Nurse-Led Interprofessional Collaboration: Increasing Colorectal Cancer Screening Completion

Background: In healthcare, missed opportunities can have a profoundly negative impact on a patient’s well-being. Morbidity and mortality in colorectal cancer (CRC) are preventable when detected early. However, CRC continues to be the second leading cause of cancer-related deaths in the United States (US) and the third most common undiagnosed type in both genders (Cooper & Gelb, 2016). According to the Centers for Disease Control and Prevention (CDC, 2016), only 57.8% of persons who qualify will actually complete a screening modality. Collaboration among healthcare providers, nurses, ancillary staff, and patients has been shown to increase compliance with CRC screening.

Objective: A quality improvement task force was formed to incorporate additional evidence-based practice (EBP) initiatives to engage patients’ participation in CRC screening and increase HEDIS scores.

Methods: The following quality improvement opportunities were identified: 1) ineffective patient teaching, 2) specimen not being returned, 3) improper sample collection, 4) incorrect or invalid lab orders, and 5) no fecal immunochemical test (FIT) kit provided to patient. The task force worked with interprofessional partners in identifying additional challenges such as patients’ socioeconomic status; psychological, physical, and team challenges; and inconsistent patient teaching. The following process was launched to promote completion: 1) nurses completed daily pre-clinic chart reviews and FIT orders were placed and held in a pending status for adult patients (50-75 years) to alert the physician test was needed, 2) providers informed patients of the need for the test and signed off the orders, 3) nurses presented the FIT video and included a disposable plate to coincide with patients’ verbal instructions, 4) nurses initiated follow-up calls within one week to patients who had incomplete FIT test results, 5) the laboratory staff notified registration and nursing personnel when patient registration was required for “drop-off specimen” appointments, 6) nurses communicated with patients who needed additional education, and 7) a monthly drill-down was performed to identify outliers.

Results: Of the 2,267 patients that were tracked for 19 consecutive months, nurses completed follow-up calls resulting in 1,648 patients completing the FIT. Nursing personnel were able to improve the ambulatory health center’s baseline FIT completion rate from 52% in February 2017 to 76% by September 2018. This completion rate is above the Healthcare Effectiveness Data and Information Set (HEDIS) benchmark of 64%. In addition, 330 of the patients had a positive stool test requiring further work up.

Conclusion: The nurse-led interprofessional quality task force initiative showed a remarkable 24% increase in CRC patient compliance. Nurses are playing an important role in promoting patient compliance with CRC screening. The initiative hopefully allows for earlier detection and treatment to decrease the morbidity and mortality associated with CRC.