ANAHEIM, CALIFORNIA—A triage nurse is a vital role for a busy outpatient hematology and transplant clinic, according to research presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
Over the last decade, the majority of oncology patient care has shifted to the ambulatory setting, which has spurred a change in nurses’ traditional role. Ambulatory nurses need to be skilled in telephone triage and phone advice, as calls from patients are a major portion of nursing practice in outpatient oncology. If the nurse is not well prepared, telephone triage can be daunting.
This shift in care prompted Anna Connair, BSN, RN, OCN, and colleagues from the Ohio State University James Cancer Hospital and the Solove Research, to evaluate implementation of the triage role in a busy oncology practice.
Though the triage role had been in place for 5 years, it had not been objectively evaluated. Since 2008 when the clinic opened and the triage role was implemented, a 120% increase occurred in the average number of patients seen per month. Also, the clinic experienced a 68% increase in the number of physicians based there, and a survivorship and mental health clinic were added.
“Nurses at our clinic fulfill a very diverse role,” Connair told Oncology Nurse Advisor, noting that patients not only visit the clinic for infusions and procedures but also to see doctors and for sick visits. “Our triage role started as a phone triage role, and it’s evolved with all the challenges at our clinic, including the diverse needs that we must fulfill.”
The evaluation of the role of the triage nurse involved assessing triage documentation and examining the triage nurses by those nurses and by their patients. Data collected included number of calls over time; type of call: symptom management, teaching, and support; self-assessment of competence of triage staff; patient satisfaction; and evaluating the professional development of the staff.
The researchers surveyed first how comfortable nurses were with the triage role. Results showed that, after implementation of the triage role, nurses were more comfortable with telephone triage skills, oncology knowledge base, addressing side effects of chemotherapy, and addressing oncology emergencies.
Consequently, the data indicate strong support for the ambulatory oncology triage role from all parameters examined. These positions benefit staff, physicians, and cancer patients. The triage role enhances the nurse-patient relationship, increases the continuity of care, contributes to the professional development of the registered nurse, decreases calls to providers, enhances patient education, decreases the risk of medical complications and delays in care, and decreases both inappropriate appointments and emergency room visits.
“We’ve been able to focus our role to give the best possible care to our patients and make it really individualized,” Connair said. “We can now say we have those care teams and are able to continue developing our nursing roles.”
Wasko M, Blackburn L, Brown S, et al. Poster 7. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress. May 1-4, 2014; Anaheim, CA.