E1 Implementation of a Standardized Assessment Flowsheet and Data Collection Plan for the Duke Oncology Nurse Navigation Program
Kristin Hart, BSN, RN; Raechel Hill, BSN, RN, OCN; Nicole Scholl, BSN, RN, OCN; Valarie Worthy, MSN, RN; Caitlin Jester, MS
Duke University Health System-DCI
Background: Our providers and hospital administration recognize the important role a nurse navigator plays for our patients. As our navigator team has grown over the years across our 2 hospitals, we did not have a consistent assessment and documentation tool. We needed a way to make it easier for the navigators to quickly document their interventions for patients as well as capture metrics to quantify and show the impact of the work that is being done.
Objective: To create a standardized assessment and documentation process to help our program better care for our patients and to improve communication across Duke for all nurse navigators. By creating this assessment tool, it provides discrete data to track quality and outcome metrics for our patients.
Methods: A tool was created from best practice research gathered from AONN+ and other hospitals. We met with the electronic health record (EHR) development team to discuss options for creating a standardized assessment flowsheet based on our learnings from other institutions. We created a workgroup representing each hospital to make recommendations on key flowsheet rows, choices, and workflow. Once completed, the workgroup presented the tool to the navigator stakeholder group for additional feedback and approval. The workgroup compiled the final edits and sent to the EHR development team for creation.
Results: The flowsheet tool went live in April 2023, and within the first month we had 100% compliance with all navigators using the tool. Within the first few weeks, the navigator team stated they were documenting significantly more than before when they just created individual progress notes as the flowsheet prompts are easier to fill out and more comprehensive. The new flowsheet on average only takes 5 minutes to document for most patients. The flowsheet snapshot view that shows the summarized documentation over time makes it easier to quickly review past visits and patient needs and pinpoint interventions for upcoming visits, versus manually sorting through many progress notes. Some of the key metrics we are now able to capture include the following: patients, visits (by disease type, navigator, and hospital), risk factors, barriers, interventions, referrals, average time spent coordinating care, and time spent with patient.
Conclusion: Key lessons learned: Engage the full team in this work and seek input along the way. We had a workgroup that pushed the work forward, but we routinely went back to the broader navigators for feedback and direction. Do not let perfection be the enemy of good—we knew there were many advanced tools we could adapt within the EHR, but we were starting from a baseline without any common assessment tool or data, so we chose to get started with a foundational flowsheet that we can build on. Next, we plan to investigate EHR reports based on follow-up actions and reminders for the navigators. The initial data have been helpful to identify 2 priority areas—barrier assessment and tracking and how to better define the top intervention of care coordination. This will guide our educational efforts and refinement of our assessment tool over the next 6 months.
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