Canterbury DHB

Guidelines for Managing Patients Out-of-Hours

Outpatient Calls

Any patient who is unwell or febrile at home must contact the B6. These calls are triaged by the nursing staff using the After-Hours Nursing Telephone Triage Procedure BMTU (5032).

Patients who are likely to become neutropenic e.g., stem cell transplant patients or those undergoing chemotherapy treatment are provided with a “green card” during their outpatient assessment or first admission to the B6. The green card contains instructions for the immunocompromised patient on what to do if they feel unwell, and contact phone numbers. The green card is also an indicator to medical staff to follow the Immunosuppressed Patient’s Clinical Pathway, ref 2167.

Inpatients Causing Concern

Any patient who is being actively treated and deteriorates unexpectedly out of hours must be reported to the Haematology on call staff. During the normal working week, this is the Haematologist on call. On public holidays and at the weekend, the Haematology Registrar on call should be contacted first.

An on-call roster is produced weekly (normally issued on the preceding Friday) or alternatively the on-call roster can be viewed on the Whiteboard in Health Connect South (nee Concerto).

The Duty Medical 1 House Officer covers both ward duties and admissions from 1600 to 2300 weekdays, and 0800 to 2300 on weekends/public holidays. Contact the HO via the Clinical Coordinator pager 5265.

From 2230 to 0830, the Clinical Coordinator directs available and appropriate medical staff to cover duties, page 5265.

Between the hours of 2300 and 0700, it is important that the Haematologist is made aware of any significant unexpected deterioration of patient condition, e.g., a high EWS. General medical issues, e.g., request for mild analgesia, fluid balance, insomnia, can be appropriately directed to the night specialty registrar.

The Bone Marrow Transplant Unit registrar should hand over to the Consultant before going home. This handover should focus on any new problems identified since the morning ward round or unstable patients for whom a change in therapy might be required.

The nursing staff have the option of calling the on-call Haematologist at any time if they feel that patient safety is at risk.

Topic Code: 4634