Name: Helen Morris
Job title: Matron, Lead Nurse Southwest Paediatric Oncology
Specialty: Children’s nursing
Organisation: Bristol Royal Hospital for Children
I led on the development of an Oncology/Haematology Telephone Triage Tool Kit for Children and Young People as a guideline for the provision of triage assessment and advice for staff answering telephone advice line calls from families who were at home with their children who were undergoing cancer treatment. Having researched a suitable tool, there was none that was available for paediatric oncology patients so decided to create one that could be used nationally.
I recognised in my centre that there was little formal assessed training or guidance for nursing staff taking calls from families at home when undergoing cancer treatment and that documentation and communication about advice given was not always clear. When I raised this at a national meeting, other centres felt the same and so we decided to set up a development group to address this gap. We decided to adapt a validated tool that had been used in the adult setting developed by United Kingdom Oncology Nursing Society (UKONS).
How did you initiate the work?
A development group was set up consisting of paediatric oncology nurses, UKONS adult nurses and representatives from the RCN. There is little published evidence regarding CYP oncology/haematology triage, though there was anecdotal evidence regarding the provision of 24-hour telephone advice line support for parents and carers in CYP Principal Treatment Centres (PTC) and CYP Paediatric Oncology Shared Care units(POSCU). The development group found following a national audit that the advice and support provided was reliant on the experience and knowledge of the nurse or doctor answering the call and that although there were local models of good practice they had not generally been validated.
There were no tested assessment or decision-making tools in use at the time. Furthermore documentation and record keeping differed from trust to trust. Despite this we wanted to develop a national tool that every centre would use and that families would recognise where ever they were in the country.
This Tool Kit would provide:
- Guidance and support to the practitioner at all stages of the triage and assessment process
- A simple but reliable assessment process
- Safe and understandable advice for the practitioner and the caller
- High quality communication and record keeping
- Competency-based training
- An audit tool
The first phase was to agree nationally the criteria that would be used and this was a challenge initially where different centres used slightly different guidance even based on national criteria. This required working corroboratively and ensuring the medical colleagues were also in board. We also had to think about how we could ensure that the toolkit would work in the many varied environments that paediatric oncology is given.
We then had to think about how we would finance the development of the toolkit and how it would be accessed by everyone. I decided to approach 2 charities and work with them as this toolkit would be very much about improving care and support for families, areas that I was aware both of these charities were very passionate about. CLIC Sargent agreed to help fund the development, printing and ongoing reviewing and auditing of the toolkit and Children Cancer Leukaemia Group (CCLG) agreed to host the toolkit and associated documentation on their open website so that it was easily accessible.
What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?
The first phase of implementation was to pilot the tool and the RCN very kindly agreed to support this. The tool was subject to a pilot in 5 PTCs and 2 POSCUs, which resulted in a very positive evaluation from both staff and families. Following some minor alterations we then further developed the education and competencies around the tool and submitted the toolkit to the RCN to be assessed from a governance perspective as nurses needed to be clear they would be supported in its use. Having not undertaken this before, I did underestimate the time that this would take but the toolkit was passed in time for a national launch day supported by the RCN, CCLG and CLIC Sargent.
This day was crucial to get right to ensure that we met our aim of rolling this tool out across all 4 nations of the United Kingdom. We had attendance from nearly all PTC leads and all agreed to roll this tool out to their centres and review its future use in the POSCUs, which was incredible at the time. I believe that we have achieved this due to staff recognising a gap in their knowledge, the big impact that staff could see it would have for patient care, the support of the charities involved and the excellent national networks that we have in paediatric oncology.
Has the initiative or project made a difference to patients/service users and or staff?
The pilot feedback was extremely positive with staff saying that they felt much more supported, especially the more junior staff, an improvement in documentation of advice given and positive feedback from families. Most PTCs have now rolled the tool out to their POSCUs as well and I was also approached by a team in Australia who wanted to use it. The tool was also commended in a coroners case that occurred. I presented the toolkit at an international paediatric oncology conference where it won best nursing poster. It is used on a daily basis around the country supporting staff and improving patient care.
What are the long-term aims for the work?
I believe that we have met our aims of:
a) Improving patient safety and care by ensuring that they receive a robust, reliable assessment every time they or their carers contact a helpline for advice
b) Ensuring assessments are of a consistent quality and that advice is determined based on the use of an evidence based assessment tool
c) Providing management and advice appropriate to the patient’s level of risk. To ensure that those patients who require urgent assessment in an acute area are identified and that appropriate action is taken, but also to identify and reassure those patients who are at lower risk and may be safely managed by the primary care team or a planned clinical review and avoid unnecessary attendance
d) Forming the basis of triage training and competency assessment for practitioners
e) Helping to maintain accurate records of the assessment and decision-making process in order to monitor quality, safety and activity
The next step is to ensure this continues so CLIC Sargent and I are currently in the process of setting up a formal audit and review of the toolkit following 2 years of its use to back up the anecdotal feedback that we have. We will then publish this work.