Telephone Triage Guidelines - St. James's Hospital

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HAEMATOLOGY ONCOLOGY TELEPHONE TRIAGE GUIDELINESASCITIESSIGNS AND SYMPTOMSACTION Increase in abdominal girth Abdominal fullness,bloating, heaviness ortightness Ingestion Nausea and vomiting Increased frequency ofvomitingCome to HODC forassessment on next clinic Swelling of ankles Inability to eat or drink for24 hours Weight gain Decrease in ability toperform ADLs Inability to sleep or rest dueto shortness of breath orabdominal discomfort Lack of bowel movementCome to HODC forassessment Difficulty breathing Abdominal discomfort Weight gain Uncontrolled nausea andvomiting for >24 hours Change in mental status Inability to perform ADLsAdvise to come toHODC/WSW/DBU/A&Efor assessment Severe shortness of breath Acute abdominal pain Unresponsiveness Temperature >38CSeek Emergency careimmediatelyHOPe Directorate, St. James‟s Hospital V2 201230
Mood AlterationHAEMATOLOGY ONCOLOGY TELEPHONE TRIAGE GUIDELINESMOOD ALTERATIONInitial Assessment Questions1. Is this a new problem?2. Any physical:a. Shortness of breath? b. Sleep disturbances? c. Dizziness or muscle tension?3. Any psychological:a. Racing thoughts? b. Depression? c. Excessive worry? d. Irritability?4. What are the sources of patient support?5. Does the patient have a history of depression/any psychiatric illness?6. Is the patient taking any new medications?7. Is ? the patient on steroids (including inhaled steroids)? If yes:a. What dose are they taking?b. When did they commence?c. When was the dose last reduced or increased?d. Was the dose weaned or did they just stop as part of a treatment regimen?8. Is palliative care involved with the patient?9. Is the patient starting to die?Grading of Mood Alteration:Grade 1 Grade 2 Grade 3 Grade 4 Grade 5Mild mood Moderate mood Severe mood Suicidal Deathalteration notinterferingwith functionalteration interferingwith function, butnot interfering withADL; medicationindicatedalterationinterferingwith ADLideation;danger to selfor othersNCI-CTCAE v3.0 (2003)HOPe Directorate, St. James‟s Hospital V2 201231
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Page 16 and 17: ConstipationHAEMATOLOGY ONCOLOGY TE
Page 18 and 19: MucositisDry mouthXerostomiaHAEMATO
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Telephone Triage Guidelines - St. James's Hospital

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