Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient...

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Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer Institute

Transcript of Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient...

Page 1: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Click to Add TitleClick to Add Subtitle

Breast Patient

Navigation

Lindsey Jerkins RN, BSN, OCN

Clinical Director UT Medical Center Cancer

Institute

Page 2: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Disclosures• I have no disclosures.

Page 3: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Objectives

Define Navigation

National Trends in Navigation

Building Navigation Programs

Alignment of Navigation Programs

Breast Navigation

Page 4: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Navigation: Background & Beginnings

Screening

• Initial Outreach

Diagnosis

• Suspicious or Abnormal Finding

Treatment

• Confirmed Diagnosis

Survivorship

• Treatment Complete

Dr. Harold Freeman “Longitudinal Model” Patient

Navigation

Page 5: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

What is a Navigator?

Nurse Navigator-

– A professional registered nurse with specific clinical knowledge

in the area he/she is navigating.

– Offers individualized assistance to patients, families, and

caregivers to overcome healthcare system barriers.

– Utilizes the nursing process (assessment, nursing diagnosis,

planning, intervention, evaluation) to advocate on behalf of the

patient and provide education and resources for informed

decision making and timely access to quality care

Lay Navigator-

– A nonprofessional or volunteer trained to work in the area

he/she is navigating.

– Offers assistance in removing barriers to care to patients,

families, and caregivers to gain timely access to quality care.

– Acts at the direction of the nurse navigator or other trained

health professional.ONS, Oncology Nurse Navigator Core Competencies,2013

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiOtdDrjq3NAhWEKiYKHZ9UBsYQjRwIBw&url=http://www.wespark.org/ongoing-classes/&psig=AFQjCNH_00ey-aJllLHvkiN1WI5_WKNvIQ&ust=1466186003966214
Page 6: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Nurse Navigator vs. Lay Navigator

Page 7: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

National Trends

Page 8: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Tumor Site Specific Navigation

Page 9: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Tumor- Site Specific Navigation

Tumor Site Navigation: Breast Cancer Serve as main point of contact for patients and MDs

Intake all patients in need of Diagnostic Evaluation

Intake all patients in need of additional imaging (Recall)

Provide patient education regarding diagnostic process:

Diagnostic Exam

Ultrasound

Biopsy

Breast MRI

Advocate for patient: Correct Patient Placement

Ensure timely care

Metrics

Remove barriers to care

Metrics

Coordinate referrals

Metrics

Page 10: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Breast Cancer Navigation: Where Do I

Start?

Identify Areas for Improvements• Timeliness of Care?

Days from call to diagnostic evaluation

Days from Mammogram to biopsy

Days from biopsy to first MD contact

Days from biopsy to surgery

• Patient Retention

Number of breast cancers diagnosed vs. number

treated (outmigration)

What navigation services are offered by other

facilities

• Patient Satisfaction

Page 11: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Care Coordination GAPS

Page 12: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Opportunity: Lost to Follow-up: Navigation &

Breast Health Outreach Pilot

Page 13: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Metrics: Timely Referral for Care

Breast Care Service

Metric Goal Jan Feb Mar

Self Referral 550 YTD 35 34 55

MD Referral 1500 YTD 162 133 167

Recall 100% 119 61 87

Total Referrals 3500 YTD 316 228 309

Positive 22 20 16

Avg Time to

Surgeon

≤ 10 calendar

days

5.9 9.3 10.7

Patient

Satisfaction

≥ 80th percentile 92 93 78

Page 14: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Goals of Navigation & Alignment of

Goals with Organization

• GUIDE patients through the cancer continuum of care

• EDUCATE patients regarding cancer diagnosis, and

treatment options

• ADVOCATE for the unique needs of each patient to assure

all care needs are met using UTMC and community

resources

• SUPPORT patient/family by actively listening and providing

evidenced based information

• ENCOURAGE and coach patient to be engaged in their care

planning and decision making

Page 15: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Understanding the VALUE of Patient Navigation

Patients

• Satisfaction

• Advocacy for optimal care and outcomes

• Accessible point of contact

• Empowerment through education and encouragement

Healthcare Providers

• Perform at highest level of efficiency

• Ensures communication among members of multidisciplinary team to

prevent fragmented or delayed care

• Communication of treatment plan

• Quality of Care- Disease Specific Pathway, Treatment Algorithms, and

Evidence Based Care

• Better Stewards of Resources- Avoid duplication of testing thus avoiding

increased cost to the patient and healthcare system

Page 16: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Patient Satisfaction

Page 17: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Clear Delineation of Responsibilities

Page 18: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

A Little Bit of Everything

Page 19: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Breast Navigation: Abnormal Finding

RecallExplanation of screening results

Additional views on one or both breasts

Ultrasound

Radiologist Input

Possible

Biopsy InformationType of biopsy (stereotactic, ultra-sound guided, core needle)

Medication prior to biopsy (needed vs. need to omit)

Driver ?

NPO?

ResultsSet Expectations

When will biopsy results be available?

Who will get the results?

Who will contact me?

What do these results mean?

Page 20: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Diagnosis

You have Breast Cancer• Patients experience a high level of anxiety, fear, uncertainty,

and helplessness.

• Who Do I see next?

• Do I need surgery, radiation, and/or chemotherapy?

• Patients listen, but most do not hear what is being said

♦Confusion and lack of understanding

♦Not always comfortable asking MD to clarify

♦Patients and families want someone to speak

with immediately.

Page 21: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Diagnosis: EDUCATE

Type of Breast Cancer

DCIS

Invasive (ductal, lobular, papillary, tubular)

Prognostic Markers

ER/PR/HER2

Triple Negative

HER2 Positive

Ki67

Stage (TNM)

Early, Advanced, Late

Page 22: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

What’s Next? GUIDE

Additional Testing/Procedures

Tumor Conference Presentation

Appropriate Referrals & What to Expect

Surgical Oncology

Medical Oncology

Radiation Oncology

Plastic Surgeon

Genetic Testing

Page 23: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Appointments: SUPPORT &

ENCOURAGE

Social Work/Dietician Referrals

Psychosocial Support

Financial Services

Integrative Health

Internal and External Support Groups

Community Services

Page 24: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Cancer Care Continuum: ADVOCATE

Act as an additional patient resource and point of

contact for further needs.

Assist the patient in expressing the PATIENT’S goals of

treatment.

Transition patient to other providers and services if

needed.

Page 25: Click to Add Title - UT Medical Center · Click to Add Title Click to Add Subtitle Breast Patient Navigation Lindsey Jerkins RN, BSN, OCN Clinical Director UT Medical Center Cancer

Thank You!!


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