9/1/2017 Si Sickle ckle Cell Nur Cell Nurse Navi e Navigati - PDF document

9/1/2017 Si Sickle ckle Cell Nur Cell Nurse Navi e Navigati tion on: : An Innovative Approach So Crisis Doesn't Mean an Emergency Department Visit Kerri Stuart, RN,MSN │ Natalie Merilus, RN,BSN │ Debra Burgess, RN,BSN,MHA UC Davis Comprehensive Cancer Center/UC Davis Medical Center - Sacramento, California 2017 ANCC National Magnet Conference  October 12, 2017  09:30 am  Session C530 Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion Disclosures  The presenters for this presentation have disclosed no conflict of interest related to this topic.  Objectiv jectives es  Learn viable solutions to promote excellence in nursing to improve clinical outcomes for a defined patient population.  Promote patient centered care and improve the patient experience through implementation of a nurse navigation for individuals with sickle cell disease  T o gain a better understanding of how data can motive change and help focus performance improvement projects Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion UC Davis Health System UCDHS Mission  Improve lives and transform health care by  UC Davis School of Medicine providing excellent patient care, conducting  Betty Irene Moore School of Nursing groundbreaking research, fostering innovative, inter-professional education, and  Practice Management Group creating dynamic, productive partnerships  UC Davis Medical Center with the community. 1

9/1/2017 Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion UC Davis Medical Center  Comprehensive 619-bed academic teaching hospital  Serves 33-counties, covering 65,000-square-mile radius  Reach is extended through the telemedicine program, which provides remote, medically underserved communities throughout California access to specialty and subspecialty care.  Centers of Excellence • Comprehensive Cancer Center • Regional Burn Center • Level 1 Trauma Center • Vascular & Heart Center • Stroke Center • Children's Hospital • Mind Institute Am bulatory Care Division  11 Prim 11 Primar ary y Care Netwo Network rk Sites ites Offering care in 10 cities across the region •  26 Hospita 26 Hospital l Based Based Clinics: Clinics: Comprehensive Cancer Center • Heart and Vascular Center •  Pr Provid ide e sp specialty ecialty car care in in 150 field 150 fields. Health Management and Education • Spine Center •  Over er 1, 1,000 p 000 physici ysicians make up ke up UC UCD D Women’s Center for Health • medic me dical gr grou oup Transplant Center •  Hom Home Health Health & & Hospice, Hospice, ser serving 3 ing 3 counties counties 2

9/1/2017 UC Davis Com prehensive Cancer Center  NCI designated Comprehensive Cancer Center  Medical & Surgical Oncology Clinic  Adult and Pediatric Infusion Rooms  Pediatric Hematology & Oncology Clinics  Radiation Oncology  Breast Health Center  QOPI certified  U.S. News National hospital for Cancer Care Com prehensive Cancer Center Nursing  53% of nursing staff have specialty certification (OCN, CPHON, BMTCN)  Cancer Center Clinics • Infusion Rooms • Radiation Oncology  Multidisciplinary Huddles:  Clinical Trials  Combined Modality Therapies  Unit-Based Practice Council Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion Professional Practice Model  Nursing Professional Practice Model foundation for relationship based care  Va Values  Deliver extraordinary compassion, courage, integrity, in every situation!  Missio Mission  Provide science-based, technologically precise, compassionately delivered nursing care.  Vis Vision on  The highest quality of patient care provided through the advancement of nursing practice. 3

9/1/2017 UCD Adult I nfusion Services- Main Cam pus  24,260 patients treated in FY 2015-16  49 chairs, 6 bedrooms  3 Infusion Rooms (2 adult; 1 pediatric)  Oncology and Non-Oncology patients treated (70/30)  Offer Phase 1 and other traditional and pathwayt therapeutic clinical trials  Outpatient blood transfusions Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion Historical Triage Priority for I nfusion Treatm ents 1. New chemotherapy start 2. Emergent platelet transfusion 3. Emergency IV hydration 4. Scheduled ongoing chemotherapy 5. Emergent blood transfusions 6. Scheduled blood product transfusions 7. Non-Oncology treatments 8. Sickle C 8. Sickle Cell ll Crisi isis 9. Phlebotomies 10. Endocrine tests Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion Opportunity Knocks….  Improve patient experience  Deliver patient centered care & care experience  Improve staff satisfaction  Better utilization of hospital wide resources  Innovative care delivery for Sickle Cell patient population 4

9/1/2017 Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion QI Project: I nnovative I dea for Change  Ambulatory Care Model  Implemented an outpatient model at the adult infusion center to provide Could we transfer an alternative, more therapeutic environment for SCD patients needing care from ED to treatment for VOCs the outpatient  Other services offered: central line care, chelation therapy, IV hydration setting and and manual exchange transfusions & blood product administration improve the  Designated nurse navigator patient experience for SCD patients?  Establish therapeutic relationships with high utilizers of ED/inpatient care  Focused on better management of uncomplicated VOCs YES!  Hours of operation: Monday - Thursday 8am to 8pm Friday 8am to 6pm Living w ith Sickle Cell My Life with Sickle Cell Available on YouTube at: https://www.youtube.com/watch?v=CF2uthKdpTg Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion Sickle Cell Disease  Affects nearly 100,000 individuals of African American, Hispanic, Middle Eastern, Asian and Indian descent in the United States  Inherited genetic disorder resulting from the presence of mutated form of hemoglobin (hemoglobin S)  All genotypes contain at least one sickle gene, where HbS makes up at least half the hemoglobin present. 5

9/1/2017 Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion SCD: Several Genotypes  Major sickle genotypes include the following : HbSS HbSS disease or sickle cell anemia the mo most commo mmon n form • HbS/b-0 t 0 thalasse assemia mia – Double heterozygote for HbS and b-0 thalassemia; clin clinically • indistinguis stinguishable f hable from s sickle c le cell a anemia ( (SCA) ) HbS/b+ t thalasse assemia a - Mi Mild-to-mode -to-moderate s rate seve verity rity with variability in diff differen ent ethni ethnicities es • HbSC disease - Double heterozygote for HbS and HbC characterized by mo HbSC modera rate te • clinical sev clin severi rity HbS/hereditar ditary p persiste istence o nce of fetal H l Hb (S/HPHP) - Very m mild or asy ild or asympt ptom omatic phenotype • HbS/Hb HbS/HbE syndr drom ome - Ve Very r rare with a phenotype usually similar to HbS/b+ thalassemia • Rare combinations of HbS with other abnormal hemoglobins such as HbD Los Angeles, • G-Philadelphia, HbO Arab, and others Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion SCD: Life Expectancy Over the Decades  Manifests as early as infancy  1970s: Early mortality median age of survival 14.3 years of age •  1990s: HbSS median life expectancy: females 48 • males 42 •  1990s: HbSC median life expectancy: females 68 • males 60 • Crea eating ting a a he health althier ier wo world t d throu rough b bold i innova novatio tion SCD: Disease w ith Com plex Health Care Delivery I ssues • Similar issues to care faced by • Pharmacotherapy • Acute Chest Syndrome Patient Complexity Complications Barriers to Care patients with other chronic • Compliance with treatment • Stroke illness regimen • Pneumonia • Fragmented care delivery • Behavioral Issues • Priapism system • Coping with chronic illness • Cardiac problems • Care is poor for this • Stigma associated with • PE/DVT population opioid use for pain control • Dehydration • Often lack PCP or • Sickle Cell pain crisis hematologist to manage care 6