Implementing a Breast Screening Assessment Tool in the Inpatient Setting

Problem Addressed: In a recent discussion review on the number of women being screened at the Women’s Imaging Center, the nurse navigator noticed that there was no screening program for women in the inpatient setting. After several inquiries about this issue, the nurse navigator took her findings to the Cancer Committee. Early detection and prevention are essential in decreasing a woman’s mortality from breast cancer. Breast cancer is ranked highest of noncutaneous cancers and the second leading cause of cancer death among women in the United States.¹ Fortunately, mammography screening is associated with a 19% overall reduction of breast cancer mortality.¹ The problem being addressed is that women all too often forgo or avoid their yearly mammograms for personal reasons. The American College of Radiology estimates that 40% of women over the age of 40 years are avoiding their yearly mammograms.²

Objectives: The objectives of the project were to develop a simple assessment tool that screened 100% of patients upon admission to the inpatient setting to identify women over the age of 40 years who had not had a mammogram within the past 12 months. Once a patient in need of a mammogram was identified using the tool, the electronic medical record (EMR) system would notify the woman’s primary care physician (PCP), if the patient belonged to Signature Medical Group (SMG), as well as the nurse navigator. If the woman had an outside provider not affiliated with SMG, then the nurse navigator would be consulted to speak with the woman and notify her PCP directly. It was important to incorporate the nurse navigator in the project because she can speak with these women directly and identify possible barriers that would prevent them from going to their screening mammogram appointment. The tool had to be easy, quick, and efficient enough for nursing staff to use. The tool would also allow the hospital to collect data comparing the women screened with those who were identified as needing a mammogram. Since there are many different suggestions on when women should begin screening mammograms, it was decided by the Breast Cancer Committee to follow the recommendations of the American College of Radiology, which state that annual mammography starts at age 40 years to save the most lives.²

Intervention Implemented: A change was implemented on 1 unit as a pilot program to collect and measure the data from the breast screening assessment tool. If the data yield positive results and show that the number of women requiring a mammogram was at least 15% of all women screened, it will be implemented throughout the hospital.

Methods: The first action was to obtain evidence-based practice (EBP) research articles to identify the best practice for this problem. The project is unlike any other type of breast screening assessment tool; therefore, the finding for EBP was unavailable. It is the hope of the organization to conduct a case study based on the data collected from the project and present its findings with several oncology journals. The second action was to meet with physicians in oncology, radiology, and radiation therapy to obtain information on policies and protocols currently in practice for screening women. The third action was to develop an algorithm of the assessment tool for the EMR program. The final step was presenting the need for implementing the assessment tool to various committees within the practice.

Evaluation Strategies: In evaluating the outcomes, the implementation of the breast screening tool and collecting data is ongoing. The algorithm has been approved by Informational Technologies (IT) and the Nursing Leadership and Standards Committee. However, IT has come across a program communications issue between the 2 software programs involved with this project. IT is hopeful that this problem between the 2 software companies will be resolved shortly and the project can be up and running by August 2016. The plan is to collect and evaluate data over a 1-, 3-, 6-, and 12-month period to make a determination on the project being a successful and useful instrument in screening women in the inpatient setting requiring an annual mammogram. The algorithm has been presented to several hospital committees, such as the Cancer Committee, Breast Cancer Committee, Tumor Board, and Nursing Leadership, and Management. The assessment tool has received positive feedback and the gained approval to move forward in implementing the pilot program based on the recommendations of these committees. In a recent nursing education presentation, the author simulated the use of the algorithm and was able to capture 29% of the audience in need of a mammogram.

To date, management and nurses at the hospital have been receptive to the education about breast cancer screening, and their evaluation of the education has been positive.

Outcomes: The final outcomes of this study are pending and yielding positive results in anecdotal feedback.

Conclusions: The data collection using the breast screening tool is ongoing. However, simulation of the tool with nurses in an educational setting shows a capture rate of 29%. Due to the success in the educational setting, it is the authors’ recommendation to continue using this algorithm in the hospital nursing admission assessment to identify women, during their inpatient stay, in need of their annual mammogram.

References

1. Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327-1335.
2. American College of Radiology. (n.d.). www.acr.org.