A clinical pathway for congestive heart failure
| Publication Type | | Caremap |
| Year of Publication | | 2001 |
| Authors | | Hoskins, L.M.; Clark, H.M.; Schroeder, M.A.; Walton-Moss, B.; Thiel, L. |
| Journal | | Home Healthcare Nurse |
| Volume | | 19 |
| Number | | 4 |
| Pagination | | 207-217 |
| Type of Work | | Journal Article |
| Topic | | Congestive Heart Failure |
| Abstract | | This article outlines a clinical pathway for elderly home care patients with congestive heart failure (CHF). The clinical pathway was developed by a group of nurses and was based on the guidelines for the management of heart failure cited by the Agency for Health Care Policy and Research (AHCPR). The clinical pathway outlines specific tasks to be delivered by a multidisciplinary team over nine home visits. Tasks include patient education, assessment and referrals. An outcome evaluation form was developed for use with the clinical pathway. This form allows documentation of whether six specific goals were met and provides space to document the reasons goals were not met. The outcome evaluation forms are used to evaluate the ongoing effectiveness of the pathway. Several materials were developed for use with the pathway including educational materials, a symptom log, telephone instructions and nursing clinical visit notes. The pathway was evaluated through comparing re-hospitalization rates of CHF patients cared for before (usual plan of care) and after pathway implementation. An in-depth description of the research design and results can be found in Part I of this article (Hoskins, Thiel, Walton-Moss, Clark, & Schroeder, (2001), “Clinical Pathway Versus a Usual Plan of Care for Patients With Congestive Heart Failure: What’s the Difference?”, Home Healthcare Nurse, 19(3):142-150). A profile of the 67 patients cared for using the pathway was outlined. The re-hospitalization rate for patients cared for using the pathway was 12.5%, compared to 22.9% in the usual care group. Only 1 of 12 patients receiving medications as proposed by the guidelines was re-hospitalized. Of the patients for whom data were available, 78% met one or more of the pathway goals. The most common reasons for goals not being met were cognitive status and re-hospitalization. Regression analysis of the five goals relevant to all patients using the pathway explained 27% (p=0.006) of the variance in re-hospitalization. Thus, the pathway goals appear to be important in preventing re-hospitalization. The number of nurse visits with the pathway (13.48) was higher than for usual care (12.18), in order to reach the pathway goals. Future possibilities for home care of CHF patients are described. |
| Cluzeau rating | | 14 |
| Evidence rating | | 1 |
| Combined score | | 31 |
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