Vía clínica de la colecistectomía laparoscópica asociada a un plan de cuidados de enfermería

Abstract

ObjectiveClinical pathways are standardized care plans for specific processes. They constitute a tool that coordinates all the professionals involved and consequently the joint work of doctors and nurses is fundamental. The objective of this study was to present the planning and evaluation of a clinical pathway for laparoscopic cholecystectomy and a standardized nursing care plan. MethodsPlanning of the clinical pathway was carried out through weekly meetings of the entire group for 3 months. The group was composed of surgeons, anesthetists, nurses from the various units involved, and quality coordinators for surgery and nursing. A series of patients that underwent laparoscopic cholecystectomy in the year before planning of the clinical pathway (n = 160) was evaluated and a list of weak points was identified using group techniques. A literature search for scientific evidence as well as for other published clinical pathways was performed. The main documents of the clinical pathway were then drawn up and discussed with the members of the surgery service and nursing units. The results were compared with the series of patients who underwent surgery in the year after the implementation of the clinical pathway (n = 140). ResultsThe protocols of care in the immediate postoperative period and antithrombotic prophylaxis, as well as the main documents of the clinical pathway are presented, including a standardized nursing care plan. The estimated length of hospital stay after surgery was 1 day. A series of 160 consecutive patients who underwent surgery during the year prior to the creation of the clinical pathway and who fulfilled the accepted inclusion criteria was evaluated, with a mean stay of 3.27 days. The mean stay of the patients included in the clinical pathway was 2.2 days (p < 0.001). The degree of compliance with length of hospital stay was 65.7%. The most frequent causes of breach were patient-related (vomiting, pain, etc.), followed by staff-related causes. ConclusionsLaparoscopic cholecystectomy is a suitable process in which to initiate systematization of clinical pathways. The incorporation of standardized nursing care plans adds value to the clinical pathway and helps to systematize nursing care. The results have significantly reduced the length of hospital stay without increasing morbidity. Patient satisfaction has been high.