Management of Patient Pathways within CHARM (Adults Only)



Canberra Health ServicesOperational Procedure Management of Patient Pathways within CHARM (Adults Only)Contents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc13565546 \h 1Purpose PAGEREF _Toc13565547 \h 2Alerts PAGEREF _Toc13565548 \h 2Scope PAGEREF _Toc13565549 \h 2Section 1 – Background PAGEREF _Toc13565550 \h 2Section 2 – How to Complete or Discontinue a Patient Pathway PAGEREF _Toc13565551 \h 3Discontinuing a pathway: PAGEREF _Toc13565552 \h 3Completing a Pathway: PAGEREF _Toc13565553 \h 4Section 3 – Delete a Patient Pathway PAGEREF _Toc13565554 \h 4Section 4 – Adding a New Treatment Pathway PAGEREF _Toc13565555 \h 5Section 5 – Deceased Patient Pathway PAGEREF _Toc13565556 \h 6Implementation PAGEREF _Toc13565557 \h 6Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc13565558 \h 6Definition and Terms PAGEREF _Toc13565559 \h 7Search Terms PAGEREF _Toc13565560 \h 7Attachments PAGEREF _Toc13565561 \h 7Attachment 1 – How to Discontinue a Pathway PAGEREF _Toc13565562 \h 9Attachment 2 – How to Complete a Pathway PAGEREF _Toc13565563 \h 10PurposeTo outline the steps involved in the management of patient treatment pathways within the Cancer Information Management System known as CHARM. This procedure sets out the specific pathway to follow when a patient’s treatment is completed, discontinued or the patient is deceased. Alerts A pathway can only be deleted by two approved Oncology Pharmacists.In the event that a pathway with associated history is deleted, resulting in a loss of clinical data from a clinical record, it must be reported as a significant incident by the person who identified the incident as per the Incident Management Policy and Procedure found on the Policy Register.ScopeThis procedure relates to all patient pathways within the Cancer Information Management System CHARM and applies to:Medical OfficersAll staff managing scheduling and booking within CHARMOncology PharmacyCHARM System AdministratorPlease note this document does not include information relating to creating new and maintaining CHARM Treatment Pathways. Refer to CHARM Protocol Management Clinical Procedure on the Policy Register for more information. Please note Treatment Pathways in this document does not refer to an individual patient pathway but to the pathway library that is available within CHARM to apply to a patient.Section 1 – BackgroundCHARM uses the concept of Treatment Pathways to manage patient care. Treatment pathways map the journey for an individual patient from start to finish and support the healthcare provider to ensure consistently high quality care. Treatment Pathways can: generate all treatment medication charts for medication ordersschedule all patient treatment appointmentsprovide nursing staff with comprehensive drug administration instructions provide pharmacy staff with compounding and dispensing information When it comes to managing patient pathways in CHARM, there are two main screens that provide end-users with pathway information. The first screen is the Daily Diary screen, and this is generally the default log-in screen for most end-users. The Daily Diary provides end-users with an overview of all the patients planned to attend for treatment, on a given day, in that end-user’s authorised locations.The other main screen is the Treatment Plan screen in the Pathway module. This screen provides end-users with detailed information about a patient’s current, previous or planned treatment and can be accessed directly from the Daily Diary. The Treatment Plan screen has been designed to enable end-users to view or access all the information likely to be required to ensure the safe delivery of treatment. It is from this screen that end-users are able to manage a patient’s pathway.Back to Table of ContentsSection 2 – How to Complete or Discontinue a Patient PathwayWhen a Medical Officer decides that no more treatment is to be given on the current pathway, the pathway can be discontinued or marked as completeBoth discontinuing and completing a pathway will remove all future treatment days, pharmacy orders and patient appointmentsThe electronic record in CHARM remains intact in the pathway historyEnsure correct patient has been selected prior to discontinuing or completing a pathwayDiscontinuing a pathway:When no more treatment is to be given on the current pathway, the pathway can be discontinued Discontinuing can also be used when no treatment is to commence but the pathway history needs to be retainedDiscontinuing treatment removes the future treatment days, including the selected day. Please note the pathway does not minimise on the screen, pathway days, as well as the treatment header will still be visibleA pathway can be discontinued by either the Medical officer, Clinical Nurse Consultant, Clinical Pharmacist or System Administrator at the direction of a medical officer. How to discontinue a pathway:Right click the day the pathway is to be discontinued This day will also be deletedSelect discontinue treatmentDocument the reason for discontinuing treatment then select OKPathway display will only show the past completed cycles and days. The future days and cycles, including the one selected are now deletedPlease see Attachment 1 for details on How to Discontinue a pleting a Pathway:When a Medical Officer decides that no more treatment is to be given on the current pathway and they want the pathway to minimise for clarity, the pathway can be marked as completeCompleting a pathway completes the day selected and removes all future treatment days. The pathway will minimise on the screen, so only the pathway header is visible. It can be expanded by clicking on the headerHow to mark pathway as complete:Right click on the day or cycle to be completedThe selected day (if day selected) or cycle (if cycle selected) will be marked as complete and treatment will be discontinued for all future daysSelect Pathway CompleteEnter the reason for completing the pathway then select OK The pathway display will now be minimised with only the pathway header (which can be expanded by clicking on the header to display the completed cycles and days)Please see Attachment 2 for details on How to Complete a Pathway. Back to Table of ContentsSection 3 – Delete a Patient PathwayA pathway can only be deleted by two approved Oncology Pharmacists who can be contacted via oncologypharmacy@.au A pathway is only deleted if: No treatment has been administered under the pathway and:The patient is placed on the incorrect pathway OR The treatment pathway needs to be changed due to a change in diagnosis or circumstances OR The patient will not be attending the Canberra Region Cancer Centre (CRCC) for treatment There is no pathway history that needs to be kept on the patient record. The request to delete a pathway must be provided in writing or email from a Medical Officer. The request must include the patient name, date of birth, Medical Record Number and reason for deletion requestCHARM has the ability to run a logical audit trail of activity against that patient. The pathway history includes a user log of users who have made changes, edits, inclusions or deletions to the patient record and the audit trail of activity is available via a report in CHARM, even after the pathway has been deleted. If required, Citadel Health (vendor), via the system administrator, can perform a SQLlevel audit which can provide more detail.Before deleting the patient pathway, the approved oncology pharmacists will print a hard copy of the following documents and send them to the ACT Health Clinical Records Service via internal mail:Medication chart, crossed out in penCover sheet indicating it is a deleted pathway from CHARM and is required to be stored appropriately in the Clinical Records Unit (the coversheet is located on the Q Drive under CHARM -> Documents). A copy of the notification in writing or email from the medical officer including the patient’s name, date of birth, medical record number and reason for deletion request.This hard copy will be stored with other electronic documents appropriately removed. The Clinical Records Unit will scan the deleted patient pathway into the patient’s scanned Canberra Health Service record. Two Oncology Pharmacists must be involved in the deletion process and: Both pharmacists will check that the correct patient has been identified using the three patient identifiers: Patient’s name, Date of birth and Medical Record Number, as per the Patient Identification and Procedure Matching Policy and Procedure.Both must verify that the pathway to be deleted meets the above criteria The first pharmacist will deactivate the pathwayThe second pharmacist will delete the pathway and will document in “reason for changing record” at the request of [doctor’s name] and the [reason] either incorrect pathway, incorrect patient, pathway change necessary due to change in diagnosis or circumstances, or patient to have treatment elsewhereIn the event that a pathway with associated history is deleted, resulting in a loss of clinical data from a clinical record, it must be reported as a significant incident by the person who identified the incident as per the ACT Health Incident Reporting Policy and Procedure available from the Policy Register.Back to Table of ContentsSection 4 – Adding a New Treatment PathwayThis process involves deleting pathways from the TEST patient once the new pathway is finalised, and is the only acceptable pathway deletion that does not require a written request from a medical officer.The process of adding a new pathway to CHARM involves:Placing the “TEST” patient on the new pathway, Ordering and printing out the pathway,Having the pathway signed off by a consultant, nurse, trials staff (trials only) and an additional oncology pharmacist (who did not create the pathway). That pathway is then deleted from the TEST patient, once it has been signed off by the relevant staff. To delete a pathway on the TEST patient:The pathway is marked as deactivated by the CHARM PharmacistAn email is sent to the System Administrator requesting deletion of the pathway from the TEST patientThe pathway is deleted by the System AdministratorBack to Table of ContentsSection 5 – Deceased Patient PathwayWhen a patient is updated as deceased within ACTPAS, the CHARM System Administrator will monitor these occurrences and discontinue pathways and cancel associated appointments from the first appointment following the date of death, noting that the patient is deceasedThe CHARM System Administrator will notify the relevant Medical Officer and treating staff via email when completed.Back to Table of ContentsImplementation This procedure will be implemented and communicated to affected staff via the CACHS (Cancer, Ambulatory and Community Health Support) Clinical Governance Committee and ward/staff meetings. Back to Table of Contents32T Related Policies, Procedures, Guidelines and LegislationPoliciesClinical Records ManagementCHHS Incident Management Patient Identification and Procedure Matching Clinical Records Management ProceduresCHHS Incident Management Records Disposal for ACT Health Clinical RecordsManagement of Protocols within CHARM Clinical Patient Identification and Procedure MatchingClinical Records ManagementGuidelines Health Records (Privacy and Access) Act 1997Human Rights Act 2004Work Health and Safety Act 2011Back to Table of ContentsDefinition and Terms Completed Pathway: is a treatment pathway where the patient has completed all the treatment on the pathway, or is to receive no further treatment on the pathway. Completed pathways are minimised and will only appear in the patient’s treatment plan screen as a pathway header. The pathway can be expanded by clicking on the header. Discontinued pathway: is a treatment pathway where the patient is to receive no further treatment on the pathway. Discontinued pathways still display as open.Deleted Pathway: a pathway is only deleted from the patients file if there has been no treatment given to the patient from the pathway and the patient was placed on the incorrect pathway OR the treatment pathway needs to be changed due to a change in the patient’s diagnosis or circumstances OR the patient will not be attending the Canberra Region Cancer Centre for treatment. The deletion of the pathway must be approved by two approved oncology pharmacists. Treatment Pathway: CHARM uses the concept of Treatment Pathways to manage patient care. Treatment pathways map the journey for an individual patient from start to finish and support the healthcare provider to ensure consistently high quality care. 32TSearch Terms Pathway, Cancer, CHARM, treatment, completed, discontinued, deleted32T32TBack to Table of Contents3232T32TTAttachmentsAttachment 1 – How to Discontinue a PathwayAttachment 2 – How to Complete a PathwayDisclaimer: This document has been developed by Canberra Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Canberra Health Services assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 26 July 2019Complete ReviewCathie O’Neill, ED CASCHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameAttachment 1 – How to Discontinue a PathwayNavigate to the treatment plan screen.Right click on the cycle you want to discontinue from. The cycle you have clicked on, and all future treatment will be removed. In the example below, C7 and future treatment after that will be removed.Select ‘Discontinue Treatment’:Document a reason for discontinuing treatment:The cycle you selected and all future cycles past that point have been removed. In this example, C7 and future treatment after that has been removed.Attachment 2 – How to Complete a PathwayRight click on the cycle and day you want to complete the pathway from, and chose ‘Pathway Complete’.If the chosen cycle is not already marked as complete, it will mark the chosen cycle as completed.Note: You can’t complete a cycle from a future date. The date must be either in the past, or today.Ensure the Last Treatment Day is correct. You can use the drop down button to select a different treatment day.The selected day will be marked as complete and treatment will be discontinued for all future days. Enter a reason for completing the pathway. Then press OK.The pathway will now be minimised, with none of the treatment days automatically displaying.To see the treatment dates, click on the pathway name and the details will appear: ................
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