Specialist Community Palliative Care Triage Guideline

The Community Palliative Care Service in SWSLHD is part of the Primary and Community Health Network. The South Western Sydney Local Health District (SWSLHD) Community Palliative Care Service is a nurse-led model. The care coordination of palliative care clients is managed by the Community Health Nurses (CHNs). They are supported by a team of specialist palliative care nurses, including clinical nurse consultants (CNCs), clinical nurse specialist (CNSs) and registered nurses (RNs), who work within a consultative model. These specialist palliative care nurses provide expertise to support the CHNs in their management of palliative care clients. This is a community-based triage guideline.

Nurse led

Standardised triage guideline to facilitate early referral to care

Symptom burden assessment used to prioritise referrals

After hours patient and carer phone support

Creating a consistent guideline for community palliative care triage across a large and diverse LHD

The triage project was initiated as part of planning for the community palliative care COVID- 19 response. It was identified that the service did not have a formal and consistent method across the district for prioritising referrals to the community palliative care nursing service. A triage guideline was developed by the Community Palliative Care CNC Group. It includes:

• a guide to documents that should be reviewed in the eMR prior to the call
• a script for nursing staff to introduce the triage process
• utilisation of PROMSNAMES assessment guide acronym (although this was already used in practice).

The process of triage has been integrated into usual community nursing practice and is supported by the SWSLHD Primary and Community Health Palliative Care Model of Care.

Improving efficiency and efficacy for clinicians, and support for clients

• The structure of the new triage guideline enables clinicians with different skills to attend a palliative care triage call.
• The prompt questions ensure that the nurse attending the triage phone call has a structure to follow.
• The script gives guidance to introduce the service and helps facilitate consistency in how the service is introduced to new clients.
• The structure of the call fosters rapport with clients/carers from initial contact.
• Clinical assessment from triage enables early referrals to allied health if required, and appropriate timing of initial visit according to severity of symptoms on telephone assessment.
• The triage guideline gives clear directions on the expected timing for allocation of clients to a care coordinator, expected time frame for referral to triage and a pathway outlining how to proceed if they are unable to contact a client or a client declines service.
• Assessing the client’s symptom burden enables CHNs to prioritise their workload and prioritise joint visits with the specialist palliative care nursing team referrals to be managed.

What tips do you have for others?

• Engagement with the Community Health Network teams is crucial to see the value of a comprehensive phone assessment as the starting point of care, rather than an extra task they had to do in an already busy work schedule.
• Linking the guideline to a documentation format that was already in place enabled the new triage guideline to be adopted by the Community Health Network care coordinators.
• To ensure consistent education is delivered across geographically dispersed teams, an education plan was developed with standardised flowchart and PowerPoint slides.
• Incorporate education on the new triage guideline in orientation programs for new staff commencing work with the palliative care team.