Brodsky, Jeffrey, MD

DeFalcis, Lilianna

Feher, Cathyann, RN, MSN

Fritts, Kimberly, DPT

Joyce, Christine D, BSN, RN, CMSRN

McLoughlin, Thomas A

Neiman, Candace, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationDevelopment of a Clinical Pathway for theWhipple ProcedureLilianna DeFalcisSt. Joseph's UniversityCathyann Feher RN, MSNLehigh Valley Health Network, Cathyann.Feher@lvhn.orgJeffrey Brodsky MDLehigh Valley Health Network, Jeffrey_T.Brodsky@lvhn.orgCandace Neiman RNLehigh Valley Health Network, candace.neiman@lvhn.orgChristine D Joyce BSN, RN, CMSRNLehigh Valley Health Network, Christine_D.Joyce@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtDeFalcis, L., Feher, C., Jeffrey Brodsky, J., Neiman, C., Joyce, C., Fritts, K., Mcloughlin, T. (2016, July, 29) Development of a ClinicalPathway for the Whipple Procedure. Poster presented t LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network,Allentown, PA.AuthorsLilianna DeFalcis; Cathyann Feher RN, MSN; Jeffrey Brodsky MD; Candace Neiman RN; Christine D JoyceBSN, RN, CMSRN; Kimberly Fritts DPT; and Thomas A. McLoughlinThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/research-scholars-posters/460© 2016 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaDevelopment of a Clinical Pathway for the Whipple Procedure• By standardizing health care services in the most efficient, safe, and cost-effective way, clinical pathways can be successful in driving healthcare towards the goals of the Triple Aim.• Patients who undergo a pancreaticoduodenectomy are at a high risk for post-operative complications due to the radical nature of the procedure and the circumstances under which they receive this procedure.• A patient typically undergoes a Whipple procedure if they are diagnosed with a cancer that resides within the head of the pancreas, ampulla of Vater, the lower end of the common bile duct, or the duodenum. • During a standard Whipple procedure the head of the pancreas, the gallbladder, a portion of the common bile duct, the duodenum, and the pylorus of the stomach are all removed.• The purpose of this investigation was to see how the development of a clinical pathway for the Whipple procedure could be beneficial to patients and  LVHN.Ellison E, Zollinger R.M., Jr. Ellison, E. Christopher, and Robert M. Zollinger, Jr.(2016). PANCREATICODUODENECTOMY (WHIPPLE PROCEDURE). In Ellison E, Zollinger RM, Jr.. Ellison E, Zollinger R.M., Jr. Eds. E. Christopher Ellison, and Robert M. Zollinger, Jr. (Eds), Zollinger's Atlas of Surgical Operations, 10e. Retrieved July 19, 2016 from http://accesssurgery.mhmedical.com/content.aspx?bookid=1755&Sectionid=119130026Walters, D. M., McGarey, P., LaPar, D. J., Strong, A., Good, E., Adams, R. B., & Bauer, T. W. (2013). A 6-day clinical pathway after a pancreaticoduodenectomy is feasible, safe and efficient. HPB : The Official Journal of the International Hepato Pancreato Biliary Association, 15(9), 668–673. http://doi.org/10.1111/hpb.12016• No patient outcome statistics were produced.• This was due to the lack of a sufficient amount of time to collect these measures of data after the pathway had been developed.PathwaySurgical referencePatient Outcome Statistics1. Day of nasogastric  tube removal2. Day of discharge3. 30-day mortality rate4. 30-day readmission rate5. Post-operative morbidity Anesthesia referenceNutrition reference Physical Therapy referenceMed-surge  reference• Other studies with similar pathways showed great success in adhering to pathway standards while maintaining patient outcomes.• University of Virginia (113 patient study): – Post-Op Day 3 NG tube removal = 93.0%– Post-Op Day 6 discharge = 35.4%– 30-day mortality rate = 0%– 30-day readmission rate = 15.9%– Post-operative morbidity = 48.7%• An all-encompassing clinical pathway for the Whipple procedure was produced.• Upon further investigation and data collection, the institution of this clinical pathway may prove to be beneficial to its affected patients and Lehigh Valley Health Network itself, achieving the goals set by the Triple Aim.  • Success of other investigations involving clinical pathways demonstrates the significance in continuing the development of clinical pathways for other procedures.• Clinical pathways naturally lend themselves to constant reevaluation and further improvement.Lilianna DeFalcis, Cathyann Feher R.N., Dr. Jeffrey Brodsky M.D., Candance Neiman R.N., Christine Joyce R.N., Kimberly Fritts D.P.T., Dr. Thomas Mcloughlin M.D.BACKGROUND / INTRODUCTIONMETHODSOUTCOMES RESULTSDISCUSSION/CONCLUSIONSPre-Op Clinical Visit-Malnutrition screening, appropriate assignment of nutritional  supplements (Ensures)-Patient education on diet and nutrition; Dietary Manual, The Pancreatic Cancer Diet Education Booklet, Nutrition and Symptom Management Following Whipple Procedure-Cardiology clearance-Anesthesia consult-Basic Mobility ScreeningDay of Surgery-Epidural placed (T8-12 dermatomal distribution) -NG tube placed-Pre-incision antibiotics-Sequential compression devices and spongy pad placed-Standard pancreaticoduodenectomy -PACU recovery-Transfer to surgical floor or ICU-NPO, ice chips ad lib-Administer protonix (PPI)-Antibiotics x 24 hrs for patients with pre-operative stents-Bolus with colloid or crystallite; Ringers lactate 150 ml/hour-Within 24 hours, basic mobility screening Post-Op Day 1-Move patient to sit in chair-NPO, ice chips ad lib-Switch IV to dextrose fluid-SQ Heparin -Schedule post-op cardiac consult if neededPost-Op Day 2-Basic Mobility screening (PT consult or mobilized immediately)-NPO, ice chips ad libPost-Op Day 3-Remove epidural-IV morphine after removal of epidural-6 hours later, remove Foley catheter -Remove NG tube-Ice chips ad lib and sips of waterPost-Op Day 4-Clear liquids, nutritional supplement (Ensure Enlive)-Percocet administration (1 at a time)Post-Op Day 5-Clear liquids, nutritional supplement (Ensure Enlive)-Percocet administration (1 at a time)Post-Op Day 6-Discharge on PPI -Schedule surgical follow up in 1 week-Resume regular diet-Drain management (on per case basis)

Development of a Clinical Pathway for the Whipple Procedure

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Development of a Clinical Pathway for the Whipple Procedure

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