Clinical/Patient Care Guidelines Category

CLINICAL GUIDELINE FOR MANAGEMENT OF ACUTE GASTROINTESTINAL HEMORRHAGE (BLEED)

Comments are from: Margaret Freundl MSN RN CS Director Disease Management St John Health System in Warren Michigan St John Health System is an 8 hospital health care system which developed an inpatient clinical guideline for acute GIB this spring The key recommendations clinical algorithm standing orders and pathway along with patient education material is included below We had great debate working on this project which I had thought would be relatively simple! Here are some issues that surfaced: 1 Whether or not to include both upper and lower GIB We concluded to do both since so many cases begin in ED and often it is not clear where the bleed is at that point We acknowledged some differences in LOS with upper vs lower mostly due to the LGI prep time 2 Gastroenterologists are not the only endoscopists at several of our hospitalsthere are surgeons who also do the EGDs etc and they get very offensive if not included up front On the back side they often dont do the interventional procedures so if there is a positive finding the cases may get delayed We are going to track that as part of our outcomes measurement 3 Know the population being admitted for GIB at your site At one of our hospitals a few years back when we first worked on this the impression was we were going to see a lot of ETOH-type cases After we audited we discovered that MANY of our cases were elderly using NSAIDS hence the pt ed material This has been reinforced in a recent study this year re: ulcer management ?Kaiser studythey found more cases were getting screenedtreated for Hpylori but there was no change in patient education practices 4 Our target is getting timely GI workup done 1 day for upper 2 days for lower because of prep and to encourage discharge on day of procedure for those with negative findingsfor those with interventional procedures they must be kept in hospital for another 48-72h per the literature because of risk of re-bleed What we found on baseline audits was that most of the cases not discharged were being treated like high risk cases but had negative findingsthis will entail more than a clinical pathway to fix We proposed that the endoscopist contact the attending from GI Lab to notify them of negative findings and sign off on the casewe are also going to be monitoring this as I think it will be a tough change If the endoscopist doesnt do this then I think the problem is going to fall in the lap of the case manager Adobe pdf format Contributed By: Margaret Freundl MSN RN CS You may Download CLINICAL GUIDELINE FOR MANAGEMENT OF ACUTE GASTROINTESTINAL HEMORRHAGE (BLEED) or share your own Nursing Policies or Nursing Management Procedures

Patient Questionaire Pain Management

Pain Management Questionnaire For Patients: What was their expectation regarding pain control while in the hospital and how well was their pain managed? Adobe pdf format You may Download Patient Questionaire Pain Management or share your own Nursing Policies or Nursing Management Procedures

Patient Transfer Form

Patient Transfer Form Adobe pdf format Contributed by:Sherie Waldron RN Carson City Hospital You may Download Patient Transfer Form or share your own Nursing Policies or Nursing Management Procedures

Interdisciplinary Treatment Planning/Problem Identification Form

Interdisciplinary Treatment PlanningProblem Identification Form Adobe pdf format You may Download Interdisciplinary Treatment Planning/Problem Identification Form or share your own Nursing Policies or Nursing Management Procedures