Evidence based proposal for change: the introduction of a clinical care pathway for the care of the patient with a fractured neck of femur

The emphasis of this proposal of change is for the Advanced Nurse Practitioner (ANP) to introduce a ward based clinical care pathway for fracture neck of femur patients. Currently there is no such pathway within the trust and standards are not being met. National guidelines (National Institute for Health and Clinical Excellence (NICE), 2014 ) state that patients should receive surgery on the day of admission or the day after, evidence shows locally this is not the case (National Hip Fracture Data Base (NHFD), 2016) increasing the risk of mortality and morbidity to these patients (Morrissey et al., 2017). Evidence given discusses how an effective fracture neck of femur pathway is being implemented in the Accident and Emergency department within the local trust with positive results and National Standards being met (NHFD, 2016) which ensures patients are admitted to the ward within a timely manner. However there is no such pathway at ward level and evidence has shown that patient care is being compromised once they arrive on the ward. The literature review undertaken shows the need for the change and highlights that clinical pathways were effective ensuring patients were optimised and investigations completed within a timely manner to ensure the time to theatre was not delayed. Benefits from introducing a clinical pathway are also highlighted within the literature review which include continuity of care, a reduced time to theatre, reduce mortality and morbidity rates, reduced length of stay (LOS), a reduction in complications and increased financial revenue to the NHS by meeting Best Practice Tariffs indicators for fracture neck of femur patients. Different models of change were critiqued and discussed, with Kotters (1996) stages of change being the most appropriate to guide the ANP and to collaborate with stakeholders throughout the process of change, whilst also allowing for structure through the process. The importance of leadership and leadership styles i.e. autocratic, democratic and transformational have also been discussed within the change chapter. A discussion has been given on how different styles can be adapted for different situations, with transformation style being an appropriate style for implementing change whilst also adhering to working at an advanced level of practice (Royal College of Nursing, 2012 RCN). The evaluation chapter shows the importance of evaluating the change process. Throughout the evaluation process the six step approach was applied (Centre for Disease Control (CDC), 2011), using this approach throughout the evaluation process allowed the ANP to work collaboratively with stakeholders. This process also highlights how the results from an evaluation can lead to change and from lessons learnt can continue to improve further services