Developing an integrated care pathway for total knee replacement patients in an acute orthopaedic setting : an action research project

Abstract

This study explored the need of enhancing clinical documentation through the integration of Multidisciplinary notes using an Integrated Care Pathway (ICP). An Action Research approach was used and different members of the Multi-disciplinary team, including nurses, doctors, occupational therapists, physiotherapists and social workers participated. There were twenty eight participants, each involved in all stages of the process leading to the introduction of an ICP for Total Knee Replacement patients (TKR). The Action Research process included an audit of thirty (30) traditional patient histories prior to the introduction of the ICP using the Dudley NHS Trust, Multidisciplinary Audit Forms of Documentation. A Nominal Group Technique (NGT) session carried out before the introduction of the ICP identified the factors that hinder effective documentation and identified the need of introducing an ICP. The Clinical Pathways Education Package was administered to increase the knowledge of participants in relation to ICPs. The outcomes of this programme were measured using a Pre-Post test questionnaire which identified an enhanced level of knowledge related to ICP after the training programme. The ICP was then constructed based on standardized ICPs for TKR with adaptations according to feedback received from the participants. A second NGT carried out five months after the introduction of the ICP, identified that the majority of the participants were satisfied with the use of the ICP and several suggestions were recommended on how to improve the ICP. Another documentation audit on thirty ICPs was carried out after the introduction of the ICP and this revealed a statistically significant improvement in documentation when compared to the previous audit of the traditional patient histories. The areas where notable improvement was registered included easy access to notes, reduction in duplication, improvement in the legibility of the notes, enhanced discharge planning and patient involvement. The strengths and weaknesses of this study were discussed and recommendations for practice, education and further research were suggested.