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Mary's Story - Adaptable Clinical Protocols and Pathways

The following scenarios depict how the methods and technology derived from the ACPP can be used in real life situations.

Merging Multiple Clinical Pathways

Mary, a 63 year old woman, is admitted on the Emergency Unit with acute chest pain. She has a history of an old gastric ulcer for which she was admitted ten years ago.

A clinical path "acute chest pain" is started and presented to the attending physician. He approves the first steps in the path: nurses and doctors are doing the necessary investigations and urgent treatment as proposed in the path: an electrocardiogram shows there is myocardial ischemia and appropriate drug treatment is started.

As part of the investigations a urine analysis is being done. This reveals a urinary infection. Blood analysis also shows that she has mild diabetes. The care path is recalculated accordingly: regular blood analyses are scheduled and nurse tasks for getting the samples are generated. Temperature is measured every two hours.

(Note how the different pathways "chest pain" and "diabetes" now merge into one treatment plan in Mary's case)

Mary receives a default antibiotic, according to the in house antibiotic guide lines of the institution, and an antibiogram is started.

After one hour she gets an anaphylactic (allergic) shock. Antibiotic medication is stopped immediately and urgent administration of cortico-steroids can reverse the shock. The system now proposes another antibiotic treatment.

A nurse measures the temperature and enters into the system that Mary has fever. The system proposes to give an anti-fever medication with the remark that care should be taken because of the history of a gastric ulcer. This action is submitted to the physician for approval.

The next day the result of the antibiogram confirms the choice of the second antibiotic. Apparently the fever has dropped as well.

The chest pain has decreased. The electrocardiogram show the myocardial ischemia is getting better.

The next day blood analysis shows that, while still in a normal range, blood sugar levels are raising. An alert is generated and the treating physician is notified. He decides to not give medication yet, but wait until the next day, to decide.

Test results on the following day show that the ischemia is gone, the infection is under control and the sugar level is not rising anymore.

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