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Getting it Right the First Time: Oncology RN Telephone Triage
Board / Thu 12:08, 07 Apr 2016

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Getting it Right the First Time: Oncology RN Telephone Triage

Background:

•For the past 20 years, cancer patients have been treated in outpatient settings limiting extended face-to-face contact seen in previous extended inpatient admissions.1

 

•Telephone triage in the ambulatory setting is another venue to  address patient/ family needs for these shorter visits.1

 

•Necessary elements for quality telephone-based nursing care: (a) access to protocols to guide the assessment and advice provided, (b) documentation of calls, (c) quality monitoring, and (d) training.2

 

•With this service, there is an assumption that face-to face assessment skills are directly transferable to the telephone. However, nurses report more training is needed and one study found the quality of communication from the telephone triage nurse was an important factor influencing patient compliance.3

 

Purpose: Purpose was three-fold:

1.Standardize process for telephone triage at University of Colorado Hospital Cancer Center (UCH/CC).
a)Identify a resource for Oncology specific telephone triage protocol.
2.Integrate Oncology Nursing Society (ONS) telephone triage text into the Electronic Health Record (EHR).
3.Educate RNs on protocols and documentation.

Interventions:

Licensing agreement with ONS to purchase telephone triage templates for EHR

Written approval from Medical Director for RN use of protocols

RN training, Education planning and development

Pilot” group began in March, 2015, option for six 1 hr sessions, and one 4 hr hands-on practice in computer lab with Information Technology (IT) support

IT team built protocols with UCH RNs validation process to approve for implementation into EHR

Training revamped per feedback from initial attendees

Total impact: 106 RNs x 5 hrs = 530 hrs RN training completed

Discussion/Implications for Practice:

•Participants reported both increased proficiency in use of protocols within EHR (from 42% to 49%) and knowledge of ONS triage book (from 36% to 54%).
•Manual chart audit (431 telephone triage encounters) only 11 calls were documented as using the ONS protocols in the EHR (2.55%).
•Implications for practice: Assess barriers to usage and/or need for additional education and training.
 
References:
1.Hickey, M. & Newton, S. (2013). Telephone Triage for Oncology Nurses (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.
2.Stacey, D., Macartney, G., Carley, M., Harrison, M. B. & The Pan-Canadian Oncology Symptom Triage and Remote Support Group (COSTaRS). (2013). Development and evaluation of Evidence-Informed Clinical Nursing Protocols for Remote Assessment, Triage and Support of Cancer Treatment-Induced Symptoms. Nursing Research and Practice, 2013, 1-11.
3.Purc-Stephenson, R. J. & Thrasher, C. (2011). Patient compliance with telephone triage recommendations: A meta-analytic review. Patient Education and Counseling, 87(2012), 135-142.

 

 

 

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