PowerPoint Presentation

ONS 39th Annual Oncology Nursing Society CongressNurse Navigator Core Competencies: Coordination of CareBarbara Rizzo McHale RN, BS, OCN, CBCNSamaritan Hospital Cancer Treatment Center St. Peters Health PartnersTroy, NYAnalytic cases per year- 459Navigator for 8 years

Barbara Rizzo McHale RN, BS, OCN, CBCN I feel that coordination of care, both within and across healthcare systems, to promote optimal outcomes while delivering the best patient centered care is the foundation of oncology nurse navigation. An example of meeting the competency category 3: coordination of care can be seen in this case presentation. B.W. was diagnosed with Breast cancer in September 2009. I worked with B.W. at that time by reviewing information given to her by surgeons, Medical Oncologist, Radiation Oncologist and providing further clarification and information. I also assisted in scheduling appointments, surgeries and streamlining the time to treatment initiation. 2

Over the past 4 years she has been very proactive and involved in her care and has kept up to date with all recommended diagnostic tests and follow up appointments with Medical Oncologist and Radiation Oncologist. B.W. would periodically call and check in with me when she had questions or concerns. 3

This connection and coordination of care was instrumental in diagnosing a second primary Breast Cancer. She called and said I had a mammogram in January that they recommended I have a Breast MRI due to my dense glandular tissue. My insurance company denied it even with input from my surgeon, Medical Oncologist and Radiation Oncologist. I was then scheduled for a 6 month follow up diagnostic mammogram exam. I just had the mammogram and Ultrasound and again the Radiologist recommended alternating Mammogram with Breast MRI due to the dense glandular tissue. The insurance company stated that the exams were negative and denied the request. I appealed to Medicare and I received a letter stating they agreed with the recommendation and they approve the Breast MRI and that my insurance company had 72 hrs to approve it. What am I supposed to do next?

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http://m.dailysentinel.com/gallery/collection_de61139c-ec38-11df-a851-001cc4c03286.html?mode=jqm

We generally don't have animals in the house, but Butcha Butcha came in for mutual TLC.10

The Medical Oncologist ordered further testing be done and an Oncotype DX was ordered. She is waiting for the results of this test in order to determine the best plan of care. All through this process we have utilized the NCCN guidelines and recommendations for care. B.W. has dealt with this second diagnosis remarkably well, utilizing the Distress Thermometer she was only a 3. She stated without the guidance or coordination of her navigator she would have been more anxious and stressed. She tells everyone without this help she would not be where she is now.

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My Daughter saw me through the surgery day. My Sister took care of my Mother for 2 weeks after my surgery.

Peeling apples 2 days after surgery. Several people gave me a little grief over this, but I tell them I was only using my hands!She cares for her elderly mother and was able to celebrate her 100th birthday two days after her surgery. She plans for more family gatherings and birthdays to come with the help of her team at the cancer treatment center at Samaritan Hospital.

Mom celebrated her 100th 2 days after my surgery!

The coordination of care and advocacy allowed her to get the appropriate diagnostic tests and timely initiation of treatment from positive pathology, which are metrics we continually measure.