Harnessing the Power of the DNP: Leading the Development and Implementation of an Evidence Based Clinical Program JOELLE FATHI, DNP, RN, ARNP, CTTS

Transcription

1 Harnessing the Power of the DNP: Leading the Development and Implementation of an Evidence Based Clinical Program JOELLE FATHI, DNP, RN, ARNP, CTTS

2 Objectives Identify innovative ways in which the DNP can utilize their training and special interests to impact positive health care outcomes. Recognize the direct application of the DNP training and skills in various clinical settings while advancing the delivery of healthcare. Identify the critical roles the DNP fills as a transformational leader, a change agent in translating evidence to the bedside, and in the delivery of clinical excellence.

3 It is not just Academics but the Journey that Defines Us BSN MN, ARNP DNP

4 Doctors of Nursing Practice Meeting the Nation s Health Care Needs Leadership Practice Inquiry Advanced Practice

5 Responsibility to Meet Quality Standards Six Dimensions of Quality Healthcare AcrosstheChasmSixAimsforChangingtheHealthCareSystem.aspx

6 The DNP in Action Swedish Tobacco Related Diseases and Lung Cancer Screening Program

7 Annual Mortality from Tobacco Related Diseases One of every 5 deaths are tobacco related One of every 3 cancers are tobacco related Life expectancy for smokers is at least 10 years shorter than for those who are never smokers Smoking causes 90% of all lung cancers

8 Lung Cancer is the Leading Cause of Cancer Related Mortality

9 The Power of Research International Early Lung Cancer Action Program (IELCAP) 80% 10 year survival with low dose CT scan National Lung Screening Trial (NLST) 20% reduction in lung cancer mortality 6.7% reduction in all cause mortality National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lungcancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5): International Early Lung Cancer Action Program I, Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006;355(17):

10 Scientific Evidence Emerges into Clinical Care United States Preventive Services Task Force delivers a Grade B recommendation for lung cancer screening in high risk persons. Ages Currently smoking or quit in past 15 years Minimum 30 pack year history of smoking Affordable Care Act mandates coverage for Grade A and B USPSTF recommendations CMS returned a favorable National Coverage Determination 10 million Americans qualify for this screening

11 Screening Saves Lives Before low dose CT screening 15% were alive in 5 years With the benefit of low dose CT screening 80% were alive in 10 years

12 Coping with False Positive Findings 24% to 30% of all screened will have abnormality/ lung nodules (false positive) Only 2% to 3% of those nodules will be malignant 96.4% of those nodules will be benign This clinical scenario can cause significant psychological distress and anxiety

13 Addressing Smoking Cessation Annual Quit Data 70% want to quit 52% make a quit attempt every year 3% are successful quitting on their own Benefit of Multi-Modal Therapy 3% quit on advice alone 10% with counseling % with counseling, medication treatment, and clinical follow-up CDC, Quitting smoking among adults - United States, Morb Mortal Wkly Rep 2011; 60: Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004, 99: 29-38

14 Essentials to Screening Safely and Responsibly Adherence to eligibility criteria Adherence to shared decision making encounter Radiology component has to be in place Adherence to nodule management guidelines is essential Counsel to avoid anxiety Ensure NO nodule is left behind! Multidisciplinary clinical team oversight Address smoking cessation

15 A Program is Born Swedish Tobacco Related Diseases and Lung Cancer Screening Program Tobacco Related Diseases Evaluation Low CT scan and counseling Tobacco cessation counseling and treatment with follow-up

16 Case Study 75 year old female with 50 pack year history of smoking Quit 13 years ago In good health, works part time and travels frequently First baseline low dose CT scan in 2013

17 Nodule #1, mm Right Middle Lobe

18 Nodule #1, mm Right Middle Lobe, Unchanged

19 Nodule #1, mm Right Middle Lobe, Unchanged

20 Nodule #2, mm Right Lower Lobe

21 Nodule #2, mm Right Lower Lobe, Unchanged

22 Nodule #2, mm Right Lower Lobe, Unchanged

23 Nodule #3, mm x 4.5mm Right Lower Lobe

24 Nodule #3, mm x 4.5mm Right Lower Lobe, Unchanged

25 Nodule #3, mm x 9mm Right Lower Lobe, Changed!

26 Clinical Outcome Underwent right lower lobe wedge resection Hospitalization for 24 hours Diagnosed with a Stage I lung cancer Cured of lung cancer with no need for adjuvant chemotherapy or radiation Will continue under surveillance by low dose CT scan

27 Tobacco Related Diseases and Lung Cancer Screening Program Statistics % monthly growth (n=305) Early stage lung cancers detected = 8 Late stage lung cancer detected= 1 Metastatic pancreatic cancer detected=1 Tobacco related diseases detected 63% with CAD 38% with emphysema 8% with aortic dilation or aneurysm Smoking cessation 60% of those smoking on initial assessment have quit smoking on follow-up visit

28 Complimentary Clinical Programs Incidental Pulmonary Nodule Clinic TeleLung and TeleTobacco Center for Nicotine Dependence

29 We Don t Succeed Alone Collaboration is essential for change and a critical competency for achieving and sustaining high performance.

30 Transformational Leadership and Collaborative Partnerships

31 Collaboration Calls for Convergence of Professions Quality and Patient Centered Care

32 Critical Elements of a Collaborative Partnership Communicate and Build Cohesion Create Shared Vision and Purpose Encourage Diversity by Including all Members Develop Trusting Relationships Kouzes, J. M., & Posner, B. Z. (2007). The leadership challenge (4th ed.)

33 Create Shared Vision and Purpose Shared goals A collective focus bonds people/teams Shared goals give reason to be together

34 Communication and Cohesion Communicate openly, often, and face-to-face Include everyone on the team Err on the side of over communicating Fix things when communication goes wrong

35 Encourage Diversity Include everyone Diversity creates synergy Learn from others

36 Develop Trusting Relationships A team is defined by working with others People have to rely on others The heart of collaboration is trust You can t get extraordinary things done without trust Trust begets trust

37 Working in Collaborative Partnerships We Can

38 Innovating on the Front Lines of Clinical Health Care: You Can Do It! Identify a clinical need Conduct a needs assessment Evaluate best clinical practices Survey existing evidence Identify and consult with stakeholders Translate evidence to clinical care with programmatic elements Collaborate with others every step of the way Set your goals high, and plan proactively Don t forget that people are looking to you for leadership

39 Visualize the DNP in YOU! Clinician Leader Educator Researcher Author

40 Alone we can do so little; together we can do so much. Helen Keller

41 Thank you very much!