[blackwell.72]

Greg – I did not take the ED or ICC comment negative in any way. I felt you were complementing both services. Care of oncology patient overall is very different than patients without cancer. When I switched over I had to totally change my way of thinking, especially in the area of providing emotional support! thanks again,

[shalvoy.1]

You are welcome Kasey. I am glad you found the article helpful. I agree, I think diarrhea is much more common than we often think and we may forget to teach our patients about this.

[shalvoy.1]

Hi Greg,
I agree with you that float nurses can be an asset to the units to let them know how other units are dealing with symptoms of all of our new drugs. I am also hoping that we can also share this type of information in a forum like this one. We already have nurses from several units. I am excited, as we grow we hopefully will have a even more diverse experience base to draw from.
I am also interested in whether or not the implementation of the telephone triage team has improved outcomes. I will see what I can find out about that.

[blackwell.72]

Does anyone have any ideas for a topic for next club? Does anyone want to lead it?
Have a great weekend – enjoy the sun and heat we waited so long for!

[goodman.100]

Did anyone ever hear back from telephone triage regarding their screening questions? I assume they have some kind of screening questions for patients that call in with symptoms, but I doubt it is drug- or treatment-specific. Having floated to the ED and ICC before I am surprised we did not have treatment specific screening tools in IHIS. We focused on patient symptoms for treatment (sepsis, short of breath, et.) but those treatments would be different based on causes.

[smith.10494]

Hi again,
I think Kasey makes an excellent point with regard to RN providing education. How many of us have been in the room when the physician is talking to a patient and their eyes glaze over due to the volume of the info given or the terminology isn’t understood. I think we as nurses have a better understanding if the patient has a handle on the education they have been provided and/or if they need additional information or review. Physicians and APPs often don’t have the time to pick up on educational deficits.

[smith.10494]

Good input Greg!
I agree with you about the importance of a multidisciplinary team and how true it is that sometimes patients tell one person one thing and another person a different thing. I recently heard of an experience where a patient had been denying having diarrhea for months. It turns out that his definition of diarrhea was “run to the bathroom”, not watery, loose stools. :/
Sometimes, it is the way we word our questions that help get to the bottom of issues.

I would also be very interested in seeing how effective the triage line is in reducing admissions or unnecessary ED visits. I feel certain having the triage line for patients to access after hours has to be a great comfort for the patient and help with in basket volume.

Thanks!
Holly

[miller.2849]

This is a great opportunity – thanks Renee for setting this up so we can be a part of it!!

1. Knowledge Gained
I’ve know that these immuontherapies have been around. New information I gained was information related to the respective immune checkpoint inhibitors and their identified site. With IPI is is CTLA4 and with Nivo and Pembro the PD1 (programmed death 1). I also not sure I realized that skin was the most common and earliest side effect they may experience. I have seen many patients with varying degrees of rashes and do report them to respective providers for follow up and maintenance. One especially important charting availability that we have is being able to take pictures to document what a person is objectively experiencing. This allow for a true comparison on return visits to the clinic, and or discussing the occurrence on the phone with them in a triage area. It was great to be reminded that the occurrence of the adverse respects with immunotherapy vary greatly with each individual, and are less able to be predicted as in relation to standard chemo therapies.

2. Influence to my practice
I am a JCRU float RN and practice in all the clinics at the James, and mainly in the infusion areas. This information is extremely important as the RN is the first person the patient sees that can assess and report these findings to a provider. The James uses APP’s a lot with all their services, and this is so great as we have multiple provider contacts to follow up with to assess patient complaints, instead of one MD to be the respondent. I will continue to assess, and try to document more descriptive the complaints and presentation of my patients. My brother is one patient that has been on Nivo for 2 years and has a severely pruritic rash, to the point he uses a hair brush to scratch!! I can’t wait to forward the first article to them.

3. Agree / Disagree with Conclusions
I agree with conclusions. Especially with the second article and the need to have assessment strategies set to evaluate and respond to our patients when they call in with a complaint. As much as we do not want our patients to have to make a trip to the ER or additional clinic appointment, our patients would much prefer to remain home also to enjoy their days!

[miller.2849]

I agree with Holly and the other comments made, that the triage line is a GREAT start to helping assist our patients with their symptoms, questions and complaints without a physical appointment if able. I have seen their “tree” of questioning with symptoms. I would like to know if they / or the NP’s have a standardized “tree” to follow like the article with the rash treatments when patients call in with the more common complaints with treatment.

[miller.2849]

I agree with Mindy, our patients are much more acceptable to go to the ICC for symptom treatment management than the ER. I worked in the ICC for many, many years at the “old” James, and it was always an appreciated site for patients. I wish they would have seen that as a continued need when moving to the “new” James, although I do feel that the James ED beds they felt would be able to cover this need. I am so glad to have it again as an option for our patients, and enjoy working there with the staff! I really like that they have a set of parameters to follow for appropriate patients to be seen in the ICC setting.

[gabel.164]

Hello all! This is Patti Gabel from SSCBC infusion- I’m so excited that we have the opportunity to participate in a journal club remotely. Is it too late to participate in this journal club?

[Author]

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