Wright Speaks on Successful Telephone Triage
From left, Barbara Perry, clinical education manager for Pfizer, BWH’s Mary Reynolds, RNP, MS, Ambulatory Care nurse educator, speaker Wendy Wright, and Susan Donnelly, managed markets account manager for Pfizer. ?
Determining whether the symptoms a patient describes require urgent care during a three- to five-minute phone call is one of the most difficult tasks nurses handle.
More than 80 BWH nurse practitioners, registered nurses, clinical nurse specialists and licensed practical nurses from every ambulatory area in the hospital last month attended a seminar on telephone triage led by Wendy Wright, MS, RN, ARNP, FNP, an adult/family nurse practitioner. Wright, who has been teaching telephone triage around the country since 1995, provided advice for nurses during her talk at BWH.
The most important thing a nurse does during triage is rank patients in order of severity, Wright said. “You have to decide when a patient’s appointment should occur.”
Nurses must not make a medical diagnosis. “Except for nurse practitioners, nurses cannot make a diagnosis,” she said. However, if a patient says he thinks he has bronchitis, the nurse can write in the chart, “patient thinks he has bronchitis.”
“The difference is, you’re not assigning a diagnosis to the patient,” Wright explained.
- Wright shared the following tips during her talk:
- When you receive a call, state your name and title and ask, “How may I help you? Is this a medical emergency?”
- Always assume the worst. When triaging, nurses should consider the most worrisome diagnoses first, in particular, myocardial infarction, ectopic pregnancy, testicular torsion, stroke, appendicitis or aneurysm.
- Phone calls should be private and not overheard by other patients.
- Always document telephone calls and conversations, no matter how trivial they may seem. Such documentation could be crucial later.
- If you forget to document, put a late entry in the chart and explain why it is late. Date and time the entry.
- Remember to document no shows, cancelled appointments, telephone calls made to a patient to check on him or her, letters sent and calls made to remind a patient of a particular test that needs to be done.
- Document a patient’s refusal of care and that you have explained the risks, benefits and alternatives of treatment. Also discuss and document the risks of refusing treatment.
- Conclude a phone call by giving very clear instructions, speaking slowly and restating what you have heard, if needed, and end the call with instructions to, “Call me, should…” Advise the patient to return or call if the symptoms are persistent, changing, worsening, anxiety provoking or symptom-specific (PCWAS).
- Be pleasant and don’t argue with a patient. Avoid long waits for phone calls to be returned.
Educational funding for this seminar was provided by Pfizer, Inc. For additional information, contact mreynolds1@partners.org
Wendy Wright chats with Guerly LaRoche, RN, of Brookside Community Health Center before the program begins. ?