****NOTE: This supplement refers to charts that could not be shown. We are sorry for any inconvenience.

Critical Path Network-Care planning algorithm for lower-extremity amputation

The algorithm on the next page is a snapshot — an interdisciplinary planning guide, says Sandra Sperry, RN, MPA, senior vice president of clinical resources at Sisters of Charity Health Care System in Staten Island, NY. The algorithm goes in the front of the progress notes, to which everyone on the interdisciplinary team contrib utes and has access. "Whether you are a nurse or a house officer," she explains, "you can quickly get a sense of certain basic guidelines on the care of the patient with an amputation."

On the two pages following the algorithm are sections from Sisters of Charity's interdisciplinary pathway. "That is a day-to-day documentation tool and planning guide where staffers chart specific interventions and variations," explains Sperry. "The algorithm is used in conjunction with the pathway."

She says amputation patients at Sisters of Charity are down to an average five-day stay. "They go home with home care or ambulatory rehabilitation, depending on the patient's functionability." She explains that people who have amputations are typically sick with diabetes, peripheral vascular disease, or some other condition that led up to the amputation. "Although for this particular hospitalization, the amputation is the issue, they have some kind of chronic problem that brings them to this point. That three-day Milliman & Robertson Optimal Recovery Guideline [see algorithm] is unrealistic, unless what is being amputated is a toe."