Effect of a Clinical Pathway on Outcome of Children with Hemolytic Anemia

Abstract

Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than the bone marrow can produce them. Hemolytic anemia is a high risk form of anemia in which red blood cells is destroyed. So, clinical pathway could be very beneficial for the patient, physician, nurse, and all health professionals. As patient knows the care to expect and the goals of care, teachings tool for the patient and family or significant others. Benefits for health professionals, for a physicians it provided a way to standardize and organize care for routine situations. For all health care professionals, care was coordinated and specified for improving communication among health team members. Aim of the study: The study was aimed to design a clinical pathway for children with hemolytic anemia, implement the designed clinical pathway and evaluate the effectiveness of the clinical pathway technique on outcome of children with hemolytic anemia. Research hypothesis: Children with hemolytic anemia to whom clinical pathway is applied have fewer complications, less hospital stay and less readmission than those who will receive routine hospital care. I-Technical Design The technical design for this study includes research design, setting, and subject of the study and tools of data collection. A quasi -experimental research design was utilized in conducting the study. This study was carried out in both in-patient and out- patient hematology clinics belonging to Ain Shams Children Hospital and Benha Children Hospital. The two places were chosen for their acceptance to apply the clinical pathway. A purposive sample consisted of seventy (70) school age children had the eligible criteria for clinical pathway implementation as recorded in their file. Thirty five (35) served as studied underwent the clinical pathway by the researcher and the hospital clinical pathway team. Thirty five (35) served as control who received the routine care according to hospital policy. The two groups were matched for hemolytic anemia type. Tools of data collection: The following five tools were used for data collection they were designed by the researcher and after one was developed, based on hospital policy: 1 -Pre-designed questionnaire sheet (Appendix I) This tool was designed by the researcher in simple Arabic language, after reviewing related literature. It included the following two parts: Part I: Demographic data regarding child such as age, sex and level of education. Part II: Disease characteristics, such as: Frequencies of hospitalization and duration between visits per weeks. 2- Medical data sheet (Appendix II) 3- Patient assessment data sheet (Appendix III) 4- Complication monitor sheet (Appendix IV) 5- A clinical pathway design (Appendix V) Tools had been validated by (5) expertises in the field of Pediatric Hematology - Preparatory phase: A review was done of the available local and international, pervious and current related literature to get acquainted with the nature of the study and the various aspects of the problem, to design the study tools, and also to finalize them by using books, articles, and magazines and internet. - Ethical considerations: Approvals to carry out the study were obtained from the Ethical Committee Ain Shams University and hospitals administration. An oral consent was also obtained from either the all hospital staff member to participate in the study. Confidentiality of data and results were considered. - Pilot study: A pilot study was conducted on 10% of the sample who fulfilled the eligible criteria to evaluate the effectiveness of the applicability of the study tools, to determine the time consumed, to apply the tool. According to the results obtained of the pilot study, the necessary modifications were done. The sample of pilot study was not included in the sample. - Field work: The actual field work was carried out from September 2011 up to February 2012 for data collection. The researcher were available in the study settings two day per week, on Sunday and Wednesday at the mooring shift from 8.00 a.m to 2.00 p.m in Benha Children Hospital and on Tuesday in Ain Shams Children Hospital, the researcher introduces herself to all hospital staff members in the two hospitals settings. The researcher explained the aim of the study and asked for the hospital team for cooperation. Children with hemolytic anemia were divided into two equal groups (study and control group). The researcher performs the research in the assessment, implementing and evaluated phases.