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Nancy E Cisneros

Excelsior College, USA

Title: Improving pediatric case management in home health

Biography

Biography: Nancy E Cisneros

Abstract

Problem

This project author recognized a deficiency in home-based care regarding a lack of a standardized pediatric case management model.  Due to this deficiency, and through evidence-based research, many post-bone marrow pediatric patients treated at hospitals are often not discharged home for aftercare and are kept in the hospital causing a great financial burden to the stakeholders along with added stress to patient and family. 

Purpose

The purpose of this capstone project is to provide through evidence-based practice that Registered Nurse (RN) case managers quarterback patient-and family-centered care through coordination, teamwork and collaboration within a vast interdisciplinary team; meeting positive outcomes/ goals, while decreasing re-hospitalizations that can offload the financial health costs. 

Goal

This capstone project seeks to position the pediatric cancer patient and family/caregivers as the core team member(s) and the drivers of a collaborative patient-centered care model in the home-based setting. The proposed model will evidence the unique aspect of teamwork and collaboration with the inter-disciplinary care team in the home health setting and the inter-disciplinary oncology treatment team based in the hospitals responsible for delivery of in-patient and follow-up medical care. 

Objectives

This author will demonstrate through education and leadership, the best practices to employ home-based patient-and family-centered care directly to the pediatric patient with the assistance of the larger interprofessional team.  The RN case manager’s knowledge will be gained and competencies met through observing YouTube video simulation of central line access with lab draw, and effectively communicating through coordination with the home health and hospital teams. 

Outcomes and Results

With the utilization of this proposed project, the pediatric post-bone marrow transplant cancer patient has enhanced home-based care outcomes and decreased risk of re-hospitalization, which has significantly impacted more than forty patients during 2016.  Additionally, the patient can be treated safely in their home setting which significantly decreasing the cost of care to the insurance companies, the hospitals, families, along with the security for the pediatric patient to be treated in their own loving homes.