Implementing a 24 hour telephone triage system for Haematology patients following chemotherapy and bone marrow transplant. Presented by: Paul Hickey

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Implementing a 24 hour telephone triage system
for Haematology patients following chemotherapy
and bone marrow transplant.Presented by Paul
Hickey Amy Sinacola Macmillan Haematology
Clinical Nurse Specialists
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The Haematology Patients journey
DIAGNOSIS
SUPPORTIVE CARE. Blood products, antibiotics,
symptom control
CHEMOTHERAPY (inpatient or outpatient) 2-6 cycles
BONE MARROW TRANSPLANT auto/allo/mud
REMISSION AND LONG TERM FOLLOW UP
POST TRANSPLANT MONITORING immunosuppressants,
infection, graft vs host disease, renal impairment
RELAPSE
CURE
PALLIATION
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The need for a triage tool
Telephone calls received by different members of
staff (ward nurses, day unit nurses, CNS,
transplant co-ordinators)
Unsafe advice sometimes given but no way of
finding out how to address individuals training
needs
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.

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
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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 AE
  attendance
• An agreed service specification for 24 hour
  telephone advice
• Patient education on symptoms and who to contact
  if unwell

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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
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Implementing the Triage service

• Documentation
• Training
• Technical
• Patient education and awareness
• Staff education and awareness (Acute Oncology
  Service, Medics, day unit)
• Database and audit

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

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

• CNS lead
• Training
• Rota
• Audit

Listening and responding

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

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

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Patient experience
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
Ive been told to go to AE I have been admitted
because I have had an infection
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 know I have phoned a lot but I have never been
made to feel a nuisance and I have always
received good advice.
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Problems and challenges

• Managing expectations
• Clinical need and bed availability
• Geography of patients
• Trafford Hospital
• Workload and time
• Administrative support

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Future developments

• Adapt flowchart to incorporate Trafford patients,
  transplant patients and links
• with ambulance control and acute oncology
  services at other regional AEs
• 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