Clinical Pathways

Good points to consider, thanks. Here's what I'm thinking, or at least along these lines. Cert pd is 60 days, assume frequency is 3xwk for 1 wk, 2xwk for 3-4 wks (depending on how it falls), then 1xwk for 4 wks. The pathway would look similar to what's in the hospital. Let's take a newly insulin dependent diabetic.

Goals:

(long-term) Pt demonstrates fasting blood glucose within range of 70-120 5/7 days per week and/or HgbA1C <7.0 within cert pd.

(short-term) Pt. demonstrates ability to draw up and self-administer insulin injection within 3 visits.

(long-term) Pt verbalizes understanding of diabetic diet teaching and/or glycemic index scale.

(long-term) Pt. verbalizes understanding of pathophysiology of diabetes including possible outcomes of non-compliance.

So then your pathway would be something along these lines:

visit 1--nurse demonstrates proper procedure to draw up and administer insulin as patient watches; assess pt's understanding of dx; provide daily log for blood sugar monitoring; provide handout: How to Self-Administer Insulin

visit 2--nurse provides visual and verbal cuing to assist patient with drawing up and self-administering insulin; brief overview of diabetic teaching including handout: Now You Need Insulin [I made that one up]; review daily blood sugar log

visit 3--nurse observes patient draw up and self-administer insulin providing cuing as needed; mark short-term goal met if applicable; begin diet teaching including handout: Create Your Plate; review daily blood sugar log.

visit 4--begin ed on the pathophys of diabetes, how it occurs, how it progresses; include handout: Insulin for Type 2 Diabetics; review daily blood sugar log

visit 5--continue with ed on pathophys, include handouts: Avoiding Diabetic Complications; review daily blood sugar log

visit 6--draw HgbA1C; teaching on labs used to monitor diabetes; include handout: Diabetes and Lab Tests; review daily blood sugar log

visit 7--review results of HgbA1C; review daily blood sugar log; review previous teaching sessions, correct any misunderstandings; no new teaching/handouts at this time

visit 8--Discuss diabetic foot care; include handout: Diabetic Foot Care; review daily blood sugar log; begin discussing resources for discharge

I could keep going for the full 12-14 visits, but I think the point is clear. Anyway, the idea is to have a schedule for teaching so that everything is covered, the goals are clear and measurable, and if a fill-in nurse comes, s/he knows exactly where the patient is.

Does that sound reasonable or am I dreaming?