That's really interesting information Ruth and I would be interested to see your operational policy too if that's OK?
My service is now getting to the point where I need to be looking at formally categorising my patients (for want of a better phrase!) and being able to justify the level of support and contact they require / receive, both to support the service now but also support the development of the service going forward.
So with that in mind it would also be useful to see what the team at the Christie are doing with this please Catherine?
I look forward to hearing from you
The Christie use a stratified follow up approach to help with workload. if you drop me a line I can put you in contact with them if you wish?
It is part of the recovery package work and I saw it in a report re the National Cancer Survivorship Risk Stratification Model - sorry, can't find the link now, but have found this one below, and think the image I was talking about is on p8.
I borrowed the concept of categorising my case load into red, amber and green according to complexity and need, just to clarify it for myself and my manager.
I tried to attach the document of my own (very basic!) diagram, but could only send a link (sorry, I am extremely IT illiterate!). I put my tweaked version in my operational policy to illustrate how I would manage the case load, and I keep three distinct sections of nursing notes. Obviously this system is fluid, as patients move from one category to another. Just to clarify, all patients have my contact details and can access the service as they need, whatever group they fall into, but some will be counted as new contacts if this is after a significant period of time.
I also always let patients know they are in the 'green' group, so this is done with their awareness and agreement. It just helps to clarify that we are not always the best person to answer all queries if they are not cancer related and to encourage them to use their GPs etc, otherwise I found I was becoming the central point for all information and health issues for an awful lot of patients with stable disease!
Hope any of this info is helpful,
imhabe tried looking for the Macmillan risk stratification model but cannot see anything on line
have you got a link to this
I'm sure a lot of us will really relate to this. Personally speaking, I don't think my referral criteria necessarily helped with this, as I have to accept referrals for any new metastatic breast cancer patients from MDT, being the only key worker for this group. Occasionally I will negotiate with my Breast Care Nurse colleagues to hang on to a new patient with local recurrence, but if it's unresectable, they are still technically palliative.
I think discharge criteria may be more relevant for your problem. I use the Macmillan Risk Stratification model (found online and classifying pts as red, amber or green in terms of complexity or unmet needs). This helps to separate those patients seen/contacted regularly and those who are long term stable and who don't make contact very often: as long as I met them when new in post and gave them my contact details, these patients don't necessarily need regular input. I really hope this helps and would be interested in any other suggestions from colleagues.
I just wondered if any of you have created any referral criteria? My caseload is getting to the point of becoming untenable. The breast team are informing me about every new diagnosis and I am doing an enormous amount of rescue work for the existing patients'.
Any suggestions/referral criteria about how you manage this would be greatly appreciated