Documentation and Clinical (Critical) Pathways

Documentation tools that integrate the standards of care of multiple disciplines have been developed to meet the needs of managed care. Managed care is a systematic approach to care that provides a framework for the coordination of medical and nursing interventions.

These documentation tools are called clinical (critical) pathways. Clinical (critical) pathways allow staff from all disciplines to develop standardized, integrated care plans for a projected length of stay for patients of a specific case type. The case types that have clinical (critical) pathways are usually those that occur in high volume and are predictable. A clinical (critical) pathway for a total hip repair may recommend on a day-to-day basis the level of activity, pain control therapy, advancement in diet, and educational topics necessary for a patient’s recovery.

The exact contents and format of these clinical (critical) pathways vary among institutions. The contents include a care plan, interventions specific for each day of hospitalization, and a documentation tool. The clinical (critical) pathway replaces other nursing forms such as the nursing care plan.

The LPN/LVN and other team members use the pathways both to monitor a patient’s progress and as a documentation tool. CBE is frequently the method used with pathways. Staff members document only when anticipated interventions are not provided as projected.
Many agencies use military time, a 24-hour system that uses digit numbers to indicate morning, afternoon, and evening times regardless of which method of documentation is used (Figure 3-11).