Implementing a 24 hour telephone triage system for Haematology patients following chemotherapy and bone marrow transplant.

Presented by: Paul Hickey & Amy SinacolaMacmillan Haematology Clinical Nurse Specialists

The Haematology Patients journey

PALLIATION

DIAGNOSIS

CHEMOTHERAPY(inpatient or outpatient)2-6 cycles

REMISSION AND LONG TERM FOLLOW UP

SU

PP

OR

TIV

E C

AR

E.

Blo

od

pro

du

cts,

an

tibio

tics,

sym

pto

m c

on

tro

l

RELAPSE CURE

BONE MARROW TRANSPLANTauto/allo/mud

POST TRANSPLANT MONITORINGimmunosuppressants, infection, graft vs host disease, renal impairment

The need for a triage tool

“I had a temperature of 38 and rang the ward last night. I told them I was coming to clinic today so they told me to take paracetemol and wait to see the doctor today.”

Telephone calls received by different members of staff (ward nurses, day unit nurses, CNS’, transplant co-ordinators)

Different advice given depending on level of experience, knowledge of patient, workload of nurse taking call and bed availability at the time of call

No robust way of documenting calls or reviewing calls taken

Unsafe advice sometimes given but no way of finding out how to address individuals training needs

The UKONS Triage tool

Developed by the United Kingdom Oncology Nursing Society (UKONS) in

response to The Cancer Reform Strategy, The DOH Manual for cancer

services(2004) & The NHS constitution, 2009 which call for:

• Advice and assessment of chemotherapy related complications by appropriately trained staff.

• Assessment of unscheduled admissions prior to A&E attendance

• An agreed service specification for 24 hour telephone advice

• Patient education on symptoms and who to contact if unwell

Aims and objectives of the triage tool

UKONS has piloted, audited and validated a triage tool that provides:

ACCOUNTABILITY

ANY NURSE USING THE TOOL CAN PROVIDE ADVICE THAT IS SAFE,

CONSISTANT AND CORRECT

Implementing the Triage service

• Documentation

• Training

• Technical

• Patient education and awareness

• Staff education and awareness (Acute Oncology Service, Medics, day unit)

• Database and audit

Breakdown of triage calls April 2012-March 2013 (499 Calls)

36%

6%19%

18%

9%

2%

10%

A&EGPAdviceClinicDay unitWardInappropriate

Celebrate Success

Leadership

Delivers best patient care

Accountable

Communicates effectively

•Traceability of calls•Training needs identified•Auditable•Respond to complaints/concerns

•Safe, consistent advice•Appropriate follow up•Prompt follow up on admission•Improved patient experience

•Patient and families•Haematology team•Acute Oncology•Regional Haematology teams at admitting hospitals

Listening and responding

•CNS lead•Training•Rota•Audit

Patient experience

“Having this number has given me reassurance, comfort and confidence. I know that whatever time of day or night I phone I will be able to speak to someone and get good advice”

“I can sleep at night knowing I have this number to call if I feel unwell”

“I have always been given the correct advice, even if its not what I have wanted to hear. If I’ve been told to go to A&E I have been admitted because I have had an infection”

“I know I have phoned a lot but I have never been made to feel a nuisance and I have always received good advice. “

Problems and challenges

• Managing expectations

• Clinical need and bed availability

• Geography of patients

• Trafford Hospital

• Workload and time

• Administrative support

Future developments

• Adapt flowchart to incorporate Trafford patients, transplant patients and links

with ambulance control and acute oncology services at other regional A&E’s

• Development of a policy for patients requiring review and admission via

Haematology day unit

• User survey

• Extend training to more Haematology Nurses

• Monthly review of calls highlighting any that indicate training needs

• Quarterly report on calls received and full audit yearly

• Administrative support