Congress Abstracts 2006

107

IMPROVING CARE ACROSS THE CONTINUUM FOR THE NEURO-ONCOLOGY PATIENT. Nancy Eisenson, RN, MSN, and Cindy Bohlin, RN, MSN, Duke University Medical Center, Durham, NC.

In 2003 there were approximately 18,000 new cases of primary brain and nervous system tumors in the United States(Jemal et al, 2003) Over 13,000 people will die from these tumors. Deficits related to brain tumor location, size, and pathology can impair cognition, motor/sensory abilities, and induce seizure activity. The Brain Tumor Center at Duke evolved to meet the complex needs of these patients.

To discuss how an advanced practice nurse improves care across the continuum for the Neuro-Oncology patient and their caregivers.

A screening assessment plan was developed by the inpatient neuro-oncology clinical nurse specialist. This involved daily screening of neurosurgical patients for potential craniotomies. A rounding book was developed and used to track information regarding each potential brain tumor patient. Surgery dates, and pending pathology sections were made to serve as daily followup reminders for discharged patients. Once a patient's pathology is received it would be discussed with the neuro-oncology team during multidisciplinary brain tumor center rounds. Possible treatment options would be discussed and the APN would call the patient with the pathology and possible treatment options formulated by the team. Then a new outpatient consult appointment would be made to finalize the plan.

Neuro-Oncology patients seen for followup in the outpatient clinic who are diagnosed with non-complicated DVT's who were previously admitted for anticoagulation are now seen by the APN who facilitates subcutaneous teaching and the administration of the first Lovenox^® dose. The APN also confirms that insurance will approve the Lovenox^® prior to releasing them from the outpatient facility.

The Neuro-Oncology APN facilitates improved care for the neuro-oncology patient from pre-admission to post discharge. Patients report improved satisfaction with timely access to pathology and possible treatment options prior to their first outpatient visit. In the last six months two patients have avoided hospital admission from non-complicated DVT's as a result of the APN driven screening/education plan.

APN tools/methods such as this could be used in any oncology setting.