Telephone Advice and Triage within Paediatric Oncology.

Abstract

The topic of telephone triage is of particular interest to the author who works in a
paediatric Oncology Unit which is the principal treatment centre for children’s cancers
within the Merseyside and Cheshire Cancer Network. This Unit provides 24 hour
telephone advice for patients, families and carers. In addition, professionals within the
network access the line for specialist information to support patients who are receiving
on-going treatment for cancer, in particular, designated shared care centres and
community teams who provide care nearer to home. To help develop good practice, the
Oncology Unit developed a protocol supported by nine separate algorithms and a
proforma upon which to document the ‘Telephone Consultation Notes’ made by the
nurse (or other health professional). Having completed the handwritten documentation
the policy requires the member of staff to further document these details on Meditech.
The nine algorithms relate to nine separate health triggers which reflect the core of
telephone triage calls and these algorithms aim to guide safe and appropriate practice
and indicate what action the nurse should take. This study was developed in response to
this initiative.
The aim of this study was to explore triage trained nurses’ experiences of providing
telephone triage in one NHS children’s oncology setting. This study was underpinned by
a two phase, exploratory mixed methods design although the main focus was on the
qualitative data generated in the second phase. Phase 1 involved analysis of logged
telephone consultation notes. In Phase 2 selected nurses working within the setting who
had received training in the triage protocol and who had logged calls within the study
period were interviewed.
In Phase 1, a total of 221 telephone triage calls (from parents or District General
Hospitals) were logged as being received over the four months of data collection and
were analysed and eight nurses (6 female and 2 male) participated in the second
interview phase of the study. Following analysis of the data four main themes were
identified in relation to telephone triage protocols as a means of (1) managing remote
communication; (2) promoting safe and legal nursing actions; (3) ensuring best
evidence-based practice; and (4) documenting comprehensive assessment
Telephone triage is a relatively new development, particularly within children’s oncology
care and whilst it provides parents with 24 hour access to advice and support it also
creates challenges. Remote, hands-off assessment is not easy and whilst protocols can
guide practice and support the practitioner to make clinical decisions it is clear that
nurses in this study did not always adhere to the protocol. The study highlighted that
nurses rely on their ward-based, face-to-face knowledge and skills and that this is not
always readily transferable to telephone triage. Nurses expressed both levels of
confidence and levels of uncertainty about their role in telephone triage.
Recommendations for practice are proposed based on the findings of this study.