Beaupre, Laura, BSN, OCN, CBPN-IC

Chicas, Martiza Y, RN, PCCN

Kenna, Jeanne, RN, OCN

Miller, Angela, RN

Pauls, Alyssa

Roman, raizalie, RN, BSN, OCN

Sevedge, Kathy, RN, MA, AOCN

Smith, Cynthia, RN

Zubia, Jane, RN, OCN, CBPN I-C

English

Roman-Rosado, Raizalie, BSN, OCN, CMSRN

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingDeveloping a New Specialty Multi-disciplinaryClinic while Orienting as a Novice NurseNavigatorAngela Miller RNLehigh Valley Health Network, angela.miller@lvhn.orgJeanne Kenna RN, OCNLehigh Valley Health Network, Jeanne_D.Kenna@lvhn.orgLaura Beaupre BSN, OCN, CBPN-ICLehigh Valley Health Network, Laura.Beaupre@lvhn.orgJane Zubia RN, OCN, CBPN I-CLehigh Valley Health Network, Jane.Zubia@lvhn.orgMartiza Y. Chicas RN, PCCNLehigh Valley Health Network, Maritza_Y.Chicas@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis 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 AtMiller, A. Kenna, J. Beaupre, L. Zubla, J. Chicas, M. Roman, R. Smith, C. B., Pauls, A. Sevedge, K. (Nov,2016). Developing a NewSpecialty Multi-disciplinary Clinic while Orienting as a Novice Nurse Navigator. Poster Presented at: AONN, Las Vegas, Nevada.AuthorsAngela Miller RN; Jeanne Kenna RN, OCN; Laura Beaupre BSN, OCN, CBPN-IC; Jane Zubia RN, OCN,CBPN I-C; Martiza Y. Chicas RN, PCCN; raizalie Roman RN, BSN, OCN; Cynthia Smith RN; Alyssa Pauls;and Kathy Sevedge RN, MA, AOCNThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/patient-care-services-nursing/693As our Cancer Program evolves with multidisciplinary care, leadership approved adding two specialty multidisciplinary clinics (MDCs), Hepatobiliary (GI) and Skin and Soft Tissue (SST) to existing Breast, Thoracic, and Prostate MDCs.  Physicians were invested in developing these MDCs. Our model of MDC coordination by nurse navigators required hiring two navigators facing the challenges of learning the role as well as developing the clinics.© 2016 Lehigh Valley Health Network•  An 8 week orientation competency checklist was completed.  •  Overall patient satisfaction score for SST = 4.7/5, for GI = 4.9/5. Existing goal is 4.7/5. •  Anticipated MDC volumes for SST= 50/yr.; GI= 144/yr., actual to date for SST 8 months = 42, GI 11 months = 57. OBJECTIVES:•  Identify “must haves” needed to develop an MDC.•  Demonstrate high patient satisfaction.•  Improve novice Navigators’ competency through structured orientation. The Navigator as coordinator of the MDC has proven successful and yielded high patient satisfaction. Administrative and physician support for both the MDC and the investment in a structured, comprehensive navigator orientation was critical to the success of a new MDC. As the Navigator assumes the role of coordinator, development of collegial relationships among all team members is also critical. MDCs are a mark of quality and can differentiate your program from the competition.Guided by NCCCP MDC Assessment Tool and Oncology Roundtable “Maximizing the Value of Patient Navigation”, navigator interviews involved physicians, key to assuring the right fit. MDC “must haves” were identified by physicians completing an LVHN MDC application form. “Must haves” in place included physician team, support staff & clinic space. Metrics chosen were patient satisfaction (homegrown tool) and volumes. Patient satisfaction should match existing MDCs. Navigators completed an 8 week orientation with a competency checklist and preceptor that included: shadowing Navigators, attending specialty MDCs, and meeting with Cancer Support staff to understand their roles.  Shadowing physicians and observing surgeries was crucial in establishing collegial relations. Navigators self-educated and researched their specialty through NCCN guidelines, LVHN’s standard. Navigators attended MDC team meetings to plan the startup of their MDC. MDC Application Form     Date: ________________________  Name of Physician Champion_______________________________________ Type of MDC____________________________________________________ Where will the clinic take place? _____________________________________  Who is the navigator?  _____________________________________________  Physicians/:  Medical Oncology_______________________________________ Back-up       Surgical Oncology_______________________________________           Radiation Oncology______________________________________           _____________________________________________________           _____________________________________________________ Do all physicians meet criteria for MDC privileges?   _____yes   _____no Support team members:   Social work____________________          Psych Counseling______________ Financial Counseling_____________         Genetic Counseling_____________ Rehab________________________          Dietitian______________________ Palliative Care__________________          Clinical Trials__________________ Other_________________________  Proposed schedule (weekly, bi-weekly, monthly, AM, PM) _________________________________________________________________  Number of patients expected annually/in each clinic _______________________  Staffing needs:  MA (chart prep, arriving pts) Check in/check out Office support Other:  IT needs:   Planning Team members:    Date presented to MDC Working Group:                           CCLC:               Cancer Committee:   Assessment Area Educational Conference (tumor board) that does not impact treatment planning. Retrospective review of cases. Level 1 2 3 4 5Case Planning Case planning and treatment is performed by individual physicians without input from a multidisciplinary conference. Patients present to multiple physician offices on different days. <25% of case planning is done through a multidisciplinary conference which occurs on recurring basis. 25-75% of case planning is done through a multidisciplinary conference which occurs on recurring basis. >75% of case planning is done through a multidisciplinary conference which occurs on recurring basis. All case planning is done through a multidisciplinary conference which occurs as the patient encounters care Physician Engagement Diagnostic and treatment Physicians belong to multiple independent groups, with little interaction. Diagnostic and treatment Physicians belong to multiple independent groups, and each group is actively engaged with the cancer center The cancer center is implementing a Conditions of Participation agreement, and physicians are actively engaged in developing treatment standards Same as prior with the addition of engagement for strategic direction. Majority of physicians have signed Conditions of Participation. Same as prior with the addition of physicians who have clinical operational authority for the MDC. All physicians have signed Conditions of Participation. Treatment Team Integration Sporadic integration of diagnostic and treating physicians (<80%) Consistent integration (=> 80%) of case appropriate diagnostic and treating physicians. Same as prior; Integration of additional allied health practitioners (e.g., nutrition, PT/OT, palliative care, genetic counselors, mental health practitioner) Same as prior; all members of MDC team participate in treatment planning by consensus. Same as prior; Primary Care Physician is consistently notified of treatment plan.Integration of Care Coordinators (includes but is not limited to Nurse navigators, navigators, survivorship nurses, social workers, and case managers)Patient care is episodic. Patient has to present to multiple locations on different days for treatment and or diagnostic modalities. Information is stored in multiple locations, and difficult to coalesce. No Care Coordinators.A Care Coordinator is available if needed to arrange treatment and diagnostic modalities to make care less episodic. Information is coordinated and is readily available to physicians and staff.Same as prior with a Care Coordinator engaging <25% of patients at least once during their treatment.Same as prior with a Care Coordinator engaging 25-75% of patients at least once during their treatmentMultiple Care Coordinators are utilized for >75% of patients from the point of initial contact through survivorship. A system to track interventions that lessen barriers to efficient care is used by care coordinatorsInfrastructureLimited physical infrastructure. Hospital, physician office modelN/ASome dedicated physical facilities which do not cover the full spectrum of careN/ADedicated cancer center with ability to provide the full spectrum of care to patientsFinancialBilling is episodic based on encounter with facility or physician. No facility fee is applied.N/APhysicians bill separately. Facility fee for MDC. Prospective financial counseling available to patient.N/AGlobal bill for MDC billing inclusive of facility fee. Prospective financial counseling available to patient.Clinical TrialsPatients not screened for eligibility for clinical trials. Patients not informed about clinical trial options.N/AAll patients screened for trial eligibility and availability; clinical trials staff present at MDC.N/ASame as prior; Clinical trials staff reviews all eligible charts, engages care coordinators and treating physicians prior to initial treatment.Quality ImprovementNational care guidelines not used to guide treatmentNational care guidelines are used as a framework for decision making.Same as prior with QOPI and/or RQRS data used to guide quality improvement initiatives in the hospital and physician officesSame as prior with patient survey data (any type) used to guide quality improvement initiativesSame as prior with a structured compliance review process in place to measure guideline adherence and guide quality improvement initiatives.Medical RecordsMedical records are not integrated. Little to no sharing. Mixture of paper and EMR.N/A>50% of cancer physicians have an integrated EMR and/or major IT functions shared with the cancer centerN/A> 75% of cancer physicians have an integrated EMR and/or major IT functions shared with the cancer center to provide access to information across the care continuum.Elements of the Multi-Disciplinary Care continuum Prospective review of cases For the definition of “prospective” please see the Commission on Cancer program standard 2.8 Elements present may reflect institutional variability of site-specific disease burden and patient volume MDC Assessment Tool – Version 3.0 Approved by NCCCP Executive Subcommittee 3-10-2011 Page 1 Final Ratings Very Poor  Poor  Fair  Good Very Good 1. Convenience of parking ☐ ☐ ☐ ☐ ☐ 2. How well your consultation was handled and recommendations explained ☐ ☐ ☐ ☐ ☐ 3. Likelihood of recommending the service to others ☐ ☐ ☐ ☐ ☐       Your recommendations to improve this service    Comments (describe good or bad experience)   Please provide us with some follow up information:  Yes No Do you plan to follow through with any of the second opinion recommendations ☐ ☐ If yes, please explain:     Where do you intend to obtain any recommended treatments?    Do you wish to be contacted by a Supervisor to discuss problems or concerns regarding your recent visit?  If yes, please provide us with the following information: First Name:             Last Name:                   Daytime Phone Number     -    -       Thank you for your help.    Department of Cancer Support Services, Lehigh Valley Health Network Cancer Institute, Allentown, PennsylvaniaDeveloping a New Specialty Multi-disciplinary Clinic while Orienting as a Novice Nurse NavigatorJeanne Kenna, RN OCN; Angela Miller, RN MEd OCN; Laura Beaupre, RN BSN OCN CB-BN; Jane Zubia, RN OCN CN-BN; Maritza Chicas, RN BSN OCN PCCN; Raizalie Roman, RN BSN OCN; Cynthia B. Smith, RN BSN MA; Alyssa Pauls, RN BSN OCN, Kathleen Sevedge, RN MA AOCNMDC Results TableStart Up MDCBENCHMARKSatisfaction ScoresPatient Satisfaction ScoresAnticipated Volumes / MDC at Start-upActual Volumes to Date / MDCGI MDC 4.7/5 4.9/5 144/YR 57 (11 months)Skin & Soft Tissue MDC 4.7/5 4.83/5 50/YR 42 (8 months)This homegrown tool is sent to all patients that attend the MDC. The results are benchmarked against a successful established MDC. Both forms are completed by the Physician Team and reviewed by the Cancer Center Leadership prior to implementation of the MDC. These provide our baseline “must-haves” and benchmark for volumesLEHIGH VALLEY HEALTH NETWORK CLINICAL SERVICES  UNIT-SPECIFIC COMPETENCY ASSESSMENT FORM  Position Title: Oncology RN Navigator_________________  Competency/ Behavioral Expectation Date Validated Competency/ Behavioral Expectation Date Validated Prepares and presents cases for  preconference or tumor board.  Effectively assesses symptoms over the phone and facilitates appointment in office as needed.   Sends QCL’s as needed to communicate patient need.   Present case study at navigator team meeting  Attends department specific observation experiences relative to department interaction; (i.e.)  Breast Health  Radiation  Infusion  Med Onc  Surg Onc  Gyn Onc  Cancer Support  Dietitians  Cancer Risk  Palliative  Patient Ed  Financial Counselors           Review of Organizational and Unit Specific policies and procedures X drive documents Caseload spreadsheet  Shadows navigator colleagues:   ● Bilingual ● Thoracic ● Breast ● GI ● Skin & Soft Tissue ● Head & Neck   Reviews oncology treatment algorithms  Attends key office visits with patient to assure coordination of care and understanding  Observes MDC:   ●Thoracic ● Breast ● GI ● Skin & Soft Tissue ● Head & Neck ● GU   Survivor PLACE  Demonstrates competency in documenting in MOSAIQ.   Navigators completed an 8 week orientation with this competency checklist and preceptor. Upper GI Multidisciplinary Clinical Consultation Team Satisfaction Survey  1. Date of Service      3. Date of Birth   /   /            /   /      2. Your Sex?      4. If someone other than the patient is completing         survey, please check here: __ Male  __ Female      __ Yes __ No  Instructions:  Please rate the following services you received.  Fill in the number that best represents your feelings.  Also comment on any good or bad experience you might have had.  When you have completed the survey, lease mail it in the postage paid envelope provided.  Thank you.   On the phone: Very Poor  Poor  Fair  Good Very Good 1.  Ease of getting through to nurse navigator ☐ ☐ ☐ ☐ ☐ 2. East of getting an appointment for the time/date you wanted ☐ ☐ ☐ ☐ ☐ 3. Promptness with which your calls were answered ☐ ☐ ☐ ☐ ☐ 4. Courtesy of nurse navigator ☐ ☐ ☐ ☐ ☐ 5. How clearly the consultation process was explained ☐ ☐ ☐ ☐ ☐ 6. How clearly the nurse navigator answered your questions ☐ ☐ ☐ ☐ ☐  Comments (describe good or bad experience          During your consultation: Very Poor  Poor  Fair  Good Very Good 1. Length of wait in the reception area ☐ ☐ ☐ ☐ ☐ 2. Courtesy of receptionist ☐ ☐ ☐ ☐ ☐ 3. Comfort and pleasantness of waiting area ☐ ☐ ☐ ☐ ☐ 4. Waiting time to see the doctor(s) ☐ ☐ ☐ ☐ ☐ 5. Respect doctor showed for your questions ☐ ☐ ☐ ☐ ☐ 6. Concern shown for your privacy ☐ ☐ ☐ ☐ ☐ 7. How clearly the doctor explained your condition ☐ ☐ ☐ ☐ ☐ 8. Length of time doctor spent with you ☐ ☐ ☐ ☐ ☐ 9. Doctor’s concern for your comfort during your examination ☐ ☐ ☐ ☐ ☐ 10. Clarity of follow up instructions ☐ ☐ ☐ ☐ ☐ 11. Usefulness of written recommendations ☐ ☐ ☐ ☐ ☐ 12. Value of meeting with social worker ☐ ☐ ☐ ☐ ☐       Comments (describe good or bad experience)   BACKGROUND RESULTSMETHODSCONCLUSIONS

Developing a New Specialty Multi-disciplinary Clinic while Orienting as a Novice Nurse Navigator

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1698&context=patient-care-services-nursing

Developing a New Specialty Multi-disciplinary Clinic while Orienting as a Novice Nurse Navigator

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Lehigh Valley Health Network: LVHN Scholarly Works