Use of an integrated care pathway: a third round audit of the management of shoulder pain in neurological conditions
Diana Jackson, Lynne Turner-Stokes, Heather Williams, Rana Das-Gupta A1 Regional Rehabilitation Unit Northwick Park Hospital Harrow Middlesex A2 Academic Rehabilitation Kings College London London UK
Objectives: To complete a third round audit of management of shoulder pain using an integrated care pathway, to evaluate pro forma documentation and to determine outcome. Subjects and setting: Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the integrated care pathway. Methods: Retrospective review of pro forma documentation against pre-determined standards. Results: Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. Conclusion: Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining integrated care pathways in the context of rehabilitation are discussed.
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Journal of Rehabilitation Medicine S:T Johannesgatan 22A SE-753 12 Uppsala, Sweden