WORKING IN THE PERI-OPERATIVE ENVIRONMENT

Working in the Peri-Operative Environment



Working in the Peri-Operative Environment

Part A: Patient Journey from GP Visit to Admission for Surgery

For the purpose of this assignment, we have selected a fake patient named 'John' who is suffering from Hip fracture. In this section, his journey from GP visit to admission for surgery has been discussed. The care pathway has also been discussed.

Some care pathways have been designed to focus more on the process of care as opposed to the specific problems pertaining to a diagnosis. Cummings (2006 15-19) has evaluated the content of a 161 item care pathway for patients suffering from hip fracture by subjecting the components of the care pathway to a panel of experts. This team established a high content validity (CVI=0.94) for the care pathway although the study reported no data on how it was implemented in practice. There have been no reported studies testing the most appropriate way of developing a care pathway or if a health care pathway would improve the outcomes of care. (Eneroth and Thorngren 2005 297-303)

The study took place on a 16-bed, psychiatric mixed, sex adult psychiatric ward in a severely deprived Borough of London where John was admitted. There was a high turnover of patients on the study ward (120% bed occupancy) and most of the patients suffered from a serious mental illness such as hip fracture, severe forms of personality disorder and bipolar disorder. John was admitted onto the ward for an average of 5 weeks, although some patients remained in hospital beyond clinical need due to a shortage of supported accommodation. The ward was chosen because prior to the study taking place there was a high proportion of the staff in full-time permanent positions on the ward. The researcher attempted to engage with John and this involved frequent daily visits to the research site, informal discussions and communication through the Trust newsletter.

The average length of time spent on the care pathway was 21 days (5-43). John needed to be transferred to the psychiatric intensive care unit. The staffing problems identified above became critical resulting in nurses untrained in using the care pathway becoming a regular occurrence. It was deemed that John may be at risk of not having their care documented as well as required. It was therefore required to terminate the project at this stage of the implementation phase to protect patient care and safety. However, these needs to be balanced against the findings that other forms of record keeping may also be poor. Cummings (2006 20) explored the documentation procedures of nurses in 'long-term' care settings and found that nurses also failed to record information on interventions, evaluation of care outcomes and changes in health states. (Murphy and Lumbers 2000 7)

Although large sections of the care pathway were uncompleted, which led to unsatisfactory care delivery, John did note some pertinent advantages of the care pathway system. For example, there was a heightened awareness of delivering care within specific time ...