Application Of Clinical Pathway Research Articles

Evaluation of Antibiotic Use in Pediatric Patients Hospitalized with Acute Diarrhea as a Result of Clinical Pathway Implementation in Hospital

This study aims to determine the effectiveness of clinical pathway implementation in pediatric patients with acute diarrhea with mild-moderate dehydration on clinical outcomes, length of stay, use of quality and quantity of antibiotics at North Jakarta Teaching Hospital. This study is a quantitative study using a retrospective cohort case study method. The samples in this study were pediatric patients with a diagnosis of acute diarrhea with mild-moderate dehydration who were hospitalized at the North Jakarta Teaching Hospital for the period January-December 2020 and JanuaryDecember 2021 before and after the implementation of the clinical pathway, totaling 274 patients. The data used is secondary data in the form of medical records of pediatric patients with acute diarrhea with mild-moderate dehydration who were hospitalized at the North Jakarta Teaching Hospital. The data that has been collected is then processed and analyzed using the chi-square test. The results showed Qualitative use of antibiotics with the Gyssens method after the application of clinical pathway is better than before the application of clinical pathway. Quantitative antibiotic administration with the DDD method in pediatric patients with acute diarrhea with dehydration before and after the application of clinical pathway the highest was ceftriaxone antibiotics after the application of clinical pathway with DDD/100 patient-days value increased compared to before clinical pathway.

A Study on the Application of Clinical Pathway Teaching Method in Teaching Gastroenterology Nursing Interns

Objective: To investigate the application effect of the clinical pathway teaching method in the teaching of gastroenterology nursing interns. Methods: 36 interns from the Department of Gastroenterology of our hospital from July 2022 to April 2023 were selected as the study subjects and divided into the control group and the study group (n = 18 each) by randomized grouping method. The control group was given conventional teaching methods and the study group adopted clinical pathway teaching methods. The effect of internship in the two groups was compared. Results: Under the influence of the clinical pathway teaching method, the theoretical knowledge achievement and practical skills of interns in the study group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion: Compared with the conventional teaching mode, the use of the clinical pathway teaching method in the teaching of nursing interns in gastroenterology can not only realize the optimization and innovation of traditional teaching means, but also mobilize the interns’ enthusiasm, improve their learning interest, and promote the comprehensive improvement of theoretical knowledge and practical skills.

The Impact of Clinical Pathway Application on The Quality and Quantity of Antibiotic Use in Inpatient Patients With Tyfoid Fever at Fmc Bogor Hospital

<p>Typhoid fever is a global health problem, especially in developing countries, one of which is Indonesia. The incidence of resistance to the use of antibiotics in the treatment of typhoid fever can occur due to inappropriate use of antibiotics. This study aims to determine the impact of the application of clinical pathways on the quality and quantity of antibiotic use in typhoid therapy at FMC Bogor Hospital. This research is a descriptive analytic study conducted retrospectively which was analyzed using the Gyssens and ATC/DDD methods. The research data was taken from patient medical records for the period January-December 2018 and January-December 2020 which met the inclusion criteria. The results showed that from 115 medical records of typhoid fever patients, ceftriaxone was used as the most widely used antibiotic for typhoid therapy. The quality of antibiotic use as much as 40% was declared rational before the use of clinical pathways and as much as 57.3% after the use of clinical pathways (category 0), while the other 60% were irrational (categories I-VI) and after CP as much as 42.7% were included in category 0, the rest fall into the irrational category (Categories I-VI) which includes the use of antibiotics that are not appropriate for the administration interval, the use of antibiotics that are too long, the use of antibiotics that are too short, there are other antibiotics that are more effective, and there are other antibiotics that are less toxic /safer. The quantity of antibiotic use was stated to exceed WHO standards, namely the use of ceftriaxone by 81 DDD/100 patient days before the clinical pathway and 92.4 DDD/100 patient days after the clinical pathway. Based on the results of statistical tests, it was obtained 1) There were differences in the quality of antibiotic use between before and after the implementation of the clinical pathway in inpatients with typhoid fever at FMC Bogor Hospital; 2) There are differences in the quantity of antibiotic use between before and after the implementation of the clinical pathway in inpatients with typhoid fever at FMC Bogor Hospital. The results of this study are expected to be a consideration for the hospital as material for evaluation and improvement in order to increase the rationality of using antibiotics.</p>

PENDAMPINGAN PEMBUATAN CLINICAL PATHWAY DALAM PENINGKATAN MUTU PELAYANAN KESEHATAN DI RSUD DR. SOEKARDJO KOTA TASIKMALAYA

<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Clinical pathways are used for quality and cost control in health services in hospitals. A clinical pathway is the main requirement for quality control and cost control, especially in cases that have the potential to spend large resources. Research shows that the application of clinical pathways can reduce the length of stay and hospital costs. The existence of clinical pathways in hospitals is sought to refer to the National Guidelines for Medical Services (PNPK). The existence of clinical pathways at dr. Soekardjo does not all meet these criteria. Community service activities are carried out referring to the lecturer roadmap that has been made. The purpose of the activity is to the availability of clinical pathway forms that can be used in hospitals as needed and the preparation of clinical pathways according to PNPK criteria. The method of activity is in the form of FGD and Assistance in making clinical pathways. The activity was carried out well and agreed on a form that refers to the standards of the Hospital Accreditation Committee. Mentoring activities involve all health workers as users, both doctors, nurses, pharmacists, nutritionists, and PMIK so that the results are expected to be by the needs of the hospital. The results of the activity are in the form of an agreement on the form used and the arrangement of 10 clinical pathways according to the needs of the hospital. </span></p></div></div></div></div></div></div>

Effectiveness of Clinical Pathway Application on Improving Nurses' Knowledge and Practice in Managing Eclamptic Women

Effectiveness of Clinical Pathway Application on Improving Nurses' Knowledge and Practice in Managing Eclamptic Women

Application of Clinical Pathway in Radiotherapy Nursing Care of Patients with Nasopharyngeal Carcinoma

Application of Clinical Pathway in Radiotherapy Nursing Care of Patients with Nasopharyngeal Carcinoma

Application of Clinical Pathway Teaching Model In nursing Teaching of Respiratory Department

Respiratory medicine is one of the important specialized courses in clinical medicine. Its main purpose is to improve students' mastery of TCM theoretical knowledge and medical practice skills, so as to lay a good foundation for doctors in the future. In the traditional teaching mode, the problems such as individual differences and physiological factors of patients are often ignored, resulting in low classroom efficiency and unable to effectively connect medical personnel with patients. In view of the above situation, this paper studies the application of clinical pathway teaching model in nursing teaching of respiratory department. Firstly, this paper introduces the basic concepts, characteristics and functions of nursing teaching in respiratory medicine, then studies the application of clinical pathway teaching mode, and uses the method of questionnaire survey to study its practical application. Finally, the survey results showed that both the control group and the experimental group had excellent scores in theory and operation examination, and the two groups were improved to a higher degree, including theoretical knowledge, skill proficiency and clinical practice experience, but the results of the experimental group were higher than those of the control group. The satisfaction of teachers and patients with nursing students in the experimental group was higher than that in the control group.

Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery.

PurposeEnhanced Recovery After Surgery (ERAS) reduces postoperative complications and shortens hospital stays. We aimed to describe the implementation and improvement of ERAS protocols in our institution through a multidisciplinary team approach.MethodsA multidisciplinary team comprised of colorectal surgeons, anesthesiologists, nurses, pharmacists, nutritionists, and a performance improvement team was launched to develop the ERAS protocol. The ERAS protocol was followed in patients who underwent colonic and rectal surgery between January and November 2017. The ERAS protocol comprised 22 elements in the preoperative, intraoperative, and postoperative phases. After the initial application, ERAS compliance was monitored and audited every 4–6 months and improvements made as necessary.ResultsThe length of hospital stay significantly decreased after the application of the ERAS protocols for colon cancer in 2017 and 2018. And there was no significant difference in the duration of hospital stay after applying the rectal cancer ERAS protocol. Moreover, after starting the colon ERAS, there was a significant decrease in the complication rate. Since December 2017, there was a continuous increase in the colorectal ERAS clinical pathway application rate, which remained high (>90%). The patient compliance rate significantly increased between 2017 and 2018, but slightly decreased again in 2019.ConclusionThe application and continual improvement of an ERAS protocol are crucial. Improving compliance may result in better clinical outcomes. Additionally, the basic guidelines of ERAS must be applied and developed according to each hospital’s situation based on the team approach.

EFFECT OF CLINICAL PATHWAY OF POSTOPERATIVE NURSING CAREON IMPROVING POSTOPERATIVE OUTCOMES FOR WOMEN UNDERGOING HYSTERECTOMY

Background: Utilization of a multidisciplinary clinical pathway during care of women undergoing hysterectomy is considered to be more effective during women' management than routine hospital care.Aim: This study was conducted to investigate the effect of clinical pathway of postoperative nursing care on improving postoperative outcomesfor women undergoing hysterectomy. Design: A quasi experimental design (study and control group). Settings: The gynecology and obstetrics departments at two hospitals affiliated to University Hospital and Shebin El-Kom teaching hospital, Menoufia Governorate. Subjects: 100 women who are undergoing hysterectomywere selected. Tools: three instruments were used for data collection;a structured interviewing, numeric pain intensity scaleandpatient satisfaction record.Results: The current study shows that women underwent hysterectomy in the study group were significantly more likely to experience less mean pain score, lesser need for analgesiaand Significant differences in the length of stay were observed compared to those in the control group.Significant differences in the early oral intake, postoperative bowel mobility and need to antiemetic drugswere observed between the study and the control groups. Concerning women’s satisfaction related to the care provided,the score given was mostly satisfied and neutral. Conclusion: application of clinical pathway improving postoperative pain successfully, short length of stay postoperative outcomes related to early ambulation, early oral intake, and bowel mobility, hours to remove catheters and drains and patient satisfaction. Recommendation: Sit is recommended to generalize application of clinical pathways in other clinical areas to improve patient outcomes and reduce postoperative complications.

Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient.
 
 Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

Clinical Pathway Implementation with the Quality of Service and Satisfaction Patient of DM Gangrene in the General Surgery Poly at RSUD Ra Basoeni Gedeg Mojokerto

DM management requires collaborative and integrated team involvement in working with patients to set goals and implement treatment for patients. The need for treatment to individuals with DM helps provide psychological support, psychomotor skills, promote self-management, and set goals for better and optimal outcomes. Therefore, in the care of DM patients, it is necessary to apply services that can help patients in undergoing treatment better, one of which is by applying clinical pathways. The design of this research is crossectional analytics. The variables of this study are the application of clinical pathways as independent variables as well as quality of service and patient satisfaction as dependent variables. The population of all dm gangrene patients in the General Surgery Department of RSUD RA Basoeni Gedeg Mojokerto was 137 patients in February - March 2020. Samples were taken with simple random sampling techniques as many as 105 respondents. The data was collected by questionnaire and processed using editing, coding, scoring and tabulating and tested with chi square test. The results of this study showed that partially and simultaneously independent variables influence the occurrence of dependent variables due to the value of < of 0.05. The application of clinical pathways can help patients know all forms of services that will be received from the beginning of the action until the patient returns home. Mechanism of application of clinical pathway will be a basis of communication that is built with good quality between hospital staff and patients so that patients will receive the maximum service and patients are satisfied with the service

Effect of Clinical Pathway Application on Stroke Patients’ Outcomes

A clinical pathway is a process for managing patient by states the goal and main elements of care basedon Evidence Based guidelines, best intervention to enhance quality of care; outcomes and reduce length ofpatient’s hospitalization.Aim of the Study: To evaluate the effect of clinical pathway applications on stroke patients’ outcomes.Design: Quasi-experimental design was used to test the research hypothesis.Subjects: A purposive sample of 78 patients, they divided randomly and alternatively into two equal groups38 patients in each as follows: (1)The study group (I): received their care by application of clinical pathway(2) The control group (II): received routine hospital care.Setting: The current study was conducted at Emergency, Intensive Care Unit and Medical ward at MenoufiaUniversity Hospital; Menoufia Governorate; Egypt. Tools for data collection: four tools were utilized bythe researchers to achieve the aim of the study and to collect the necessary data. Tool (I): Semi structuredquestionnaire (demographic and medical data Sheet); Tool (II): bio- physiological measurements (indicatorsof improved patients’ outcomes); Tool (III): National Institutes of Health Stroke Scale, or NIH Stroke Scale(NIHSS); and Tool (IV): Multidisciplinary planned sheet team.Results: There was improvement in values of vital signs, oxygen saturation, central venous pressure, arterialblood gases interpretation, central venous pressure, blood glucose level during the last measurements afterapplying clinical pathway in study group compared to control group, also there was a highly statisticalsignificant difference between two groups regarding to post stroke complications. Additionally there washighly statistical significance difference between them stroke severity. Shorten length of stay in hospital instudy group compared to control due to improvement in study group outcomes.Conclusion: clinical pathway has a positive effect on reducing length of patient’s hospitalization stay, andearly improvement in patients’ outcomes with apparent positive effect on quality of patient care.Recommendation: The researchers recommended that; application of clinical pathway on large samplesand variable measurements are in need to generalization of the results. Clinical pathway should be carriedout routinely for managing stroke patients in intensive care unit.

Analysis of Practical Application of Clinical Pathway Teaching Method in Clinical Teaching of Endocrinology Department

Analysis of Practical Application of Clinical Pathway Teaching Method in Clinical Teaching of Endocrinology Department

Effect of Intrapartum Clinical Pathway Application on Maternity Nurses' Performance and Women Satisfaction

A clinical pathway is a multidisciplinary management tool based on evidence-based practice in which the different tasks interventions by the professionals involved in the patient care are defined, optimized. It can be utilized in education and facilitate access to care and providing improved outcomes for patients and increasing women and staff satisfaction. Aim: The study aimed to evaluate the effect of clinical pathway application on maternity nurses' performance of intrapartum care and women's satisfaction. Design: A quasi-experimental design was used. Settings: This study was applied in gynecology and obstetrics departments affiliated with Tanta University Hospital. Sample: A purposive sample of 60 maternity nurses and 120 intrapartum women were recruited in this study. Six tools were used for Data Collection: a structured interviewing questionnaire for the nurses, a structured interviewing questionnaire for the intrapartum women and clinical pathway checklist for maternity nurses, an observational checklist for women, a Numeric Pain Intensity Scale, and maternal satisfaction with hospital based intrapartum care scale. Results: Statistically significant differences were found between pre and post-implementation of the clinical pathway reflected by higher knowledge and performance score for nurses' improvement in the maternity nurses' knowledge regarding all items of the postpartum clinical pathway after the intervention than before the intervention. The majority of nurses adequately done all items of newborn care; assessment of newborn, suctioning, Apgar score, cord care, eye care, measurements, body temperature, vitamin K administration , and identification. Also, only (8%) of the intrapartum women suffered from severe pain in a clinical pathway group compared to 38% routine care group. In addition, intrapartum women's satisfaction in the study group has improved. Conclusion: using of clinical pathway had a positive effect in improving the maternity nurses' performance and women satisfaction of intrapartum care post clinical pathway application than pre-intervention. Recommendations: Training programs should be implemented for maternity nurses about intrapartum care based on the clinical pathway to improve nurses' performance.

Effect of Clinical Pathway Application on Health Outcomes of Patients Undergoing Colorectal Surgery

Colorectal cancer is a disease with a major worldwide burden. Care for colorectal cancer patients undergoing surgery tends to be suitable for clinical pathway development because of high-cost of the procedure and the predictable course of events and complications that may occur during hospitalization. Objective: Determine the effect of clinical pathway application on health outcomes of patients undergoing colorectal surgery. Setting: The study was conducted in the Colon and Rectal Surgical Unit at Alexandria Main University Hospital. Subjects: A convenience sample of 50 adult patients with colon or rectal cancer or both undergoing colorectal surgery was included. They were equally and randomly recruited into two groups: a control group and a study 25 each. Tools: Three tools were used for data collection. I: Perioperative Colorectal Surgery Patient Assessment. II: Clinical Pathway Variance Observational Checklist, and III: Colorectal Surgical Patient's Satisfaction tool. Results: There were statistical significant differences between control and study group with whom the (clinical pathway was implemented) as they showed better post colorectal outcomes in relation to wound healing, pain control, achieving criteria for discharge. Conclusion: Patients undergoing colorectal surgery on whom the clinical pathway was applied exhibited improved postoperative outcomes than those on whom it was not. Recommendations: It is recommended that colorectal surgery clinical pathway be used rather than the traditional delivery of care.

Hysteroscopy in the Clinic: Application of Clinical Pathway

Background::A retrospective study that analysed data for three consecutive years from the Hysteroscopy Clinic at the Department of Obstetrics and Gynecology, Valme University Hospital.Objective::To analyse the data of lesions removed in the hysteroscopy clinic in comparison with those scheduled for the operating room to show that hysteroscopy could be a more effective procedure.Method::Patients undergoing operative hysteroscopy for various indications were included. The 5 mm Bettocchi hysteroscopes and the 5.8 mm Palex Mini-Resectoscope were used.Results::A total of 1233 patients were seen in the hysteroscopy clinic between 2015 and 2017. In 2015, 344 hysteroscopies were performed, of which 57 (16.5%) were performed in the operating room. In 2016, 445 hysteroscopies were performed and 46 (10.3%) were scheduled in the operating room. During 2017, a total of 444 hysteroscopies were performed, of which only 6 (1.3%) were performed in the operating room (P < 0.001). Five large fibroids and one case of complex polyp were removed in the operating room in 2017. The mini-resector was used in 202 cases (45.4%). Paracervical local anaesthesia was given to 383 (86.2%) patients.Conclusion::The data obtained in our study shows a significant reduction in the number of hysteroscopies scheduled for surgery in 2017 (1.3%) and, therefore, hysteroscopy has been shown to be a more effective procedure. This trend may be due to the introduction of the mini-resectoscope and the use of paracervical local anaesthesia.

Improving burn surgery education for medical students in China.

In China, although burn treatment develops rapidly, and ranks in the forefront of the world, there is a relative shortage of burn specialists, which limits the development of burn education. In traditional curriculum of surgery education, burn surgery education accounts for few proportions, which results in the indifference to the burn surgery among medical students. To date, few research reported the application of Clinical pathway- Problem based Learning (CP-PBL) in burn surgery education. The objective of the study is to explore the teaching effect of this novel teaching method in burn surgery education. A pilot study was performed. One hundred and six students were randomly divided into a Lecture based Learning (LBL) only group (control group) and a LBL combined Clinical pathway- Problem based Learning group (observation group). A set of test was designed as evaluation criteria based on questions of burn surgery in National Medical Licensing Examination (NMLE) from 2011 to 2018. The students with Clinical pathway- Problem based Learning had better academic performances in profession theory. Type A2 and Type A3/A4 scores in the observation group were higher than those in the control group (p < 0.05). The scores of the observation group were higher than those of control group in the domains of understanding and application (p < 0.05). They also have higher favorable impressions of learning experience. More active approaches yield more learning and are viewed more favorable, which provides a vital message for the evolution of curriculum in Chinese medical schools.

Clinical pathway application for pneumonia prevention in acute ischemic stroke patients

Clinical pathway application for pneumonia prevention in acute ischemic stroke patients

Assessment of the application of clinical pathways for cerebral infarction in patients aged 75 years and above

Objective To evaluate the safety and therapeutic efficacy of clinical pathways(CP)for cerebral infarction in patients aged 75 years and above. Methods A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179). The day-90 modified Rankin scale score(mRS), mortality, incidences of complications, length of hospital stay, total hospital costs and drug costs were compared between the two groups. Results The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2% or 142/184 vs.55.3% or 99/179, χ2=19.443, P=0.000). The incidences of pulmonary infection(23.9%, 44/184)and deep venous thrombosis(14.7%, 27/184)were lower in the CP group than in the control group(42.5%, 76/179 & 29.1%, 52/179; χ2=14.101, 11.014, P=0.000, 0.001). There was a significant difference in mortality between the two groups[4.9%(9/184)vs.11.2%(20/179), χ2=4.871, P=0.027]. There was no significant difference in the other incidences of complications between the groups(P>0.05). Hospital stay length(18.3±2.9) d, total cost(2.72±0.42)×104 yuan, and drug cost(0.87±0.29)×104 yuan in the clinical pathway group were lower than those in the control group[(22.8±4.4)d, (3.55±0.81)×104 yuan, (1.42±0.29)×104 yuan](t=11.546, 12.168 and 18.335, all P=0.000). Conclusions The adoption of clinical pathways can improve medical quality, shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction. Key words: Critical pathways; Brain infarction; Treatment outcome

Clinical pathway management for patients with acute exacerbation of chronic obstructive pulmonary disease undergoing antimicrobial medication

Objective To evaluate the application of clinical pathway for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) undergoing antibiotic administration. Methods One hundred and twenty six patients with AECOPD admitted from April 2017 to December 2018 were randomly divided into two groups: 63 patients in study group (63) received antibiotics treatment according to the clinical pathway and other 63 patients in control group received antibiotics according to clinical experience. The rates of sample submission and positive sputum pathogens, the rates of antibiotic use and its intensity, course of treatment, drug cost and combined medication, length of stay and costs of hospitalization were analyzed and compared between two groups. Results The sample submission rate and the positive rate of sputum pathogens in study group were significantly higher than those in control group [100.0% (63/63) vs. 90.5% (57/63), χ2=6.300; 44.4% (28/63) vs. 22.8% (13/57), χ2=6.229, P 0.05]. Types and rate of antibiotic usage in study group were lower than those in control group [9 vs. 12; 85.7% (54/63) vs. 96.8% (61/63), χ2=4.881, P 0.05). In study group, the combined antibiotics use rate was lower than that in control group [(41.3% (28/63) vs. (63.5% (40/63) , P=0.03]; the length [(7.63±3.95)d vs. (12.84±4.45) d, t=-6.939, P<0.01] and costs of antibiotics use [1 157 (745,2 002) Yuan vs. 2 063 (1 534, 2 811)Yuan, Z=-4.480, P<0.01], length of hospital stay [(11.43±3.53)d vs. (16.65±3.99)d, t=-7.785, P<0.01] and hospitalization expenses [(13 020±5 511) Yuan vs. (19 621±4 824) Yuan, t=-7.121, P<0.01] in study group were all significantly lower than those in control group. Acute exacerbation rate within 30 days in study group was not different from that in control group [9.5% (4/63) vs.6.3% (6/63), χ2=0.434, P=0.51]. Conclusion Application of clinical pathway management provides basis for rational use of antimicrobial drugs and for control of medical expenses for COPD patients with acute exacerbation. Key words: Clinical pathway; Pulmonary disease, chronic obstructive; Anti-bacterial agents; Evaluation studies