Use of an integrated care pathway: a third round audit of the management of shoulder pain in neurological conditions

OBJECTIVES: To complete a third round audit of management of shoulder pain using an integrated care pathway, to evaluate pro forma documentation and to determine outcome. SUBJECTS AND SETTING: Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the integrated care pathway. METHODS: Retrospective review of pro forma documentation against pre-determined standards. RESULTS: Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. CONCLUSION: Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining integrated care pathways in the context of rehabilitation are discussed.