United Kingdom

Oncology Nursing

Society (UKONS) Helen Roe

Consultant Cancer Nurse

President - UKONS

UKONS

Charitable organisation

Around 6,500 members – not all nurses

Board members and ambassadors

Members interest groups (MIGs)

Corporate members and Partnership agreements

Industry partners – different levels

Corporate members

Free to join

What is The Telephone

Triage Tool Kit?

A risk assessment tool using a RAG

(RED, AMBER, GREEN) scoring system.

For telephone triage of patients who:

Have received or are receiving systemic anticancer therapy

Have received any other type of anticancer treatment, including radiotherapy and bone marrow graft

May be suffering from disease-/treatment-related immunosuppression (i.e. acute leukaemia, corticosteroids)

Aim of the Tool Kit To provide guidance and support to the practitioner at all three stages

of the triage process:

• Contact and data collection

• Assessment/definition of problem

• Appropriate intervention/action.

The Tool Kit has been developed to provide:

• A simple, reliable assessment process

• Safe, understandable advice

• Communication and record keeping

• Competency based training

• An audit tool.

No agreed triage process or pathway – multitude of

numbers- changing admission points – different

level of service out of hours

No agreed training or competency assessment

No quality control or review

No data collection

The past

Background

United Kingdom Oncology Nursing Society (UKONS)

The original version was developed in 2007/2009 Positively evaluated and released in 2010

Now used widely in all areas of the UK and internationally

No serious incidents or adverse events due to the correct use of tool kit reported during the pilot or since release

The tool has now been updated and Version 2 was approved in November 2016

Factors to consider when planning

local implementation

Organisational approval and agreement should be sought as the governance responsibility sits with the user/organisation

Clear decisions should be made about the triage pathway, identifying admission/assessment areas and triage practitioners who will provide review and follow-up calls

A plan for education, training and competency assessment. This is a vital step in the process; users need to have a clear understanding of the value of the Tool Kit and the risk to the patient and themselves if it is not used properly

Regular audit and quality review of all data collected – consider electronic data collection

Governance process – as with any service, the advice line will need to be monitored and reported.

Training All staff using the Tool Kit must receive training and assessment of competency.

Training should include:

• Formal education session

• Discussion

• Scenario and role play

• Observation

A competency framework is supplied to be completed prior to using the Tool Kit

Example scenarios have been provided to assist with training.

Staff who are not trained to use the Tool Kit should not provide telephone advice.

•Brief background and

development history

•Instructions for use

•Training and competency

requirements and assessment

proforma

•The Triage Pathway Algorithm

and Clinical Governance

recommendations

•Examples of all component parts

of the Tool Kit.

The Tool Kit Manual contains:

Main elements • The assessment tool is based on

the NCRI-CTCAE common

toxicity criteria. It should be

used as a guideline, highlighting

the questions to ask and leading the practitioner through the

decision-making process.

• It is a risk assessment tool used to

grade the patient’s symptoms and establish the level of risk to

the patient, and will enable

practitioners to provide a

consistent robust triage.

• It is a cautious tool and will

advise assessment at a point

that will allow early intervention

for those at risk.

Main elements 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 standardised

telephone consultation recording

format will support the triage process

as follows:

• A guide and check list for the

practitioner, reminding them about

the important information they

should collect and reassuring them

that they have completed the

process

• A communication tool relaying an

accurate picture of the problem,

and action taken, to the other

members of the healthcare team

• A record of the process for quality,

safety and governance purposes

Scoring system Action selection is based on the triage practitioner’s grading of

the presenting symptoms/toxicity following interview, data

collection and triage:

RED – any toxicity graded here takes priority and action should

follow immediately. Patient should be advised to attend for

urgent assessment as soon as possible

2 or more AMBER = RED – if a patient has two or more toxicities graded amber they should be escalated to red action and

advised to attend for urgent assessment

AMBER – one toxicity in the amber area should be 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.

The assessment tool will:

Determine ‘the patient’s level of risk’

Prompt the practitioner with

appropriate questions to ask, 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

1 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

All GREEN – callers should be instructed to

call back if they continue to have

concerns or their condition deteriorates.

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 HAVEN’T TICKED IT,

YOU HAVEN’T ASKED IT!

Contact record – the ‘Log Sheet’

Governance and responsibilities The 24 Hour Triage tool is a guideline and should

be approved for use according to the user organisations governance and approval process.

The tool is a guideline which makes recommendations for best practice, these are not binding and should be seen as suggestions and or advice, they do not replace clinical judgment or remove autonomy.

Neither UKONS nor authors bear any responsibility for the use of the tool.

RCP developing concise guidelineshttps://www.rcplondon.ac.uk/resources/developing-concise-guideline.

Competency Framework

The manual contains a competency assessment

document linked to the national key skills

framework that should be completed for all those

who undertake UKONS triage and assessment.

It is recommended that this assessment be

repeated annually to ensure that competency is

maintained.

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.

Audit

Nominated for an RCNi Award

Check you are

using the latest

version

UKONS SACT Passport

Safety (patients and staff)

Patients and their families, receive equitable care.

Gives patients a level of quality assurance.

SACT nurses have the fundamental knowledge and

skills

SACT nurses can move freely between practice

settings - reducing time for re-assessment.

Why do we need a Passport?

STEP ONE –Theoretical Assessment

STEP TWO – Clinical Practice Assessment

The core Practice Assessment Criteria: Safe Handling and

Administration

Route Specific Practice Assessment Criteria

Pre-Treatment Consultation Practice Assessment Criteria

Accreditation

STEP THREE – Re-accreditation

Stages of the Assessment

How does it work in practice?

A band 6 clinician or above

Completed a mentorship training program or equivalent

Competent in the same route of administration you are assessing

A minimum of 6 months practice experience

Competent in conducting pre-treatment consultations

Undertaken the assessor training.

Supported to undertake the role according to local policy and your direct line manager

Delivering treatment via this route on a regular basis

Who can you become a Passport

Practice Assessor?

Latest piece of work

Please check out the UKONS

website

www.ukons.org

Where you will find the latest version of all documents

Check out the MIG’s

Find out about our conference for this year –

UKONS Annual Conference 2018 Friday 16 - Saturday 17 November SEC Centre, Glasgow, Scotland

See available awards you could apply for

Join in and have your voice heard

If you use any of our documents please ensure they have been adopted b your organisation