My core role as an ONP is to follow up with new chemotherapy patients and patients discharged from the hospital proactively, as well as to perform comprehensive assessments, treatment planning, and symptom management for chemotherapy patients presenting with cancer-related symptoms.
I also manage oncological emergencies such as febrile neutropenia, DVT, PE, and hypercalcemia in collaboration with the oncology registrar. In doing this, I try to treat patients in the outpatient setting (e.g., chemotherapy unit) to avoid presentation in ED.
Lynnette, a 64-year-old female with metastatic colorectal cancer, contacted me complaining of increased shortness of breath. I asked her to see me for an assessment in the chemo unit. On examination, she was indeed short of breath. Her oxygen saturation level was reading at 91% on room air, and her pulse was rapid at 106 BPM. I ordered a blood test and a CT pulmonary angiography (CTPA) to rule out a pulmonary embolism. After the scan, I followed up with the radiologist, who confirmed that Lynnette had multiple PEs.
The CBC and metabolic panel results were within normal limits. I contacted Lynnette's oncologist to discuss the findings. I told her treating oncologist that I commenced Lynnette on a low-molecular-weight heparin twice daily, and that I taught her how to administer this to herself. Within two hours of presenting to me in the outpatient unit, Lynnette was discharged and on her way home. I followed up with Lynnette by phone the day after, and she felt competent administering the injections. She also felt reassured and safe with the followup care delivery. Lynnette felt much better within days and avoided a trip to the ED.
As an ONP, I am able to triage patients over the phone. However, sometimes complaints from patients receiving cancer care may require additional assessment and management. I try to treat cancer-related emergencies before the symptoms become so severe that a patient needs hospitalization. Patient waiting times are reduced, and outcomes are positively influenced.
How are you documenting the positive outcomes of your practice? Other than patient satisfaction surveys, how can I effectively document and emphasize the difference I make to my patients? Any suggestions are welcome.