Cancer program carefully monitored for best results

Tool uses time and complexity to track patient acuity

OhioHealth Cancer Services in Columbus is building a navigator program called CancerConnections. The purpose of the program is to educate and support cancer patients, intervening as close to their diagnosis as possible.

New cancer patients are identified through hospital admission lists, the surgery schedule, or physician referral. Once patients are identified, information about them is gathered through the electronic medical record, diagnostic studies such as a pathology report, and discussions with their physician or the nurse on duty.

CancerConnections staff members, which are currently two RNs and one person without a medical degree, work with the patient to help him or her through the diagnostic and treatment process.

Currently, patients diagnosed with lung, colorectal, or pancreatic cancer take part in the CancerConnections program, says Mary Szczepanik, MS, BSN, RN, manager of Cancer Education, Support and Outreach at OhioHealth Cancer Services. The next group of patients who will probably be added are those with head and neck cancer, because most could use a navigator.

"We look for patients that really need us. They have a bad prognosis, and most of the time a complex surgical procedure is their very first treatment. Also, they have a shorter survival rate," explains Szczepanik.

To make sure the program runs well, it is carefully monitored. An acuity measurement tool was implemented so staff in CancerConnections can monitor their workload, based on the complexity of the patients with which they work.

Also, the program manager can monitor the overall acuity of patients in the program during any given month to determine if another staff member is needed to cover workload, or if those on staff should be given more hours. In addition, the manager can determine if the program is at a point to handle patients with another type of cancer.

Szczepanik says a database was created to record all the demographic information about patients, track the number of new patients added each month, and whether they are seen before discharge, which is one of the program's quality measures. The system also tracks whether new radiation therapy patients are contacted within 24 hours of their consultation appointment. It also measures acuity.

Special acuity tool

To gather data on acuity, a tool has been created to track time spent with each patient and factors that determine the complexity of each patient, such as the need to attend appointments with him or her. Acuity equals time plus complexity measured at each interaction with patient.

The acuity measure was implemented to help determine whether certain types of patients required more resources or needed more from staff than other types of patients, explains Szczepanik. The tool helps determine if it is individual need or if a certain type of cancer patient has a higher acuity, such as those with pancreatic cancer.

"It helps us know what types of patients really have the largest need for education, support, resources, financial assistance, and all the things that go into the acuity score itself," says Szczepanik.

Everyone in CancerConnections knows what is measured, so if one navigator nurse says her acuity is high a particular week and she cannot take a new lung cancer patient, then other staff members understand why. In addition, the tracking of the data creates a report that can be submitted to administrators detailing program acuity each month, which indicates the difficulty of the workload.

Every morning CancerConnections staff meet to discuss the patient caseload. The non-nurse navigator assumes a lot of the routine activities that do not require an RN, such as advising the patient as to what resources are available.

CancerConnections is part of the Cancer Education Support and Outreach department. Therefore, if a patient's distress score is high, he or she may be referred for a massage or to an oncology counselor. There are many resources and services within the department, including those to help children cope with the diagnosis of a family member.

"In the past, most of our support programs have been used by patients who are done with treatment. Now we see them participating while in treatment shortly after they start chemotherapy. It has been exciting to see that happening," says Szczepanik.

From the patient's perspective, Cancer Connections provides education and support. However, it provides much more. It improves communication with the staff, the physician, and the patient. It helps solidify the relationship between hospital staff and outpatient office staff.

Better communication results because the nurse navigator assists patients with physician communication and provides support during appointments, if needed. Also, the nurse navigator provides the educational information needed by each patient in the program.

SOURCE

For more information on the CancerConnections nurse navigator program, contact:

  • Mary Szczepanik, MS, BSN, RN, Manager, Cancer Education, Support and Outreach, OhioHealth Cancer Services, 3535 Olentangy River Road, Columbus, OH 43214. Telephone: (614) 566-3280. E-mail: szczepm@ohiohealth.com.