Legal Risks of Telephone Triage

Sachia Logan, RN, CPNContact Center

Introduction to Telephone Triage

• Registered Nurse

• Nursing Diagnosis

• Cost- effective

• Children’s Mercy Telephone Triage Nurses

• Decision Support Tool (McKesson)

Example of a protocol (Cold)• 4256 [1] Difficulty breathing AND [2] not relieved by cleaning out the

nose See Immediately• 67 Rule out: pneumonia

• 4257 [1] Age < 12 weeks AND [2] fever (>100.4 F or 38.0 C rectally) See Immediately

• 55 Rule out: sepsis• Care Advice• 2058 FEVER: Don't give any acetaminophen before being seen. (Reason:

need accurate• temperature documentation to decide if septic workup is necessary) (R/O

false positive)• 2071 CARE ADVICE given per Colds (Pediatric) guideline• [1] Fever AND [2] >105 F rectal or oral• (EXCEPTION: age > 1 yr, fever down AND child comfortable. If recurs,• see now.)

Certifications/Licensure

• Dually Licensed

• RNC-TNP

• CPNhttp://www.pncb.org/ptistore/control/indexhttp://www.nursecredentialing.org/

Is it really what they say it is?

Charting

• Artist-Paint a picture

• Dr. Barton Schmitt

• Details on caller

Legal Implications

• Case 93 Triage Nursing (handout)

• Where do I stand?

• Negligent Advice

Quality Assurance • FHP QA/I on all dispositions

• Physician/Patient Satisfaction Survey

• Review of nurse protocols by PAB

• Random Chart Audits

• Audit Concerns and Complaints

Audits

• Audit Concerns and Complaints

• Random Chart Audit

References• American Academy of Ambulatory Care

Nursing.(2008).Telehealth Nursing Practice Resource Directory (5th ed.).

• American Organization of Nurse Executives. AONE. (April,2000). “Telenursing, telemedicine, telelicensure?”. Nursing Management. p.15.

• Barton D. Schmitt Protocols• Case 93:Triage nursing. (2003). “Triage nurse who did

not follow the protocols and forged her references. Professional Misconduct Case Studies. British Journal of Nursing. Vol. 12, No 10. p. 589.

References (continued)• Charles-Jones, H., May, C., Latimer, J., Roland,M.(2003).

“Telephone triage by nurses in primary care: what is it for and what the consequences likely to be?” Journal of Health Services Policy.p.154-158

• Coleman, A. (1997) “Where Do I Stand? Legal Implications of Telephone Triage”..Journal of Clinical Nursing1997;6:227-231.

• Contact Center Annual Report 2008

• Edwards, B. (1998). “Seeing is believing-picture building: a key component of telephone triage”. Journal of Clinical Nursing, Vol. 7, Issue 1, p. 51-57.

• Edwards, B. (1994). “Telephone Triage: How experienced nurses reach decisions”. Journal of Advanced Nursing 19, 717-724.

References (continued)• Greenberg, M. E. (2000) “The Domain of

Telenursing: Issues and Prospects”. NURSING ECONOMIC$. Vol 18, No 4.

• Physician Advisory Board• American Academy of Ambulatory Care

Nursing.(2008).Telehealth Nursing Practice Resource Directory (5th ed.).

• Whitten, P. (1997). “Home telenursing in Kansas: patients’ perceptions of uses and benefits”. Journal of Telemedicine and Telecare.

Questions?