they're pathways of care for patients with certain admission diagnoses, such as stroke and CHF.
for example, if your patient gets admitted with a stroke, they must have a specific set of interventions met by day 1, 2, 3, etc... and tests performed and resulted by a certain time... and specific discharge measures that must be reviewed with the patient by the designated core measures nurse prior to their discharge.
so by day 1 (i have some of these memorized), the patient admitted with a stroke MUST have:
NIHSS q 2 h x 24 h
GCS q 2 h x 12 h
vital signs q 2 h x 12 h
ASA 81mg unless plavix is ordered or stroke is hemorrhagic
NSS @ 50ml/hr unless otherwise specified
MRI of the brain
MRA of the carotids
psychiatric consult
PT/OT/ST consult
SCD's or TED hose
Lovenox mg/kg QD unless contraindicated
CT of the head x 2
etc, etc, etc..... the trick is though, to get the admitting doctor to check off the proper orders!
then, each day there are new goals and interventions recommended that then nurse must sign off.
if you miss one, the core measures nurse will huff and puff and blow your house down.
last write up i got was because the nurse in the ER timed the NIH off on the paperwork from when the pt was admitted so my times were off for when they finished and i was the one who got in trouble for not having an NIH done at a certain time.
then, when they get discharged, there is a whole other process that takes an hour or two to complete.
it really is the best, evidenced based practice for care of the pt with specific diagnoses--but it's a pain for the nurse and administration really likes to dangle it over your head if you miss something when half the time it's the physician who hasn't ordered it.
