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Advice patients can trust

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Philippa Jones created an assessment tool to make cancer helpline advice safe and consistent

Collecting her Macmillan Professionals Excellence Award in November from chief executive Ciaran Devane and Olympic athlete Colin Jackson was a moment that Macmillan Network chemotherapy nurse Philippa Jones nearly missed out on.

“I didn’t want to be a nurse originally,” she says. “My mum and aunts were nurses and I was a bit rebellious, and just wanted to do something different. It must be genetic as my sisters are all nurses now as well.”

She’s glad now that she changed her mind. “I think nursing is a fantastic and really rewarding career,” she says. “I started as an auxiliary while I was a student nurse, then spent 20 years in critical care, mostly in A&E with a bit of ITU, coronary care and high dependency care for good measure. I didn’t want to leave that sort of role, but 13 years ago I moved into oncology when I needed to take a less physical job.”

It was that shift into oncology that saw her create the Macmillan award-winning project: an oncology and haematology 24-hour triage rapid assessment and access toolkit. It was something she developed with the United Kingdom Oncology Nursing Society (UKONS) Central West Chemotherapy Nurses Group.

It is designed to triage patients receiving or who have received chemotherapy and radiotherapy in the past six weeks or are at risk from disease- or treatment-related immunosuppression. It uses a red, amber and green system to assess toxicity levels, and is easily used by all staff who answer helplines.

“I was concerned about the quality of helpline advice,” she says. “Depending on where you were, or who you spoke to at which time of the day, you could get different advice. And, as some toxicities can be devastating if undetected, I was worried about safety and wanted to standardise what was going on.”

The tool provides a robust framework for triage assessment, action and audit, and improves quality and safety in care by ensuring patients receive a robust, reliable assessment every time they contact a helpline. The tool, which is based on evidence, suggests action and advice that is appropriate to the patient’s level of risk.

“We wanted to provide support for practitioners as they were making big decisions, and we wanted to give them something that gave them confidence and helped them feel they had made the right decision,” says Ms Jones.

“The form they use is easily traceable and records the conversation on one piece of paper. This allows practitioners to look back and see that they have done everything right.”

The tool ensures patients who need urgent assessment in an acute area are identified and action taken. It also identifies and reassures those at a lower risk who may be managed by the primary care team or in a planned clinical review, so unnecessary hospital attendance is avoided. It also provides a framework for triage training and competency assessment for practitioners.

The tool took three years to develop, and Ms Jones says the team “took the best bits of evidence” from different sources, including input from the National Patient Safety Agency.

Following pilots in 26 sites nationwide, as well as use in oncology in Scotland and Ireland, and training sessions for 500 staff including nurses, Ms Jones is on a mission to see it spread nationally.

“If someone goes on holiday to Cornwall, I’d like them to get the same assessment and management treatment as they would back home in Shropshire, and vice versa,” she says.

Evaluations have shown that 85% of practitioners felt the tool improved confidence and 97% said it was easy to use - they also felt it improved record keeping.

“I was so determined to make this tool work and get it off the ground. That’s also why I was so pleased to get the award from Macmillan. They have been incredibly supportive, as have UKONS. It’s great if you can just do something like this that makes sense for the patient, and do it nationally.”

Jenni Middleton

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