Exploring a New NTL Model During a Pandemic

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
•
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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)
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Benefits of Telephone Triage
• Appropriate care
• Appropriate resource utilization
• Patient education
• Improved satisfaction (MD, RN, patient)
• Cost effective, quality care
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(Omery 2003)
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WHY do Telephone Triage?
• In the Early Days
• Demand management
• Cost containment
• Today’s Goal
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Right patient
Right place
Right time
Right level of care
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In order to assure
quality care
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
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WHERE is Telephone Triage Done?
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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)
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Types of Call Centers
• Insurance Companies
• Hospitals
• Entrepreneurial Ventures
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Large Call Center
Hospital
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Call Center in Doctors’ Office
40 Physician Group Practice - 5 Sites
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Telephone Triage from Home
Good for surge coverage and social distancing…
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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)
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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
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Standards of nursing practice (ANA)
Scope of practice and licensure (NCSBN)
Telehealth scope and standards (AAACN)
Directed by individual organizational policies & experience
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Decision
Support
Tools
(Protocols)
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TRIAGE SOFTWARE &
WEB BASED PROGRAMS
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Telephone Triage Nurses…
• Use the nursing process
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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
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Caution!
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Carol Rutenberg, RN-BC, C-TNP MNSc
Telephone Triage Consulting, Inc.
carol@telephone-triage.com
www.telephone-triage.com
501-767-4564
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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
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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?
Recommendations of the IOM:
• Recommendation 1: Remove Scope of Practice Barriers
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Recommendation 2: Expand opportunities for nurses to
lead and diffuse collaborative improvement efforts.
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Image: www.futureofnursing.org
Relates to Key Message #1 – Nurses should practice to the full
extent of their education and training.
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
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Serves as a voice for ambulatory care nurses
across the continuum of health care delivery
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Membership: nurses interested in ambulatory
care and telehealth nursing
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The only specialty nursing association that
focuses on excellence in ambulatory care
American Academy of
Ambulatory Care Nursing
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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
American Academy of
Ambulatory Care Nursing
2009 H1N1
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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
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3rd highest call volume in call center history
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Proactive RN schedule for anticipated surge
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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
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FAQ’s provided for After Hours Subscribers
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Recorded Novel H1N1 message for callers
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Email teaching documents (ie: flu facts,fever)
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Support for SLCH ED surge
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SLCH staffing hotline
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