DiversityNursing Blog

By Joan Banovic

Judge's notes: This team made a change for the greater good. The initiative benefits not just the hospital but their community and beyond. They used a scientific, research-based approach and gained support from multidiscipline teams, management and administration.

It started with a single question: "Why can't I recycle this?" In the main operating room, we perform approximately 1,500 cases per month, all requiring sterile instrumentation, sterile water, sterile saline, packaged sterile supplies and implants. All of our supplies are packaged in disposable recyclable material. Operating rooms across the country contribute the largest amount of municipal trash in a hospital, secondary only to food services. If we were able to recycle half of what we used, we could make a major impact not only to our landfills and community, but potentially our small part of the world.

Jennifer Pallotta, BSN, RN, CNOR, inpatient operating room, masterminded the project. She empowered all who chose to become involved. Together, Jennifer and I spearheaded this massive undertaking. We gathered nurses, technicians, anesthesiologists and the Environmental Services Department staff to help assist with our endeavor. Together, we would all make a difference.

Our first step was educating ourselves in the art of recycling. We did it at home; how difficult could it be? We spoke with our managers and gained support and buy-in, for without them this huge practice change would have never been achievable. We joined our hospital-based "Green Team" and educated ourselves on what would be required. We then began to educate the staff, slowly introducing the concept of recycling product from the operating room. Surgery and anesthesia chairmen were informed of our initiative via emails and introductions at committee meetings. It was imperative that we had the surgery and anesthesia staff as involved as the perioperative personnel. An area of concern would be the Environmental Services Department, for without them our study could be in jeopardy. We were amazed at the enthusiasm that they displayed when we began our educational process with them. We informed them that without their support, our study would surely fail. It was a priority for Jennifer and me to ensure that they were comfortable with the process, and truly understood what a driving force their support would be. By empowering the Environmental Service Department, we gained allies that would last much longer than our study.

We initiated a pilot program. Phase I we monitored and measured five operating rooms: ENT/gynecological, laparoscopic, orthopedic, robotic and neurosurgical procedures. We would do this for a period of one month, three times a week. We would base our results on the amount of trash (weight) that we produced, separating only red bag waste from regular trash.

Coincidentally, the end of Phase I coincided with our institution's signing a Memorandum of Understanding with the Environmental Protection Agency. Not only did we have buy-in and support from our managers, but we also received support from our president and chief executive officer, as well as our executive vice president and chief nursing and patient care officer.
Once the one-month period was complete and we had our baseline statistics, the real fun began. We would need to educate staff on recycling of operating room supplies: What could be recycled as opposed to what could not be. What material was acceptable, and what we needed to watch out for. We began an educational program that consisted of in-services, posters, banners and giveaways. Jennifer and I made ourselves available at all times for questions and answers for whoever had concerns.

Phase II of our project began with the same five operating rooms, but the difference is that a recycling trash receptacle was now added. We learned from Phase I of our study that the majority of supplies placed into the red hazardous waste bag did not need to be there. A serendipitous moment came when we were able to remove the red bag receptacle from the operating rooms, and only have it available upon need. We were able to reduce our red bag waste by 50% percent; not only eliminating the financial cost of the bags, but also dramatically decreasing the cost of disposal.

During Phase II of our study we continued positive reinforcement, taking pictures of staff recycling to encourage the team. The staff members enjoyed seeing their photos displayed on the bulletin boards - all caught in the act of recycling. The staff began to take pride and ownership in the project, and began to realize that they were making a difference in something that they had full control over. Acts of positive peer pressure began to emerge. Recycling even caught on with our surgeons being more vigilant on where they disposed of their gowns and gloves; not wanting to contaminate the recyclable items.

The end of Phase II was celebrated amongst the staff. We held a party during our monthly staff in-service decorating the room, serving coffee and breakfast to the staff. We celebrated the fact that we as a team were able to increase our recycling by 34%, hence decreasing 34% of municipal waste that is dumped into our landfills. We cut our hazardous red bag waste by 50%, eliminating the cost of supplies of red bags as well as disposal fees. Our celebration ended with each registered nurse entering the operating suite with a 64-gallon blue recycling bin for each of the 22 operating rooms in the main operating arena. 

This greening initiative was very exciting. The recycling bug caught on. In an age where hospitals need to remain conscious of the earth and be aware of the potential hazards that we can add to the environment, the act of giving back and being green is something that we all can do. By recycling in the operating room, we showed the rest of the medical center that it was certainly possible for them to participate and play a part in this new culture.

This was truly the start of a new era all arising from one simple question, "Why can't I recycle this?"

What is your place of employment doing about recycling? 

Source: nursing.advanceweb.com

By Michael O'Connor

Wet snowflakes fell on that day after Christmas 1973 as she glanced out the window.

Nancy Whittaker just wanted to return a few presents with her boyfriend, but her parents worried about her making the 40-mile trip from Beatrice to Lincoln. Maybe it was best if they made the drive another day, after the weather improved.

Source: Omaha.com

By Heather Stringer

When Carrie Bilicki, RN, MSN, ACNS-BC, OCN, met a 60-year-old patient who had been diagnosed with aggressive endometrial cancer, she began to have a persistent — albeit unconventional — idea. 

Bilicki, a cancer nurse navigator in Wisconsin at the time, recently had attended a lecture about a progressive treatment for this type of cancer that involved using a chemotherapy drug traditionally prescribed for ovarian cancer. The patient’s cancer had spread to nearby organs, and she had a poor prognosis. Bilicki convinced the physicians to try the alternative medication. Unfortunately, the patient faced another serious hurdle: The insurance company would not cover the cost of the medication because it was not the standard treatment. At that point, the woman seemed to face the unenviable choice between cancer treatment and financial ruin.

Although patients and providers would like to hope this type of extreme dilemma is the exception, the case may be representative of the near future for two reasons. First, as a 60-year-old, the woman was a baby boomer, and researchers predict the incidence of cancer will increase dramatically as this large segment of the population ages. According to a study published in the Journal of Clinical Oncology in 2009, the U.S. can expect a 67% increase in cancer incidence among older adults between 2010 and 2030. 

Second, statistics suggest cancer treatment is becoming increasingly unaffordable, even for those with insurance who struggle to afford steep copayments. For example, The US Oncology Network — a national group of about 1,000 oncology physicians who treat more than 750,000 cancer patients per year — reported about half of the patients covered by a Medicare Part D plan have required copay assistance for oral chemotherapy for the past several years.

“My message to my peers is to know the financial resources available because there are hundreds of them,” Bilicki, who now is a clinical nurse specialist in breast services at Froedtert Center for Diagnostic Imaging in Milwaukee, Wis., said. “There are foundations, specialty organizations and websites that tell us where to get help. If a patient does not have an advocate to link them to that resource, they will never know it is available.” 

What's new?

For many patients, the desire to find a way to afford medication is driven not only by the fact that they have cancer, but also because the treatment options available today have increased the odds of survival. 

“By far one of the biggest advancements is more personalized medicine that targets cancer cells rather than traditional chemotherapy that did not differentiate between good and bad cells,” Kim George, RN, MSN, ACNS-BC, OCN, a cancer program consultant from Wichita Falls, Texas, said. “For example, now we can test biopsy tissue for specific tumor antigens and biomarkers and then prescribe treatments that target those antigens.” 

The advancements in cancer treatment also are reflected in improved survival rates. According to the Surveillance Epidemiology and End Results Cancer Statistics Review 1975-2009, for example, the 5-year survival rate for breast cancer among women in the U.S. between 1975 and 1977 was 75%. Between 2002 and 2008 that number jumped to 90%. During the same time periods, the 5-year survival rate for both men and women with colon cancer has increased from 50% to 65%. 

“Another major advancement has been the increase in availability of oral chemotherapy and biotherapy,” George said. “It has shifted the care setting. Years ago, the majority of cancer patients received IV infusions, and now more patients can take their medication orally at home. It is wonderful for convenience, and it is also less painful.” 

However, George said, reimbursement is not always a given with oral chemotherapy. “A lot of oncology medications are given off-label, which means that the FDA has not approved a drug for a specific diagnosis, so it may not be covered by some insurance policies,” she said. 

Point the way

The art of navigating the path to financial assistance for cancer medication is not simple, and organizations such as The US Oncology Network, based in The Woodlands, Texas, have hired professionals to help patients connect with funding resources and launched the OncologyRx Care Advantage pharmacy in 2006. Nurses in the network can refer patients to Care Advantage staff who help them apply for financial assistance. 

“The types of drugs used to treat cancer today are definitely more expensive than when I started working in oncology almost 30 years ago,” said Lori Lindsey, RN, MSN, NP, OCN, a clinical services program manager with The US Oncology Network. “Multidrug regimens, including oral targeted therapies, can sometimes cost $30,000 for a round of treatment, although the use of these drugs has markedly improved outcomes and increased survival for some diseases.” 

For patients who are uninsured, the best option is to apply directly to the drug manufacturer for patient assistance, said Meg Asher, a patient access coordinator/patient advocate lead at the Care Advantage pharmacy. “When we learn that a patient is without insurance, we notify the doctor’s office and send a manufacturer’s application to them for the patient’s use,” Asher said. “Under these circumstances, we will not be the dispensing pharmacy; the manufacturer has their own specified pharmacy that will service the patient.”

Even those who are insured under Medicare Part D often require assistance because the copayments can be thousands of dollars, Asher said. For these patients, the Care Advantage advocate team helps patients connect with various foundations that provide copay assistance in the form of grants. Some of the foundations assist patients who suffer from a specific disease, while others help those who are taking a specific drug for a disease. 

While some facilities have staff trained to help patients find financial assistance, this is not always the case. For these patients, one resource is the Patient Advocate Foundation, a nonprofit organization with case managers who help patients with life-threatening illnesses to maintain financial stability. 

“When I was a hospital nurse, I honestly didn’t know about a lot of the resources available to help patients after they left my care,” Pat Jolley, RN, the clinical director of research and reporting at PAF, said. “Many people have never had to ask for financial help in the past, and they are unaware that there are options. If they are newly diagnosed, we try to educate them about the likely expenses down the road to help identify potential problems. In my experience, when patients contact us saying they cannot afford one thing, it is usually just the tip of the iceberg.” 

For example, PAF assisted a 62-year-old woman with breast cancer who was insured, but she was having difficulty scheduling her needed mastectomy because of outstanding medical bills. She was living on Social Security disability payments, and her insurance did not cover surgeries, scans or tests. The woman received a bill for $50,000 that included the cost of previous care and several office visits. By negotiating with the hospital and the providers, the PAF case manager was able to reduce the bill to a total of $950 and also facilitate the scheduling of her mastectomy. 

Suffering in silence

For Bilicki, one of her personal goals is to encourage patients to consider the financial aspect of their cancer care before they decide to pursue a particular form of treatment. 
“Nobody wants to talk about their financial state, and I think far too often patients suffer in silence rather than saying that they are having trouble with copayments, so what I do is proactively tell them about some of the resources,” Bilicki said. “Just because they have insurance does not mean they will have resources to afford the costs, so I empower all patients right off the bat to proactively seek out assistance if they need it.”

After patients have been diagnosed with cancer, Bilicki encourages them to learn about the resources at the American Cancer Society, which has patient navigators trained to help people connect with financial resources. She also tells them about a group called Patient Resource LLC, which has a website and a patient magazine that includes national, state and local resources available for financial assistance. 
In the case of the woman with endometrial cancer who could not afford a medication that was not covered by her insurance, Bilicki helped her apply for the drug manufacturer’s patient assistance program. Based on her income and medical necessity, she qualified for full assistance. She was on the medication for 15 months, and, despite her initial grim prognosis, the cancer has been in remission for the past five years. 

“I can always remember the tears and fear in their eyes when I first meet patients, and each time it feels like I’ve won the lottery when I help them secure the treatment they need, and they start smiling again,” Bilicki said. “Part of my big mission for my colleagues is to advocate for these patients so they do not miss out on options that can change their lives.” 

A little help can mean a lot

Point the way for patients who need assistance financing cancer treatments, by seeking resources such as the following:

• PatientAdvocate.org — Provides sources for copay assistance and answers questions about disability and insurance processes
• PatientResource.com — Features information on different types of cancer, newsletters and financial and advocacy resources
• CureToday.com — Provides an extensive list of national resources for advocacy, financial and pharmaceutical assistance
• RxOutreach.org — A nonprofit organization that helps low-income families who cannot afford the medication they need 
• CDFund.org — Chronic Disease Fund — A nonprofit organization that helps patients obtain lifesaving medications
For a list of drug assistance programs from pharmaceutical companies, visit Cancersupportivecare.com/drug_assistance.html.

Source: Nurse.com

by David Tennebaum

The single-use timer that will wholesale for about a dollar is designed to make a nurse’s life easier.In medicine, time isn't just money: it can mean the difference between life and death. Clot-busters must be given in the first hour of arrival in a hectic emergency room. Intravenous medications can spoil, and catheters that overstay their welcome invite infection.