CRITICAL PATHWAY FOR NURSING ADMINISTRATION.

Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!

1. SEMINAR On CRITICAL PATHWAY Mr Kulthe Vikrant R 06/03/2019 1

2. INTRODUCTION Successful case management relies on critical pathway to guide care. Critical pathway refers to the expected outcomes and care strategies developed by collaborative practice team. Critical pathways and health care reforms are two separate entities. Critical pathways are also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequences and timing of actions necessary to achieve these goals with optimal efficiency. 06/03/2019 2 Mr kulthe Vikrant

3. DEFINITION “Critical paths are guides that outline the critical or key events expected to happen each day of patient’s hospitalization.” --Cohen & Cesta,2001. “A critical pathway are management plans that display goals for patients and provide the corresponding ideal sequences and timing of staff action to achieve those goals with optimal efficiency.”   “A critical pathway is an interdisciplinary plan of care that outlines the optimal sequencing and timing of interventions for patients with a particular condition, procedure and symptom’s.” -- Ignatavicious & hausman , 1995.   “A critical pathway is the sequence of events in a process that takes the greatest length of time.” 06/03/2019 3 Mr kulthe Vikrant

4. SYNONYMOUS Integrated Care, Pathways Multidisciplinary pathways of care, Maps Collaborative Care, Pathways Clinical pathway, Critical pathway, Care track Care pathway Anticipated recovery path Managed care plans. 06/03/2019 4 Mr kulthe Vikrant

5. HISTORY The concept od critical pathways is borrowed from the theories of Continuous Quality Improvement (CQI). Critical pathways are first developed for the use in industry as a tool to identify and manage the rate limiting steps in production processes. In health care, critical pathways were first developed and applied in 1980s to improve hospital efficiency. Most of the first critical pathway in the hospital are develop by nurses for nursing care alone. Later on these have been developed by other disciplines covering all the aspects. 06/03/2019 5 Mr kulthe Vikrant

6. FEATURES Predetermined course of progress, Variance analysis, Fiscal planning, Directing, Orientation, Identifies outcome. 06/03/2019 6 Mr kulthe Vikrant

7. GOALS OF CRITICAL PATHWAYS Selecting a best practice when practice style varies unnecessarily. Defining the standards for the expected duration of hospital stay and for the use of tests and treatment. Examining the interrelations among the different steps in the care process to find ways to co-ordinate or decrease the time in the rate-limiting step. Giving all hospital staff a common game plan from which to view and understand their various role in the overall care process. Providing a framework for the collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization. Decreasing documentation burden. Improving patient satisfaction with care by educating patients and their families about the plan of care. 06/03/2019 7 Mr kulthe Vikrant

8. PURPOSES To monitor quality of patient care. To reduce variation in care, decreasing resource utilization and potentially improve healthcare quality when used as a method. To achieved specified patient’s outcomes by a pre-set time frame. To know the predetermine times frames for initiation of treatment, generalized treatment protocols, and discharged timelines for specific conditions. To shorten the hospital stay, more efficient use of resources, more communication between discipline, and use of less expensive method of treatment without compromising quality of care. 06/03/2019 8 Mr kulthe Vikrant

9. CHARACTERISTICS OF CRITICAL PATHWAYS It should be structured multidisciplinary care plan. It supports multidisciplinary care and evidence based clinical practice. The goal and key elements of care based on evidence and best practice should be defined and stated. It should guide the management for a well-defined group of patients for a well-defined period of time. It sequences the action of multidisciplinary team. It facilitates variance managements and allows documenting, monitoring and evaluating the variance. The essential step in care of patients with specific clinical problem is detailed. It should help communication with patient by providing a clearly summary of care. 06/03/2019 9 Mr kulthe Vikrant

10. BENEFITS OF CRITICAL PATHWAYS Improve patients care. Increase use of recommended medical acre. Decrease use of unnecessary tests. Decrease increase lengths of stay of patients. Reduce costs. Increase participation in clinical research protocols. 06/03/2019 10 Mr kulthe Vikrant

11. CONTAINS Specific medical diagnosis the expected length of stay Patient identification data Appropriate time frames (in days, hours, minutes or visits) for intervention Patient outcomes Interventions presented in modality groups (medications, nursing activity & so on) Nursing diagnosis. 06/03/2019 11 Mr kulthe Vikrant

12. COMPONENTS 06/03/2019 12 Mr kulthe Vikrant

13. CRITICAL PATHWAY PROFESSIONAL Physician Nurse manager Staff nurse Social worker Dietician Occupational therapist pharmacist 06/03/2019 13 Mr kulthe Vikrant

14. DEVELOP CRITICAL PATHWAY Retrospective chart review or concurrent chart review identify costs associated with the treatment Pathway development teams are organized to develop the tool. Patient care expectations and critical events are identified for incorporation into the path Small groups within the development to refine the elements of the path Newly developed tools can be tested on previously admitted patient Implementation with collaboration with other professionals 06/03/2019 14 Mr kulthe Vikrant

15. Methods of Critical Pathway Critical path method is based on mathematical calculations and it is used for scheduling project activities. This method was first introduced in 1950s as a joint venture between Remington Rand Corporation and DuPont Corporation. The initial critical path method was used for managing plant maintenance projects. Although the original method was developed for construction work, this method can be used for any project where there are interdependent activities. In the critical path method, the critical activities of a program or a project are identified. These are the activities that have a direct impact on the completion date of the project. 06/03/2019 15 Mr kulthe Vikrant

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17. Key Steps in Critical Path Method 06/03/2019 17 Mr kulthe Vikrant

18. Step 1: Activity specification You can use the Work Breakdown Structure WBS to identify the activities involved in the project. This is the main input for the critical path method. In activity specification, only the higher-level activities are selected for critical path method. When detailed activities are used, the critical path method may become too complex to manage and maintain. 06/03/2019 18 Mr kulthe Vikrant

19. Step 2: Activity sequence establishment In this step, the correct activity sequence is established. For that, you need to ask three questions for each task of your list. Which tasks should take place before this task happens? Which tasks should be completed at the same time as this task? Which tasks should happen immediately after this task? 06/03/2019 19 Mr kulthe Vikrant

20. Step 3: Network diagram Once the activity sequence is correctly identified, the network diagram can be drawn Refertothesample diagram above . Although the early diagrams were drawn on paper, there are a number of computer softwares , such as Primavera, for this purpose nowadays. 06/03/2019 20 Mr kulthe Vikrant

21. Step 4: Estimates for each activity This could be a direct input from the WBS based estimation sheet. Most of the companies use 3-point estimation method or COCOMO based function points based estimation methods for tasks estimation. You can use such estimation information for this step of the process. 06/03/2019 21 Mr kulthe Vikrant

22. STEP 5: IDENTIFICATION OF THE CRITICAL PATH For this, you need to determine four parameters of each activity of the network. Earliest start time ES - The earliest time an activity can start once the previous dependent activities are over. Earliest finish time EF - ES + activity duration. Latest finish time LF - The latest time an activity can finish without delaying the project. Latest start time LS - LF = activity duration. The float time for an activity is the time between the earliest ES and the latest LS start time or between the earliest EF and latest LF finish times. During the float time, an activity can be delayed without delaying the project finish date.The critical path is the longest path of the network diagram. The activities in the critical path have an effect on the deadline of the project. If an activity of this path is delayed, the project will be delayed. In case if the project management needs to accelerate the project, the times for critical path activities should be reduced. 06/03/2019 22 Mr kulthe Vikrant

23. STEP 6: CRITICAL PATH DIAGRAM TO SHOW PROJECT PROGRESSES Critical path diagram is a live artefact. Therefore, this diagram should be updated with actual values once the task is completed. This gives more realistic figure for the deadline and the project management can know whether they are on track regarding the deliverables. 06/03/2019 23 Mr kulthe Vikrant

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25. ADVANTAGES OF CRITICAL PATH METHOD Following are advantages of critical path methods: Offers a visual representation of the project activities. Presents the time to complete the tasks and the overall project. Tracking of critical activities. 06/03/2019 25 Mr kulthe Vikrant

26. CRITICAL PATHWAY ANALYSIS • Analyse the effectiveness • Variance analysis  Positive variance  Negative variance • Consult with other professionals • Make change accordingly 06/03/2019 26 Mr kulthe Vikrant

27. ROLE AS NURSE MANAGER : Assess quality improvement Effective planning Evaluate quality Interdepartmental Communication Educating the staff of other departments about the pathway role and responsibilities. Provides patient care Follow critical pathway Inform any deviance Collaborate with other professionals 06/03/2019 27 Mr kulthe Vikrant

28. ADVANTAGES • Provides standardizing medical care for patients with similar diagnosis • Use resources appropriate to the care needed • Reduce cost • Reduce length of stay • Improve the quality of care • Change practice pattern to increase efficiency 06/03/2019 28 Mr kulthe Vikrant

29. 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 • Need to ensure variance and outcomes are properly recorded, audited and acted upon. 06/03/2019 29 Mr kulthe Vikrant

30. CONCLUSION Critical path identification is required for any project-planning phase. This gives the project management the correct completion date of the overall project and the flexibility to float activities. A critical path diagram should be constantly updated with actual information when the project progresses in order to refine the activity length/project duration predictions. 06/03/2019 30 Mr kulthe Vikrant

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