Abstracts

RATIONALE: Complex, multidisciplinary epilepsy center offices receive a high volume of patient telephone calls. Our five neurologists see an average of 270 patients in clinic a month. We average 20 to 30 patient telephone calls for advice to our registered nurses a day. Documentation of patient telephone calls, nursing assessment and physician assessment and advice is required. The objective of this poster is to present specific triage guidelines and computer generated forms that were developed to ensure appropriate handling and documentation of patient telephone calls.
METHODS: A team of registered nurses and neurologists met to develop guidelines for our specific patient population. Nursing guidelines for seizure activity, medication dosing, side effects, allergic reactions and headaches were created. These guidelines include general information, assessment questions, care advice and triage instructions. Computerized Call Back Forms were developed for our receptionist to document the reason for the call, requested call back time and to update demographic information. Nursing Telephone Encounters were created to document the presenting problem, current medications, guideline used, recommended disposition and patient/caller understanding and intended action. The physicians also use this form to document their assessment and advice. Links to computer generated prescription forms and pharmacy fax cover sheets were designed. The forms were implemented as part of an internal practice management database developed at the Regional Epilepsy Center using a commercial database program.
RESULTS: The guidelines and forms were implemented in November 2001. Nurses report that the guidelines and forms have improved patient care by creating more thorough and uniform assessment and documentation of patient problems and concerns. Also the guidelines have been useful in training new nursing staff. Physicians prefer the printed forms that are specific to our patient population and find the chronological history of medication doses to be very helpful. The printed prescriptions and pharmacy fax cover sheets are easier and quicker to create and read.
CONCLUSIONS: Response to patient telephone calls has been standardized and streamlined with the new system. User feedback has resulted in revisions to the forms, and new guidelines are being developed to address additional patient concerns and problems. Data concerning type of telephone call, daily volume and response turnaround times are now easily compiled and analyzed to help determine staffing needs and monitor quality of care. This system has been beneficial in meeting regulatory documentation requirements and in developing a paperless record keeping system.