are held daily or every other day.

– CPCs can be standardized because they are intended

– A CPC can be viewed as protocol for various clients

• For example, with the sample CPC presented, the nurse

• The nurse contacts the psychiatrist to inform him or her

• The psychiatrist performs additional assessments to

• The psychiatrist also writes the orders for the initial

• This particular sample CPC relies heavily on nursing

• However, other problems for the same client, such as

• Each member of the team stays in contact with the nurse

• Ideally, team meetings are held daily or every other day

Risk for injury related Day 7 Client shows no

Referrals Day 1 Psychiatrist Day 7 Discharge with

Diagnostic Studies Day 1 Blood alcohol Day 4 Repeat of selected

Medications Day 1 *Librium 200 mg in Day 3 Librium 120 mg Day 5 Librium 40 mg

Day 2 Librium 160 mg in Day 6 DC Librium

Client education Day 5 Discuss goals Day 7 Discharge with

– Help improve clinical outcomes

– Help improve and even reduce patient documentation

– Optimize the management of resources

 Can help ensure quality of care

– Help manage clinical risk

 Differences between unique patients

– Overburdened with administrative cost

– Problems of introduction of new technology

– Require commitment from staff and establishment of an

A Critical Pathway is thus a road map for a patient as

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