The following article features coverage from the 2020 ONA Virtual Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage. In addition, the original presentation is available for on-demand viewing and CNE credit until September 2021, click here to access.

 

Every day, in healthcare settings across the country, navigators are making a difference in the lives of patients and in the efficiency of healthcare delivery. For the second year, Oncology Nurse Advisor is thrilled to honor the efforts and achievements of oncology nurse navigators and navigation teams with the 2020 ONA Navigation Summit Navigation Awards.

Entries for this awards program were collected earlier this year and were judged by the members of the 2020 ONA Navigation Summit advisory board. Submissions were judged according to specific criteria for numerous categories. The categories for this year’s awards include Excellence in Disease-Specific or Generalist Navigation, Innovations in Oncology Navigation, and Outstanding Oncology Navigation Program.

Excellence in Disease-Specific or Generalist Navigation

Winner: Sara Sargente, RN, OCN, Orange Regional Medical Center, Middletown, New York
First Runner Up: Carol Leija, MSN, RN, OCN, UC Davis Comprehensive Cancer Center, Sacramento, California

Innovations in Oncology Navigation

Winner: University of Miami Sylvester Comprehensive Cancer Center Navigation Program, Miami, Florida
First Runner Up: Darlene Armijo, BS, St Mary Corwin Dorcy Cancer Center, Pueblo, Colorado


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Outstanding Oncology Navigation Program

Winner: Lehigh Valley Cancer Institute Navigation Team, Allentown, Pennsylvania
First Runner Up: Regional Cancer Care Associates Central Jersey Division Patient Navigator Program, East Brunswick, New Jersey

Read more about our winners and runners up and their achievements below.

Excellence in Disease-Specific or Generalist Navigation

Winner: Sara Sargente, RN, OCN; Orange Regional Medical Center, Middletown, New York

Sara Sargente, RN, OCN
Sara Sargente, RN, OCN

Sara became a nurse in 2000. She started as a medical/surgical nurse, but moved quickly to the field of oncology, first at Newton Hospital then joining Orange Regional Medical Center in Middletown, New York, in 2005, working in infusion. She moved to inpatient oncology in 2010, radiation in 2011, and became the head and neck/bloodless program navigator in 2015. Since 2019, she has served as the head and neck cancer and gastrointestinal cancer navigator. Her experience in all aspects of cancer treatment provides an excellent foundation for her work as a navigator.

Sara has always been very involved in the Orange Regional Medical Center Oncology Program, serving as a charge nurse, participating in Nursing Senate, and co-chairing Oncology Governance, as well as developing policies highlighted in her institution’s successful Magnet Application. An OCN and chemo/biotherapy certified nurse through the Oncology Nursing Society (ONS) from early in her career, Sara was a founding member of the very successful ONS Chapter of Orange and Sullivan counties and served as vice president, president-elect, and president for 2 terms. Sara is also a Reiki Certified Nurse and a practitioner in the complementary and alternative medicine program at her institution.

As an oncology navigator, Sara sees the barriers to care and the financial burdens that patients with cancer experience. She has worked tirelessly to find resources for her patients, which is admirable in itself, but she has gone further to help address those needs directly. As president of the Oncology Nurses of Orange and Sullivan Counties, she led the formation of the Acts of Kindness fund which provides $100 gas cards or grocery cards for patients in need. This fund has given more than $14,000 in grants to patients, all raised and administered by the members.

In addition, Sara serves as a member of the application review board for Citizens Re-united to Overcome Cancer, a community organization that provides financial assistance grants to patients with cancer.

Because there is limited data regarding quality of life (QOL) issues in patients with head and neck cancer, Sara was instrumental in designing and implementing a study under the supervision of the Orange Regional Medical Center medical director. A 46-question survey was developed to assess a range of issues and was administered by Sara prior to treatment, 4 weeks posttreatment, and 6 months posttreatment over 2 years. Sixty validated surveys were reviewed and identified eating/swallowing issues and general health areas as those most affecting QOL. As a result of the study, additional speech and swallow evaluations were implemented at regular intervals in addition to before radiation treatment and immediately after treatment. The team is currently working to publish their findings.

First Runner Up: Carol Leija, MSN, RN, OCN; UC Davis Comprehensive Cancer Center, Sacramento, California

Carol Leija, MSN, RN, OCN
Carol Leija, MSN, RN, OCN

Within the role of oncology nurse navigator, Carol’s cumulative experience demonstrates expertise in providing complex care coordination, education, and psychosocial support; the ability to identify and resolve barriers to care; and importantly, to be an exemplary patient advocate.  Carol’s patients have described her as “just like having an angel.”  Carol expands her role to improve workflows related to patient care along the continuum. She initiated a weekly leukemia multidisciplinary team huddle between inpatient and outpatient, as a platform to discuss the plan of care that includes team reports (physicians, clinic case manager, pharmacy, nurse navigation, clinical nurse specialist, physical therapy, social work, and clinical trials). As new therapies for leukemia and lymphoma continue to become available, there are ongoing opportunities to develop and standardize new workflows that optimize patient-centered outcomes. Most recently, Carol initiated a project aimed to improve the continuous administration of blinatumomab across practice settings. Carol led the workgroup using an A3 process to assess, identify, implement, and evaluate workflow components aimed to improve the workflow administration process and optimize quality, safety, and patient experience. Outcomes of the workgroup included a strengthened collective understanding of the many elements involved with the coordination of care for continuous infusions, a standardized insurance authorization letter to improve authorization timelines, delineation of roles, and contributions to standardized guidelines for the cancer center service line.

Innovations in Oncology Navigation

Winner: University of Miami Sylvester Comprehensive Cancer Center Navigation Program, Miami, Florida

University of Miami Sylvester Comprehensive Cancer Center Navigation Program
University of Miami Sylvester Comprehensive Cancer Center Navigation Program

The Sylvester Comprehensive Cancer Center navigation program was established in the 1990s and has a tumor-specific model with a team of more than 50 nurse navigators and support staff. Their catchment area is diverse and multicultural, in which they service a variety of patient populations. Over the course of 2 years they have integrated technology to be able to address important metrics that affect patient care. These include but are not limited to timeliness to first call, acuity, and barriers to care. They have also utilized their existing resources to build a tumor board module that will enhance the efficiency of their work and improve their communication throughout the patient care continuum.

In addition, they have implemented a telehealth option to connect with patients during the coronavirus disease 2019 (COVID-19) pandemic that will continue beyond the current climate called the SOON program (Sylvester Oncology On Demand Nursing). During these unprecedented times, they have added the coordination of virtual multidisciplinary clinics to enhance the patient experience and decrease delays in treatment to their workflows.

This oncology navigation team has been open to change and integrating technology to improve efficiencies and to enhance scope of practice. They are also actively involved in the community by providing special holiday events to nonprofit programs such as the Ronald McDonald House. Their outreach efforts have been extended to partnering with the local Haitian community to provide access and awareness of cancer services. Additionally, they have worked with the outreach team to provide cancer prevention education to their catchment area within South Florida.

The team has also volunteered to perform COVID-19 testing and support the employee hotline in addition to fulfilling their standard oncology navigation duties. They have done this with grace and compassion throughout the ongoing crisis in Florida.

First Runner Up: Darlene Armijo, BS; St Mary Corwin Dorcy Cancer Center, Pueblo, Colorado

Darlene Armijo, BS
Darlene Armijo, BS

Darlene Armijo will find a way to assist patients with food and housing when others have failed.  Darlene meets with every patient in the radiation center and her cancer center to assess their psychosocial needs and level of distress. She finds much needed financial support and helps patients complete their application for grants and other charity funds. Darlene has been able to help so many of our patients and relieve the financial toxicity in cancer care.

Outstanding Oncology Navigation Program

Winner: Lehigh Valley Cancer Institute Navigation Team, Allentown, Pennsylvania

Lehigh Valley Cancer Institute

The oncology nurse navigation team at the Lehigh Valley Cancer Institute was formed in 2013 as part of the National Community Cancer Centers Program (NCCCP) to increase quality care through navigation and the creation of multidisciplinary clinics (MDCs). Their model is primarily disease based and the team started with 2 breast navigators; a thoracic navigator and 2 bilingual navigators were later added. Over the past few years, additional navigators have been added for patients with head and neck cancer, upper gastrointestinal cancers, genitourinary cancers, and skin and soft tissue cancers. Presently, the team is comprised of 9 oncology certified nurses, 7 who are full time, 1 who is part time, and 1 recently retired per diem navigator. Two of the navigators are bilingual, speaking both Spanish and English. The navigators cover 3 campuses within the network, primarily in the outpatient setting. In addition to navigating patients from the time of diagnosis through survivorship, the team coordinates the MDCs, which requires triaging referrals, assessing each patient, consulting with the treatment team regarding necessary testing prior to the visit, educating the patient, presenting the cases at tumor board, coordinating the visit to include appropriate physicians and support staff, assuring the patient understands the treatment recommendations, and following up to make sure all post clinic appointments have been scheduled in a  timely manner. Each navigator within the team then continues to navigate patients throughout their course of treatment and into survivorship. The team receives approximately 1080 referrals for navigation per year and each navigator maintains an average active caseload of 125 patients in all stages of disease and treatment. Members of the team also coordinate up to 20 MDCs each month. The average monthly number of patient visits to the MDC is 40.

Recently, given the coronavirus disease 2019 (COVID-19) pandemic, the navigation team had to adapt quickly to the changes occurring on a daily basis. On March 6, 2020, changes in Medicare allowed payment for office, hospital, and other visits furnished via telehealth. On March 23, 2020, Pennsylvania instituted a stay-at-home order and MDCs were put on hold. The navigation team at Lehigh Valley Cancer Institute recognized the importance of the MDCs even in the face of the pandemic and took the initiative to integrate telehealth into their practice. The navigators created and organized telehealth visits for multiple providers in the MDC setting. Virtual MDC visits required the navigation team to assure WebEx access for themselves, providers, and patients; educate providers; work with IT and clerical staff to assure accurate scheduling, billing, and documentation; teach the MDC teams the new process; facilitate remote visits; and assure proper sign off.

The navigators were very busy assuring and supporting their patients who were so anxious during the pandemic, assisting them with getting them to necessary treatments, reassuring them if their treatment was put on hold temporarily. The “can do attitude” that resulted in the team creating a virtual MDC visit is just one example of their dedication to their patients and to providing quality care. One of the key reasons the navigators had a comfort level tackling the transition to virtual MDC visits was their close collaboration with their institution’s IT department. When the network made the switch to Epic as the electronic medical record in 2016, the navigation team was very involved in creating assessment and documentation tools to meet their needs in Epic. They also had to create a documentation tool specific to the MDCs to allow documentation by several providers and support staff in 1 visit, and to help assure the ability to properly bill both a facility fee and a hospital-based professional fee for the physician providers. The Epic build allowed data retrieval related to navigation (ie, caseload volumes and acuity scores). In the future, the team expects to extract data related to number and types of referrals made by navigators, and number and type of interventions.

First Runner Up: Regional Cancer Care Associates Central Jersey Division Patient Navigator Program, East Brunswick, New Jersey

Regional Cancer Care Associates LLC

Starting with just 1 navigator 18 months ago, the Patient Navigator Program at Regional Cancer Care Associates Central Jersey Division has quickly grown to a team of 5 navigators across their 5 office locations. The team overcame some of their initial challenges, including lack of standardization of the navigator role, the fact that each location was performing different tasks and there was confusion of the role between departments, and inconsistent documentation that did not allow for progress and success tracking. After identifying these barriers, a role for leadership was created and 1 of the nurse practitioners, Amita Patel, NP-C, became director of the patient navigator program. Amita created a workflow, and a clear delineation of tasks was designated to each department. Navigators across the program were tasked with meeting each patient at their initial visit to establish rapport and provide the patient with a comfortable point of contact in the office. At inception, the program’s initial completion rate of meeting with each new patient was at 25%. The team began creating reports of each new patient per location each day and at the end of each visit the navigator would discuss plan of care with the physician. The team documented these interactions and kept standardized records of each patient’s progress. After just 1 week of the new workflow, the new patient contact increased to 83% and the following week it rose further to 85%.