Title: / Telephone Triage / Policy Number:
Regulation Reference: OMH Accreditation Standard 2.2, AACN Telehealth Standards, ONS Telephone Triage for Oncology Nurses / Effective Date:

Purpose:

The Telephone Triage department is designed to support our patient population with immediate and urgent assessment of actual or potential health needs, health promotion referrals, education, counseling referrals, decision support and coordination of care. The program assists with symptom management, refill authorizations, rescheduling of appointments, and other general patient questions.

Policy:

XXXXX is committed to ensure that patients and caregivers have access to a Telephone Triage service to provide information and support to our patients undergoingOncology, Hematology and Radiation therapies. The telephone lines are available to patients and/or caregivers Monday thru Friday from 08:30 a.m. to 5:00 p.m., except for major holidays. Afterhours and/or weekend access to triage is available utilizing Clinicians on call.

Telephone Triage involves skills that include competency in critical thinking, decision making, expert clinical skills and judgment as well as assessment and evaluation skills. Excellent communication skills are essential to clearly and accurately express oneself to patients and colleagues. The requirements for nurses who perform Telephone Triage are as follows:

  1. RN licensure in the State of XXXXX
  2. Current certification as an Oncology Certified Nurse (OCN) or Advanced Oncology Certified Nurse (AOCN) is preferred, Chemotherapy administration experience preferred
  3. Successful completion of the Telephone Triage Program orientation. Also encouraged completion ofthe Infusion Room orientation
  4. Demonstrated effective use of clinical judgment, problem solving skills and communication skills with the patients / caregivers and colleagues as evidenced by successful completion of the probation period

Definitions:

Urgent – medically necessary, non-life threatening conditions requiring professional attention within 24 hours

Emergent – medical, maternity, or psychiatric emergencies believed to be serious enough to require immediate medical attention

Emergent Distress - signs of respiratory, cardiac, or cognitive issues. These may include, but are not limited to, confusion, disorientation, loss of consciousness, inability to breath, perfuse sweating not indicated by other means (like outside temperature), complaints of headache, flush faced, glazed look in the eyes, erratic walking (gait) or behavior.

Procedure:

Scope of the Telephone Triage department includes:

  1. Notification from the operator of urgent and non-urgent symptom calls
  2. Urgency of the symptomatic call is determined by the first responder questionnaire completed by the operator
  3. Operator places patient name and phone number on the triage board immediately
  4. Urgent symptom calls are communicated to the triage nurse with instant messenger notification
  5. Non-urgent calls are placed on the dashboard in order received for call-back
  6. Call backs are returned in the order received, but no longer than 24 hours unless specified by the pathway
  1. Assessment and management of patient / caregiver telephone calls (questions, acute care needs or emergent care needs) of the Oncologic, Hematologic, and Radiation patient population by:
  2. Calls received from the operators or direct line access
  3. Identifies self by name and as the Triage Nurse
  4. Identifies person calling in by asking for:
  5. Name of patient
  6. Name of caller
  7. if it is a caregiver making the call, verify that the HIPAA release is in the chart
  8. Date of Birth of the patient
  9. Physician
  10. Call back number
  11. The reason for the call
  12. Listen to the callers presenting symptoms
  13. Choose appropriate Triage Pathway and work though the pathway algorithm
  14. Verifies caller understands the plan of care for this symptom call
  15. Documents the call into the EMR system

Process for urgent or emergent need in which a provider visit is scheduled:

  • If call/walk-in is prior to 3pm, the appointment should be inputted into the EMR with appropriate standing orders
  • Notify front desk of add-on appointment so that appropriate paperwork can be prepared prior to patient arrival
  • When the patient arrives, the front desk staff should send them for labwork, either at draw station for peripheral access or to the Infusion room for the VAD access draw, if needed
  • The patient will then proceed to the infusion room to be assessed byan RN
  • Once the nurse assessment is complete and a review of lab work has been completed, the nurse will make the decision of whether or not the patient will need to see a clinician. If so, the nurse will call report to the patient’s physician or covering clinician.
  • The Clinician will then give orders and/or see the patient in clinic as needed. Patients who are assessed late in the day may be scheduled with the on-call clinician for after-hours clinic.
  • Patients who have urgent or emergent issues on Saturday may be added in for assessment as deemed necessary
  • All assessments should be documented in the EMR per documentation requirements

Should a patient come in for triage assessment and be found in emergent distress, Code Blue should be called in the clinic and when necessary emergency medical services should be immediately alerted.

  1. Medication refill request: Triage nurseis required to obtain the following:
  2. Name of patient
  3. Date of birth of the patient
  4. Name of medication
  5. Physician who prescribed the medication
  6. Last known date that medication was filled
  7. Location and phone number of the pharmacy and medication to be called in
  8. If medication is a scheduled narcotic,a triplicate prescription will be obtained from physicianand information entered into the medication section of the EMR
  9. If unable to grant a refill request, explanation to be given to caller
  10. Verifies caller understands the plan of care for medication refill
  11. Documents refills into EMR medication section
  12. Documents the call in the EMR

4. Direct Admissions: When clinically applicable, physicians will direct admit to the hospitals through the hospitalist at the appropriate hospital.

5. Scheduling appointments for providers and infusion room:

Refer to policy XXXXX.

Responsibility and Approval Authority:

This policy shall be reviewed by the appropriate committees, managers and staff to whom it is relevant, approved by the Executive Committee of the Board, with final signatory authority of the Medical Director.

Version Number: / Original Approval Date: / Reviewed Date:
Prepared by:
Approved by:

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