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Level 2: Care Pathways

Site: OpenLearn Create
Course: Welsh Levels of Care E-Learning Program
Book: Level 2: Care Pathways
Printed by: Guest user
Date: Friday, 9 Dec 2022, 22:12


The patient has a clearly defined problem but there may be a small number of additional factors that affect how treatment is provided.

Lay Descriptors

  • The patient has a clearly defined problem but there may be a small number of additional factors that affect how treatment is provided
  • The care is fully planned out but there is a need for regular observation to look out for any variations or unplanned changes in the patient’s condition
  • The work to deliver care may be described on a detailed pathway designed to deliver a specific treatment, for a common problem
  • The work to deliver care will include several routine tasks planned together, some skilled interventions and ongoing clinical decision making, but remains within the normal routines of the nursing team.

Clinical Descriptors

  • Patient’s condition is predictable but with some variation
  • Patient’s conditions are managed via care pathways
  • Patient requires additional support on discharge eg: a package of care or referral to District Nursing
  • Acutely Ill patients requiring ongoing intervention or with the potential to deteriorate
  • Post-operative care with complications.

Nursing Theme 1 - Assessment and Observation

  • Intermittent arterial blood gas analysis
  • Increased level of observation and therapeutic interventions
  • NEWS score trigger point reached and requiring escalation
  • Patient stable but requires monitoring and regular interventions
  • Post operative care with complications
  • Care determined by established care pathway

Nursing Theme 2 - Respiration

  • Oxygen therapy greater than 35%
  • Regular chest physiotherapy, for example 2-6 hourly
  • Ongoing care of BIPAP or CPAP
  • Ongoing care of chest drain with complications
  • Ongoing care of established or stable tracheostomy

Nursing Theme 3 - Personal Care, Nutrition and Hydration

  • Enabling, assistance or prompting with varying degrees of support for some activities of daily living
  • Pressure area care 4 hourly, including skin bundle
  • Assistance with feeding or routine PEG (percutaneous endoscopic gastrostomy) / NGT (Nasogastric Tube)
  • Daily wound dressings taking up to 20 minutes to complete
  • Catheter care and monitoring fluid balance

Nursing Theme 4 - Cognition and Communication

  • Presence of cognitive impairment and reduced level of understanding that requires ongoing support, reassurance or intervention
  • Patient with compromised cognition and communication, maybe allocated to a specific bed to aid supervision
  • Patient exhibits periods of confusion or mild challenging behaviour

Nursing Theme 5 - Medication

  • Patient controlled analgesia requiring monitoring under supervision, for example when initially established or patients condition fluctuating
  • Syringe driver
  • Peritoneal dialysis
  • Assistance taking medication
  • Multiple intravenous anti-biotics
  • Sub cutaneous medication
  • Nerve block with possible complications
  • Administration of standard blood products
  • Established central line or Portacath