Application Of Clinical Pathway Chart For Primary Glaucoma Care

ObjectivesTo research and develop a suitable clinical pathway chart for primaryglaucoma care in our hospital’s ophthalmology.To measure the impact ofimplementing the clinical pathway chart on patients outcome，hospital length ofstay，hospital costs，satisfaction level on nursing，and so on..In addition,we wantto further regulate our care and make it procedures through the implementationof clinical pathway chart.Subjects and methods1. Developed nursing satisfaction questionnaire . Selected 60 cases of ophthalmic inpatient inAugust 2010 to September 2010 to assess the validity and reliability of the nursing satisfactionquestionnaire，a week later randomly selected 30 cases of the patients with repeatedmeasurements2. Developed glaucoma disease knowledge scale.Selected 30 cases of patients with glaucoma inAugust 2010 to September 2010 with scale validity and reliability evaluation, and a week laterto repeat the measurement.3. Established a clinical pathway group ,investigated previous hospitalizationin patients with glaucoma about baseline information , medication,treatment ,and so on .Through the implementation of the preliminaryexperiments to develop and modify clinical pathway chart in July 2010 toSeptember 2010 .4. The application of clinical pathway chart for primary glaucoma care. 40 patients hospitalized in October 2010 to May 2011 for the control group , using the traditionalcare and health education.43 patients admitted in June 2011 to December 2011 for the testgroup and accepted new nursing pattern that following clinical pathway chart.Compare the two groups on the outcome of hospital costs , hospital length ofstay , satisfaction level on nursing , knowledge level on the disease and thequality on life at last .5. All the data were analyzed with SPSS 13.0 software , the main methods weused were t-test , x2 test , Wilcoxon rank sum test , the Pearson correlation analysis ,Spearman correlation analysis , and so on .The P value less than 0.05 was considered to bestatistically significant.Results1. Scale of nursing satisfaction questionnaire contained 16 items , the overallcoefficient of Chronbach a = 0.950, the test-retest reliability was 0.719 ,the 16 items in the content validity were in the range of 0.674~0.852, P<0.01.2. Glaucoma disease knowledge scale included five factors and 20 items . Theoverall coefficient of Chronbach a was 0.858 , the Chronbach’s a of the fivefactors were 0.723,0.731,0.744,0.71 and 0.882. Scale overall test-retestreliability and split-half reliability were 0.920 and 0.857. The five factorscontent validity were between 0.618 ~ 0.871 , P <0.01.3. The patients’version of clinical pathway took time as the horizontal axis,that included eight time periods , such as the day of admission , admitted tohospital the next day, the day before surgery, the day of surgery(preoperative )，the day of surgery (postoperative )，the first postoperativeday，the second postoperative day , the third postoperative day，Postoperative fourth day prior to discharge and discharge day . Thelongitudinal axis included medication, inspection, care and disposal,emotional control, diet , activity , sleeping and personal hygiene . The pathtable supplemented with easy-to-understand maps and simple text description.4. The nurse version of clinical pathway took the first day of hospitalization ,hospital day, the day before surgery, the day of surgery , postoperative firstday , second day after surgery , the third postoperative day until hospitaldischarge, discharge day as the horizontal axis , while took nursing ,healthcare , the implementation status , analysis of causes ,nurse signatureformulation for the vertical axis . Nursing and medical cooperation in the sethave the boxes, Each executed an a“√”indicates while non- implementationof the project was playing“x”said.5. Compared with controlled group ,test group has shorter hospital cost andlength of stay days ,has higher satisfaction level on nursing and knowledgelevel on glaucoma, the difference are statistically significan〔tP＜0.05〕.Withregard to the quality of life , there are have positive correlation between thetotal score of Quality of life, symptoms and visual function, physicalfunction, social activities and psychological. Compared patients quality oflife between the two groups, total score of quality of life ,symptoms andvisual function , psychological score are higher in test group, the differencesare statistically significant ( P <0.05 ). While the score differences inphysical function, social activities, ware not statistically significant (P>0.05).ConclusionHomemade nursing satisfaction questionnaire and glaucoma diseaseknowledge scale had good reliability and validity, also had feasibility andclinical value.Application of clinical pathway chart for primary glaucoma care can shorthospital costs and hospital length of stay, can improve satisfaction level onnursing, knowledge level on the disease and the quality on life, worth while recommendation.