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Assessing the acute oncology patient Who, why, where and how!

Assessing the acute oncology patient Who, why, where and how!. Clare Warnock, Practice Development Sister, WPH Kam Singh, Specialist nurse, WPH Cherie Rushton, sister, ward 2, WPH Stacey Spenser, BSc health and social care student Sue Shepley, WPH. Aim of this session.

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Assessing the acute oncology patient Who, why, where and how!

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  1. Assessing the acute oncology patient Who, why, where and how! Clare Warnock, Practice Development Sister, WPH Kam Singh, Specialist nurse, WPH Cherie Rushton, sister, ward 2, WPH Stacey Spenser, BSc health and social care student Sue Shepley, WPH

  2. Aim of this session Provide insight into the AOS needs of patients within the NT cancer network How many patients seek AOS support Which patients seek advice Why do they need help What type of support do they need How do we currently provided AOS support What tools do we have to help

  3. Triage assessment Triage = the process of determining the priority of patients' treatments based on the severity of their condition UKONS standards for triage - what do we have in place? The triage practitioner has the right of admission √ There should be an identified assessment area √ There should be a clearly identified triage practitioner for each span of duty √ There should be a process for each step of the triage pathway √ Each step provides insights into the AOS service

  4. Triage pathway Triage Practitioner Triage and log Sheet Attend for assessment WPH or A&E Advice/reassurance Follow assessment guidelines - advice on appropriate care location/service. e.g. pharmacy, GP, self monitor

  5. Who is using the service?

  6. How many calls do we receive? • 4 reviews have been carried out at WPH • October 2009 = 129 calls • October 2010 = 291 calls • April 2012 = 483 • April 2013 = 544 • July 2013 = 562 • The number of calls per month and per day vary widely

  7. Number of calls per day (July 2013)

  8. Time of day of calls

  9. Challenge of unpredictable demands • There was a wide variation in volume of telephone calls each month and each day • We did not find a pattern • The service need to meet a highly unpredictable workload • This presents a challenge faced when trying to plan and deliver oncology telephone triage services

  10. Which patients use the phone service

  11. Where do patients live (2009)?

  12. Primary diagnosis of patients

  13. Recent treatment (2013)

  14. Reason for ringing (2013)Chemotherapy treatment related

  15. Other common reasons for ringing (all patients) • Pain = 55 • Major illness = 45 • E.G. chest pain, deranged U&E, bowel obstruction, spinal cord compression, sudden confusion • Medicines advice = 33 • Minor ailments = 40 • E.G. Small bleed, infected toe, constipation, sore eye • General query = 18 • E.G. DN fax, appointment query, dental advice • Radiotherapy side effects = 10

  16. What happens when a patient or relative rings for advice?

  17. Triage pathway Triage Practitioner Follow assessment guidelines - advice on appropriate care location/service. e.g. pharmacy, GP, self monitor Advice/reassurance Attend for assessment Cancer centre, A&E

  18. How to decide assessment outcomes? • Tools for triage • Telephone triage – based on UKONS triage guidelines • AOS guidelines • Based on assessment of symptom severity and clinical signs • With elements of experience, intuition and hunches • Colour coded grading of • Minor (green) • Moderate (amber) • Severe (red)

  19. Action following assessment Green– follow advice on guidelines. 1 amber – follow advice in guidelines. Ask patient to ring back if symptoms do not improve or worsen 2 or more amber – organise appropriate medical review WAU, GP, local A&E, next OPA Red – medical review at WPH unless alternative appropriate e.g. A&E for cardiac chest pain, conditions that might require surgical intervention

  20. AOS assessment and treatment guidelines Local guidelines have been developed WPH guidelines are accessible on th intranet

  21. What are the outcomes of the calls?

  22. Outcomes of calls (2013)

  23. Are we getting it right? 3 reviews have evaluated whether phone advice was appropriate 2009 = 84.4% appropriate Incorrect advice = 7 Not enough information documented = 7 2010 = 87.2% appropriate Incorrect advice = 17 Not enough information = 6 2012 = 92% appropriate Incorrect advice = 12 Not enough information = 21

  24. Which patients attend the cancer centre for review?

  25. Attending for review • Patients attend WAU for medical review • 8 bedded unit • Figures for January to July 2011 • range 96 to 189 per month (mean 136) • Review January 2013 • 206 patients • September 2013 • 231 patients

  26. Number of patients per day (September 2013)

  27. Time of day that patients arrived(September 2013)

  28. Where do patients live (2013)

  29. Reason for treatment related admissions (June 2011)

  30. Non treatment related reasons for patients on active treatment in the past 6 weeks

  31. Patients who had not received active treatment in the last 6 weeks

  32. What care do patients need on WAU? • Medical and nursing assessment • Cannulation, IV fluids, medicines administration (oral, IV and IM), urinary catheterisation, phlebotomy • Tests and investigations • Information and support • explanation of treatments/condition, updating on the treatment plan • Consultation with senior medical staff/patients own consultant team • Transfer to wards

  33. How does the service measure up? • Three key activities were identified • observations, blood tests and cannulation. • Time for admission to observations • Range 3 minutes to 10 minutes, average 6.4 minutes • Time from admission to blood tests • Range 5 minutes to 30 minutes, average 15.2 minutes • Time from admission to Cannulation • Range 15 to 30 minutes, average 21.25 minutes

  34. Where do patients go next?

  35. Challenges of AOS and triage • Workload is variable and unpredictable • Can be a struggle to provide the service when busy • Undermines effectiveness and safety if not managed • Example of challenges: • Next call waiting while taking calls, • No time for review for patient on the phone • e.g. check ICE • Fitting in other roles (e.g. managing WAU and triage) • Patient triage and assessment isn’t easy! • requires skill and experience

  36. Is it worth it? • It IS proving to be a valuable resource for patients • Provides timely access to specialist advice and treatment • Prevents inappropriate admissions • Allays unnecessary patient anxiety • Valuable safety net • But it is a Challenging service to provide • Triage has never been funded as a separate service and has developed from existing resources • Its success over time means this should be reviewed as it is outgrowing the resources available

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