ABSTRACT
In December 2020, the Food and Drug Administration (FDA) granted emergency use authorization (EUA) for the first monoclonal antibody (MoAB) for non-hospitalized COVID-19 patients at high risk for hospitalization or severe disease. Since then, four antibodies targeting variants of COVID-19 have received EUA. Initially, the outpatient rapid evaluation clinic (REC), which provides cancer treatment and assessment of COVID-positive oncology patients, was identified as the location for all patients in the healthcare system to receive MoAB infusions, based on staff familiarity administering MoABs and managing hypersensitivity reactions. The REC accepted patients from five system hospitals, satellite sites, and non-system community referrals. However, REC space also needed to be reserved for oncology patients. Facing competing demand for space as MoAB infusion volume increased, a solution was to identify and educate other clinical areas on MoAB administration. Our purpose was to develop an educational program for staff competency in MoAB administration at identified infusion sites across the delivery network. Infusion sites were selected by each hospital and included adult and pediatric outpatient infusion areas and emergency departments. Standardized education was developed for all nurses administering MoABs. This education included: an overview of the drug and EUA approved indications, when patients no longer meet the parameters for infusion, review of the templated order-set, hold parameters, administration of medication, required documentation, and management of hypersensitivity reactions. A standardized educational sheet was developed for patients that was inclusive of all MoABs being used to treat COVID-19. Additionally, Epic smart-phrases were used to template the nursing infusion note and discharge instructions for standardization across all sites. From the inception of the MoAB program to present day, 13 adult and pediatric infusion sites have been educated with more locations identified. Staff have verbalized increased comfort with review of infusion process and management of hypersensitivity reactions. After 20 months, over 6,800 patients have been treated with MoABs across the healthcare system to prevent hospitalization or severe disease. By providing education to nurses across the healthcare system, 53% of patients were able to be treated closer to their community, optimizing the number of treatments available for non-oncology COVID patients. In the process, the REC was re-established as a dedicated site for oncology patients and their special needs in the face of COVID, maintaining continuity and quality of care.
ABSTRACT
Oncology Nursing Practice COVID-19 recovery presented nursing leadership with opportunities to document productivity measures for oncology nursing services rendered and potentially impact revenue. A nurse billing and charge capture committee composed of network nursing and revenue department team members was convened to establish billable and productivity related nursing tasks. The purpose was to identify ambulatory oncology nursing practice that would generate billable revenue, identify non-billable tasks that could generate statistical codes to measure productivity, and create an educational plan to implement changes in nursing practice to support billing. Committee leads identified key stakeholders from each of the health system network sites to participate. The committee assessed and categorized nursing practice into actions such as central line maintenance and phlebotomy to support nursing revenue (billable) versus distinct productivity measures that were documented by nursing time (non-billable). Both groups included the nursing professional development specialists who engaged nursing informatics and the IT department. Their collaboration led to standardized nursing documentation using EPIC smart phrases, charge capture codes, and stat codes for productivity. The revenue integrity team ensured charges and statistical codes were compliant with regulatory standards. EPIC analysts optimized nursing documentation by creating smart phrases to support billing and track nursing time. Departmental reports used the smart phrases to identify patients to support nursing documentation compliance. For non-billable items, the smart phrases and documented time interval were used to capture productivity. The reports were monitored for nursing documentation and charge capture compliance. In the first two fiscal quarters, 1,421 nurse billing items were documented as well as 1,648 non-billable items that totaled over 440 hours of nursing time. Results were discussed at leadership and staff meetings. The revenue group identified and prioritized a list of oncology nursing functions that were associated with chargeable specific Current Procedure Terminology (CPT) codes. Initially, two nursing tasks, central line maintenance and therapeutic phlebotomy, were implemented. Other chargeable tasks that followed included in person chemotherapy and pre-operative/post-operative teaching visits, port assessment, chemotherapy pump and peripheral line assessment follow up, dressing changes and skin assessment. The productivity group defined and prioritized a list of productivity measures which included telephone encounters, authorization and registration, form completion (FMLA, disability, prior authorization, and oral medications), chemotherapy and preoperative/postoperative teaching which occurred in tandem with provider visits or by video or telephone.