With increasing referral rates to the Specialist Palliative Care community team, it became necessary to analyse the dependency of the caseload. A review showed a lack of available tools that had been used successfully, so an in-house solution was sought to develop one.
The starting point was to utilise the experience and instincts of the Nurse Specialists to place the patients on their caseload into four different categories:- Red, Amber, Green and Blue, depending on perceived urgency and complexity of needs (with Red being the highest and Blue the lowest).
10 patients from each of the four categories were randomly picked and scored using the modified Support Team Assessment Tool. This identified a lower symptom score for patients assigned to the Blue and Green categories compared to those in Red and Amber.
Of the10 Red category patients, 7 died and 3 required admission to the Hospice for symptom control within a 2 week period. This contrasted with the patients in the other categories, who remained well controlled at home.
Analysing the scores, pain could be considered the most important indicator. The exercise showed that Nurse Specialists were able to accurately determine patients' dependency.
This has influenced the way the team manages their caseload. All patients are now categorised and home visits are carried out by the most appropriate team member, using the different skill mix of roles. Red and Amber patients are assessed by the Nurse Specialist, whereas patients in the Green and Blue category may be assessed by a Staff Nurse, reporting back to the Nurse Specialist who maintains overall responsibility.
This ensures that each patient on the caseload has regular contact, and is seen by the most appropriate professional at the appropriate time. Patient evaluation is currently underway, but informal feedback from patients and families has been positive.
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