Congress Abstracts 2004

7

ASSESSING THE IMPACT OF TELEPHONE TRIAGE ON THE MANAGEMENT OF CHEMOTHERAPY-INDUCED NEUTROPENIA (CIN) IN PATIENTS WITH CANCER. Irene Rosenberg, RN, OCN^®, and Donna Milam RN, OCN^®, BSN, Lake County Oncology and Hematology, Tavares, FL.

Telephone triage can enable oncology nurses to recognize the symptoms of potential emergencies and provide appropriate support to the patient while reducing the number of unnecessary clinic visits for patients, thus improving their quality of life. At the Lake County Oncology and Hematology Clinic, we have implemented a telephone triage protocol for the management of chemotherapy-related side effects. Here, we describe our protocol for patients at risk for neutropenia.

Patients treated with chemotherapy regimens associated with a high risk of neutropenia are provided with instructions indicating signs and symptoms for which to monitor (e.g., temperature) and a list of reasons to call the clinic (fever, chills, cough, sore throat, etc.). When patients call, we use established telephone triage flow sheets to assist in identifying problems and to guide us in the decision-making process. During the call, patients are asked to provide details on the onset, duration, and characteristics of the symptoms, any comfort measures (e.g., rest, cool compress) or interventions (e.g., acetaminophen) used, exposure to sick family members, as well as the date of the last chemotherapy session and growth factor administration. Our records provide us with the medical history of patients and risk factors present, and confirm treatment details. We complete an assessment based on the reported symptoms and decide if the patient needs to visit the clinic for further monitoring or hospitalization. For all patients who report symptoms of neutropenia, we recommend the prophylactic use of growth factors in the next cycle of chemotherapy. We record all calls made to the telephone triage center and document all advice given to patients.

To quantify the impact of telephone triage on our neutropenic patients, we plan to analyze medical records over a six-month period and compare the number of non-scheduled clinic visits made by patients before and after the implementation of our telephone triage protocols.

This data will show the extent to which the implementation of telephone triage has had a positive affect on standards of care at our clinic.