Training Pack 24 HOUR TRIAGE RAPID ASSESSMENT AND ACCESS TOOL KIT

Training Pack 24 HOUR TRIAGE RAPID ASSESSMENT AND ACCESS TOOL KIT

The training pack aims to; provide background information regarding the aims and objectives of the tool kit. provide an explanation and rationale for each step of the process allow the trainee to question the process support the trainee and act as a reference point for practice

At present there are no consistent national guidelines in place to support practitioners in helpline patient management. The steering and development group of Central West and Wales UKONS members have over a three year period developed, designed and piloted the: 24 HOUR TRIAGE, RAPID ASSESSMENT AND ACCESS TOOL KIT. The tool if used correctly provides safe and understandable guidelines and advice for both staff and patients. The process is easy and reliable with clear instructions and an established pathway. The tool is user friendly and is utilised well. Practitioners have stated that it ; has standardised care and supported decision making. provides a framework for training and competency assessment. supports governance and audit processes. Feedback from practitioners assures us that with regular use the whole assessment process is improved in quality, structure and time taken.

Background The Tool Kit has been developed over a 3 year period by a group of experienced senior nurses working within chemotherapy haematology and oncology. Supported by UK Oncology Nursing Society Oncology and Haematology involvement. Multidisciplinary consultation. Supported by the U.K. National Patient Safety Agency Meets national recommendations,ncepod,ncag and Acute Oncology Measures Extensive pilot,19 cancer centres and 17 cancer units have been involved. Pilot commencing in Australia in late 2011

The groups aim was to gather expertise and evidence and develop triage guidelines that would; Improve patient safety and care by ensuring that they receive a robust, reliable assessment (triage) every time they contact a helpline for advice Those assessments (triage) are of a consistent quality and use an evidence based assessment (triage)tool That management and advice is appropriate to the patients level of risk. This will ensure that those patients who require urgent assessment in an acute area are identified and that action is taken, but also to identify and reassure those patients who are at lower risk and may safely be managed by the primary care team or a planned clinical review and avoid unnecessary attendance To develop guidelines that would form the basis of triage training and competency assessment for practitioners.

Who should receive training?

All staff who are expected to man a 24 Hour Triage Service including; Medical staff following completion of in house education and successful completion of triage competencies Nurses who have a recognised qualification in the care of a patient receiving chemotherapy and successful completion of triage competencies Approved triage practitioners will be assessed annually in line with oncology annual assessment programme.

Training process Supported study session with : Educational slides Scenario/role play Practice observation Competency Assessment (linked to KSF)

Triage pathway Triage Practitioner Triage and log Sheet Attend for assessment Review/follow up within 24 hours Advice/reassurance Review of all Log Sheets within 24 hours: What happened to Red patients? Call and review amber patients Confirm decision of Green Patients Triage Practitioner

TOOL KIT CONTENTS

Tool Kit Manual This document contains: A brief development history Rationale for use Detailed instructions for use Triage process map Examples of all component parts A competency framework ESSENTIAL READING!!

Alert card All patients should be issued with an alert card with 24 hour contact numbers. We should rehearse situations with patients to ensure that they understand when and who they should contact if they have a problem

Triage Pathway A process map that details each step of the pathway. The pathway should be agreed by the trust. 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 Each step of the pathway must be completed

Triage Interview Perform a rapid initial assessment of the situation Is this an emergency?...999 Ask questions in a logical sequence. Follow the log sheet and the assessment tool. Speak to the patient directly whenever possible Provide information slowly and thoughtfully assessing the patients comprehension, anxiety and distress throughout the process Adopt a calm and sensitive approach

Triage Log sheet Contact Record It is vitally important that the data collection process is methodical and thorough in order for it to be useful and provide an accurate record of the triage assessment. A log sheet should be completed for all calls and unscheduled patient visits. This will facilitate audit of the helpline service. The Triage boxes MUST all be marked accordingly. IF YOU HAVN T TICKED IT,YOU HAVN T ASKED IT!!!

Data Collection Data collected should be; C A L C U T A complete accurate legible concise useful traceable auditable Step 1. Explain that you have a number of questions to ask and information that you will need to collect to make sure that you give the correct advice. Step 2. Move methodically down the triage assessment tool. e.g. do you have any nausea? If NO tick green and move on If YES use the questions provided to help you grade the problem and tick either amber or red. Step 3. Advise the patient of the action to be taken and record this on the log sheet

Triage Tool A tool that will determine the patients level of risk. Prompt the practitioner with appropriate questions to ask in order to gain information from the patient Provide a reliable guide to toxicity/problem grading Prioritise the level of urgency indicated by the presenting symptoms and will aid in identifying potential emergency situations

Assessment tool RED any toxicities graded here take priority and assessment should follow immediately. 2 AMBER Two or more amber toxicities should be escalated to red action and assessment should follow immediately.. Amber one toxicity in amber should be reviewed/ followed up within 24 hours and the caller should be instructed to call back if they continue to have concerns or their condition deteriorates Green callers should be instructed to call back if they continue to have concerns or their condition deteriorates.

Assessment face to face consultation and assessment by an appropriately trained and qualified member of the clinical team. This assessment should take place in an appropriate area that provides access to investigation and treatment facilities. Patients should be asked to attend as soon as possible for assessment and transport arranged for them to do so if required

Review/Follow Up one toxicity in this area should be reviewed/followed up within 24 hours.this may be a telephone consultation or an urgent review clinic appointment. Advise patients should be given reassurance that the problem at present does not give cause for concern but they should be vigilant and if the situation gets worse or does not improve they should call back immediately.

Exceptions If in the triage practitioners clinical judgement the guideline is not appropriate to that individual situation the rationale for that decision should be clearly documented. If the triage practitioners assessment is borderline select higher risk category, be cautious!

Follow up All Log sheets should be reviewed within 24 hours; Was this the correct advice Call the patient to assess if they are improving or not Follow the patient were they admitted or not? Admitted..find them and check treatment. Discharged.. call to see if they are improving. Original log sheets should be filed in the patients medical records. Duplicates retained for helpline audit.

Competency Framework

This assessment should be undertaken by all staff who are expected to manage 24 hour triage helplines. Assessment will include observed practice, scenario assessment and discussion. Assessment sheet will be signed by nominated assessor and also by practitioner to confirm competence.

Audit Please ensure that all copies of Log sheets are retained safely for audit and clinical governance purposes. Information may be entered onto a data base.

WHY DO WE NEED TO SUCCEED? The following scenarios are real life occurrences that have been reported as adverse events. July 11 P.J.Jones UKONS/GMCN 27

Patient on chemotherapy, had pyrexia of 39.1 0 c,shaking,feeling very unwell, vomiting and diarrhoea patients wife rang medical registrar, was told she had a choice she could telephone for an ambulance and attend A&E or call emergency GP she opted to contact the G.P. The patient was discharged post chemotherapy with recovering blood counts. The Clinical Nurse Specialist contacted the patient and gave them aftercare advice and the emergency contact number. When the patient became pyrexial 38 0 c he followed CNS advice and contacted the Helpline number/ward. The person who took the call told him to take some paracetamol. July 11 P.J.Jones UKONS/GMCN 28

Patient receiving chemotherapy with a history of neutropaenic sepsis following each previous cycle of treatment. Telephoned A&E for advice as she had a raised temperature. She was advised to take regular paracetamol and to report if temperature of 38.0 0 c whilst on paracetamol. Patient presented at chemotherapy clinic, unwell, pyrexia 38.0 0 c and neutrophils 0.1x10x9/L. Immediate admission for treatment of neutropaenic sepsis. July 11 P.J.Jones UKONS/GMCN 29

Any questions? Please read the 24 Hour Triage Document fully prior to use. Good Luck!