An Integrated Care Pathway for the Last Two Days of Life: A Pathway for Implementing a Pathway

Abstract

Aim of the Paper:

To offer colleagues a method of monitoring the process of implementing an integrated care pathway (ICP) on a local level or, across a wide area.

Background:

A training pack was developed to assist with the Wales-wide implementation of an ICP for the last two days of life. The training pack includes a workbook, which is structured around seven stages recognised as being essential to the effective implementation of the pathway. The workbook is formatted in the same way as the pathway and as such is complete with a variance sheet. The variance sheet is utilised to record instances when a desired goal is not achieved and the reason why. The workbook represents a ‘Pathway for Implementing a Pathway’, which can be used to monitor the progress of implementation and highlight inhibiting and facilitating factors.

Methods:

The Wales-wide implementation of the ICP for the last two days of life, utilised the workbook as a pro forma for assessing the progress of implementation. Analysis of the variance sheets from the workbooks permitted the identification of inhibiting and facilitating factors contributing to the successful implementation of the pathway on a local and national level.

Findings:

Inhibiting factors affecting the implementation of an ICP include: local politics, fear of failure and lack of motivation. Facilitating factors range from, ‘top-down approval’ or gaining management commitment for the pathway, to ‘bottom-up motivation’, which entails enthusing colleagues as to the benefits of implementing the care pathway.

Conclusions:

The ‘Pathway for Implementing a Pathway’ is a useful tool for implementing an ICP. Although primarily developed to accompany the implementation of an integrated care pathway for the last two days of life, it would be interesting to assess the transferability of the implementation pathway to other clinical areas.