December 2012 VOL 3, NO 6

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Uncategorized

Practice Setting–Specific Panel Discussion

Roxanne Parker, RN, MSN, CPN
Jessie Schol, RN, BSN, OCN
Karyl Blaseg, RN, MSN, OCN

This moderated panel discussion included representatives of office-based, academic, and community hospital–based settings. Each presenter focused on her institution’s practices, and the presentations led to a lively question and answer session addressing issues such as how to treat patients who feel the navigator has no other patients to work with, how to get a navigation program started, how to connect with former inpatients once they leave the service, and how to “discharge” patients from the navigation setting. Resources for tools that have already been developed were also discussed.

Ms Parker reminded participants that there may be different titles for the navigator role, eg, “patient ambassador.” In Ms Schol’s practice, navigators lay the groundwork for clinical trial participation. They do not see patients through the whole continuum of cancer care, but hand them off. However, they remain in contact with some patients. Ms Blaseg described the Billings Clinic data capture system. They used to use Excel spreadsheets for tracking everything and had initial problems transferring information to electronic medical records (EMRs). They had to push their IT department to help, but now they are using EMRs to track data.

During the question and answer period, Ms Knowles asked how to handle patients who think you’re just sitting around waiting for them to call. Ms Parker tries to treat them right then as if they were the only one, or she schedules a call back. Ms Schol says one has to come to peace with the fact that one’s job is never done. Patient needs have to be prioritized. Navigators have to recognize their accomplishments each day. Ms Parker said navigators are the go-to person for patients and the whole treatment team, so the team has to know what their department can handle. Navigators can’t do all things for all people whether these people are patients or coworkers.

In response to a question about how the navigation program was started, Ms Schol said staff members did a gap analysis and spent a lot of time talking to new patients. They realized the practice lost a lot of potential new patients who couldn’t get through. Now the nurse navigator is their first call.

Someone who regularly sees inpatients with hematologic malignancies expressed difficulty contacting patients when they are outpatients or have been discharged. Ms Blaseg suggested going to appointments with the patients. The questioner responded that the practice has 2 different sites, and they are in the process of building relationships with healthcare providers. Ms Blaseg suggested connecting with patients in the treatment area. Ms Parker does something similar. She tracks all types of appointments and tries to call each patient or sends them a letter.

Ms Blaseg was asked how she accomplishes discharging patients. She says the navigator touches base with patients, eg, if they are in surveillance and in a waiting room or after their doctor’s appointment. They used to send discharge letters, but that felt strange. They also used to discharge patients who were done with treatment, giving them a Facing Forward book. Now they discharge the patient but leave the door open. Patients are not ready to part with their navigator at the last appointment, so it’s done later during surveillance. Ms Parker noted that her practice setting doesn’t have a formal survivorship program yet. She said they are developing an exit interview.

Someone whose program has no navigators wanted templates for intake forms and other documents. Her program has no EMRs. Ms Blaseg pointed out that the American College of Chest Physicians network has online tools, and that there are other online resources. Ms Shockney said that when she thinks about capturing information, she first asks herself what she would do with it, what it is needed for, when it is needed, and what will be done with it.

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