GULF BREEZE, FL—There is telephone nurse triage and then there is telephone nurse triage for cancer patients. They are not the same, says Margaret Hickey, RN, MSN, MS, OCN, President of the Gulf Breeze, Florida-based MMH Communications, LLC and co-author of Telephone Triage for Oncology Nurses. For example, take fever, she says. Patients who do not have cancer may be told to take a Tylenol “but for cancer patients a fever could be the sign of an emergency.”
The special needs of cancer patients is one of the main reasons why Hickey and her co-editor Susan Maloney-Newton, RN, MS, AOCN®, AOCNS® decided to do a book dedicated to the telephone triage needs of oncology nurses. The first edition came out more than 15 years ago.
What was happening at that time in oncology nursing was a realization that there needed to be a way to handle phone calls more efficiently as practices were having staffing challenges and were very much into cutting costs. Having a more formalized telephone triage system could help in this regard, she says.
The two wrote the first few chapters discussing telephone triage in general, looking at practice models, tips to improve phone communications and a history of telephone triage. To develop the protocols contained in the book, they put out a call for protocols and policies to selected segments of the Oncology Nurses Society membership. These included outpatient nurses, clinical nurse specialists and educators, and administrators. Fifty people responded.
“To those, we explained how we were going to do it,” Hickey told us for the story we wrote about the book back in 2006. “We organized it as symptom based and divided it into areas such as fatigue, pain and headache and asked them for protocols.”
One of the changes from a traditional protocol system geared toward a general audience is the importance of asking the cancer diagnosis question early in the conversation. It can be a most important factor in the discussion. For example, take a headache sufferer who is on chemotherapy. “Does that drug have effects on platelets that in turn contribute to a cerebral bleed?” she told us at the time.
Reflecting on the preparation of each of the three editions of the book, Hickey says that each one has been constructed “to encourage problem solving and as a critical thinking aid.”
For this newest edition, the preface to the book discusses the new environment of cancer treatment. “This third edition has been expanded to address the patient needs which may result from the newer treatments—targeted therapies and immunotherapy. Targeted therapies for cancer are commonly small molecules which can be taken orally and managed by the patient and family at home. While supporting the patient independence, self-management of side effects may be challenging. We have added a section to address improving nursing management of oral therapies. Immunotherapy may result in adverse effects very different than traditional cancer treatments and these are addressed throughout the protocols which discuss some of the common complaints as well as a standalone section in this text.”
One of the reasons for this expansion is the particular challenge of communicating with patients receiving oral therapies for cancer. With traditional therapies the patient is regularly seen and evaluated by a medical professional when coming in for treatment; with oral therapies the patient is at home and isn’t seen as often.
Toward that end, a series of questions specific to oral therapies have been added for nurses to use as a resource when handling inbound calls from patients. In addition to taking inbound calls, Hickey says that it is also important for oncology triage nurses to proactively follow up on patients undergoing oral therapy.
The book has been one of the fastest selling books that the Oncology Nursing Society has put out. Hickey says that it is used by oncology nurses in the United States, Canada and Great Britain. Some organizations have integrated the symptom-based protocols into their EMR. It is available from the Oncology Nursing Society for $88 for members and $137 for non-members. It is available as a spiral bound book or as an e-book.