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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.
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.
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!
