1. 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

2. The Haematology Patients journey
DIAGNOSIS
Blood products, antibiotics, symptom control
SUPPORTIVE CARE.
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

3. 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

4. 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

5. 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

6. Implementing the Triage service
Documentation
Training
Technical
Patient education and awareness
Staff education and awareness (Acute Oncology Service, Medics, day unit)
Database and audit

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

10. Listening and responding
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

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

12. Problems and challenges
Managing expectations
Clinical need and bed availability
Geography of patients
Trafford Hospital
Workload and time
Administrative support

13. 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