Use and development of clinical pathways by registered nurses in an acute paediatric setting

Roberts, Pamela D.; Boldy, Duncan; Robertson, Jeanette

doi:10.1016/s1322-7696(08)60505-3

Cited by 1 publication

(2 citation statements)

References 21 publications

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“…Clinical care pathways seek to optimise clinical interventions in specific patient cohorts in an effort to provide quality care consistent with best practice standards 7 . They aim to improve resource utilisation and productivity while decreasing treatment variance and complications 8 . In different settings, they have been shown to improve patient outcomes, 9 decrease patient length of stay 10 and improve staff satisfaction 11 .…”

Section: Introductionmentioning

confidence: 99%

“…7 They aim to improve resource utilisation and productivity while decreasing treatment variance and complications. 8 In different settings, they have been shown to improve patient outcomes, 9 decrease patient length of stay 10 and improve staff satisfaction. 11 We developed a nursing care pathway to standardise the care of patients presenting to the ED with opioid poisoning which focusses on recognising opioid‐related respiratory depression and provides clinical triggers for the administration of naloxone.…”

Section: Introductionmentioning

confidence: 99%

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Dedicated nursing care pathway improved management of opioid‐poisoned patients in the emergency department: A before–after observational study

Isoardi

Learmont

Horan

2022

Emerg Medicine Australasia

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Objective Opioid overdose is increasing and accounts for two‐thirds of poisoning deaths. Opioid induced respiratory depression is life‐threatening and can be under‐recognised even in the hospital setting. We aimed to evaluate the effect of a care pathway on the management of opioid‐poisoned patients. Methods This is a before–after observational study following the introduction of a nursing care pathway for opioid‐poisoned patients presenting to ED. Medical records were retrospectively reviewed pre (6‐month period 1 year prior) and post (9‐month period following) the introduction of the pathway. The primary outcome was the proportion of documented episodes of respiratory depression (respiratory rate <10 or oxygen saturation <93% on room air) receiving naloxone. Secondary outcomes were time to naloxone, number of documented observations (first 4 h) and length of stay. Results There were 111 patients included in the study, 61 pre‐intervention and 50 post‐intervention (35 followed the pathway). A significantly larger proportion of patients received naloxone for respiratory depression when the pathway was used (134/200 [67%] vs 34/118 [29%], difference 38%, 95% CI 28–48%). The median time to naloxone was similar (pathway 28.5 min vs no pathway 35 min, difference −6.5 min, 95% CI −19 to 12 min). Documentation increased when the pathway was used (12.0 observations/presentation vs 7.5 observations/presentation, difference 4.5 observations/patient, 95% CI 2.1–7.0 observations/patient). Length of stay was similar (pathway 16.7 h vs no pathway 15.3 h, difference 1.4 h, 95% CI −2.4 to 5.9 h). Conclusions Following the introduction of a dedicated opioid poisoning nursing care pathway, naloxone delivery and observation documentation increased. A care pathway may improve ED management of opioid poisoning.

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Section: Introductionmentioning

confidence: 99%