Exploring a New NTL Model During a Pandemic Implications for Nursing Practice Carol Rutenberg, RN-BC, C-TNP, MNSc Moderator Nurse Triage Line Project Advisor Katie Brewer, MSN, RN Senior Policy Analyst American Nurses Association Mary Pat Olson, MPH, RN Director of Outreach Services National Council of State Boards of Nursing Suzanne Wells, RN, BSN President-Elect American Association of Ambulatory Care Nursing Lynn Smith-Cronin, RN, BSN Manager, After Hours Triage, Kelsey-Seybold Clinic, Houston, TX AAACN Volunteer Leader Rutenberg 3/20/12 1
WHAT is Telephone Triage? The Telephone Triage RN helps the patient decide The nature of their problem Where and when they should be seen What support and collaboration is necessary What education does the patient need? Can the patient carry out the plan of care? Is phone treatment indicated? (Initiation of prescriptions is controversial) Rutenberg 3/20/12 2
Benefits of Telephone Triage Appropriate care Appropriate resource utilization Patient education Improved satisfaction (MD, RN, patient) Cost effective, quality care (Omery 2003) Rutenberg 3/20/12 3
WHY do Telephone Triage? In the Early Days Demand management Cost containment Today s Goal Right patient Right place Right time Right level of care In order to assure quality care Rutenberg 3/20/12 4
The Perfect Storm (for TT) Disasters (9/11, Katrina, Haiti) Need for care over distance Financial Crisis Limited financial resources Looming Staffing Shortage Baby Boomer exodus Growing Chronic Illnesses Sicker patients outside hospital Pandemic Flu CDC recommended phone assessment and treatment
WHO does Telephone Triage? RN s scope of practice is both independent and interdependent. RNs function collaboratively with physicians and patients (but maintain accountability for their decisions) Critical thinking and clinical judgment guide telephone triage nursing practice Rutenberg 3/20/12 6
WHERE is Telephone Triage Done? Call Centers Doctors Offices Clinics Urgent Care Centers Home Health Agencies Many Other Settings such as Student Health Centers Prisons Same Day Surgery Centers (Anywhere a patient can access a nurse by phone) Rutenberg 3/20/12 7
Types of Call Centers Insurance Companies Hospitals Entrepreneurial Ventures Rutenberg 3/20/12 8
Large Call Center Hospital Rutenberg 3/20/12 9
Call Center in Doctors Office 40 Physician Group Practice - 5 Sites Rutenberg 3/20/12 10
Telephone Triage from Home Good for surge coverage and social distancing Rutenberg 3/20/12 11
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WHEN is Telephone Triage Done? During business hours by offices, clinics, etc. After hours by call centers (including pediatric) 24 / 7 / 365 (usually formalized call centers) Rutenberg 3/20/12 13
HOW is Telephone Triage Done? RNs with specialized training & experience Protocols Content developed by doctors and nurses Various formats Paper (home-grown or published) Software for documentation & decision support Web based programs for documentation & decision support Support assessment / some have treatment component Based on Standards of nursing practice (ANA) Scope of practice and licensure (NCSBN) Telehealth scope and standards (AAACN) Directed by individual organizational policies & experience Rutenberg 3/20/12 14
Decision Support Tools (Protocols) Rutenberg 3/20/12 15
TRIAGE SOFTWARE & WEB BASED PROGRAMS Rutenberg 3/20/12 16
Telephone Triage Nurses Use the nursing process Assess Diagnose nature and urgency of problem Develop an individualized plan of care Help facilitate implementation of plan Evaluate effectiveness of plan Refer to decision support tools Err on the side of caution Caution! Rutenberg 3/20/12 17
Carol Rutenberg, RN-BC, C-TNP MNSc Telephone Triage Consulting, Inc. carol@telephone-triage.com www.telephone-triage.com 501-767-4564 Rutenberg 3/20/12 18
ANA Supports the Nurse Triage Project Professional Scope and Standards of Practice ANA s role as the professional standard-bearer nursing Recommendations of the IOM Report The Future of Nursing: Leading change, advancing health Nursing s role in 2009 H1N1 pandemic and other disasters
Nursing: Scope and Standards of Practice, Second Edition
Standards of Professional Practice Assessment Diagnosis Outcomes Identification Planning Implementation Coordination of Care Health Teaching and Health Promotion Consultation Prescriptive Authority and Treatment* Evaluation *Applies to Advanced Practice Registered Nurses Only
Nursing s Social Policy Statement: The Essence of the Profession
Professional Regulation Self Determination Institutional Policies and Procedures Nurse Practice Act and Rules and Regulation Nursing Professional Scope of Practice, Standards of Practice, Code of Ethics, Specialty Certification Evidence
What does the Institute of Medicine s report, The Future of Nursing: Leading change, advancing health say? Image: www.futureofnursing.org Recommendations of the IOM: Recommendation 1: Remove Scope of Practice Barriers Relates to Key Message #1 Nurses should practice to the full extent of their education and training. Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Health care organizations should support and help nurses in taking the lead in developing and adopting innovative, patientcentered care models. Private and public funders should collaborate to advance research on models of care and innovative solutions, including technology, that will enable nurses to contribute to improved health and health care.
Nursing s role in H1N1 Participation in triage and algorithms for antiviral dispensing program Vaccination and nurse-managed protocols Information source Continuation of work in prior disasters augmenting health care provider resources for countermeasure dispensing
Contact Information Katie Brewer, MSN, RN Senior Policy Analyst American Nurses Association katie.brewer@ana.org
Nurse Triage Line Stakeholders Meeting Nursing Leadership Panel Mary Pat Olson Director, Outreach Services March 20, 2012
About NCSBN A not-for-profit organization whose purpose is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing.
NCSBN Programs Nurse Licensure Compact (NLCA) In 2000, NCBSN launched a new initiative to expand the mobility of nurses as part of our nation's health care delivery system. The Nurse Licensure Compact (NLC) allows nurses to have one multistate license, with the ability to practice in both their home state and other party states.
Nurse Licensure Compact
NCSBN Programs Nursys was implemented in 1999 and is a comprehensive electronic information system that includes collecting and storing a nurse's personal information, licensing information, disciplinary information and license verifications.
NCSBN Resources Getting the word out via Public Policy Network conference calls Conduit to Boards of Nursing for communication Provide resources and guidelines to the Boards of Nursing
Contact Information Mary Pat Olson Director, Outreach Services molson@ncsbn.org www.ncsbn.org
Exploring a New NTL Model During a Pandemic AAACN Perspective Suzanne Wells, RN, BSN President-Elect
American Academy of Ambulatory Care Nursing Serves as a voice for ambulatory care nurses across the continuum of health care delivery Membership: nurses interested in ambulatory care and telehealth nursing The only specialty nursing association that focuses on excellence in ambulatory care
American Academy of Ambulatory Care Nursing Over 2000 AAACN members 400 Telehealth members 22.26% of membership-telehealth nurses Telehealth Resource Directory Telehealth Nursing Practice Administration and Practice Standards Active SIG and listserve
2009 H1N1 American Academy of Ambulatory Care Nursing Provided adult and pediatric H1N1 triage protocols to membership via AAACN website Became member of CDC Clinical Outreach and Communication Activity (COCA) Created COCA listserve to disseminate COCA updates to members Partnership with AAP Section on Telehealth Care (SOTC) AAACN Liaison to AAP SOTC
Contact Information Suzanne (Suzi) Wells, RN, BSN President-Elect, AAACN Manager, St. Louis Children s Hospital Answer Line; BJC Healthcare snw4713@bjc.org
Kelsey-Seybold Clinic After Hours Nurse Triage Strategic Response to Novel H1N1 Pandemic 2009-2010
What is Kelsey-Seybold Clinic? Houston, Texas serving the metropolitan area 22 clinics/facility locations Adult and Pediatric primary care 50 specialties and sub specialties 24/7 RNs available Protocol based triage service available when regular clinic operations are closed Is mostly in-bound call practice After hours service handles 7,000 to 12,000 calls per month
KSC 2009 2010 H1N1 Pandemic One of the first effects to KSC from media stories regarding H1N1 were increased calls volumes to the triage nurses Epidemic-to-Pandemic announcements = total organization plan for addressing patient needs, meeting on a daily basis After Hours Nurse Triage no MD s on site, protocol based decision making must be safe and appropriate
KSC After Hours Nurse Triage: Challenges More call volume needs more nurses or creative handling of calls while practicing safely and staying within the scope of an RN Information and education for patients working with KSC to identify needs, changing demands for health information dispersal Protocol as appropriate for the illness 2009/ 10 H1N1 no standardized protocol until Spring 2010
Challenges continued Increase in out-of-state callers difficult to handle due to limitation of RN licensure issues After triage, getting patient s to where there was vaccine and/or medication Working with IT/Telecom to maintain technical infrastructure in order to avoid delays in care Maintaining communication with healthcare colleagues and public health agencies
Lynn Smith-Cronin RN,BSN Manager After Hours Nurse Triage Kelsey-Seybold Clinic Houston, Texas c.smith-cronin@kelsey-seybold.com 713-442-0078
American Academy of Ambulatory Care Nursing St. Louis Children s Hospital 2009 H1N1 Strategies 3 rd highest call volume in call center history Proactive RN schedule for anticipated surge National clinical collaboration-new pediatric H1N1 guidelines rapidly developed/reviewed/operationalized AAACN & AAP SOTC listserv for networking
American Academy of Ambulatory Care Nursing St. Louis Children s Hospital 2009 H1N1 Strategies FAQ s provided for After Hours Subscribers Recorded Novel H1N1 message for callers Email teaching documents (ie: flu facts,fever) Support for SLCH ED surge SLCH staffing hotline
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