During the COVID-19 novel coronavirus pandemic, patients might be fearful and uncertain if they should come to their clinic appointments. COVID-19 presents greater risks to older adults and people with comorbid diseases such as cancer and other chronic conditions, and patient concerns will likely increase the volume of phone calls into your clinics and telephone triage lines. Oncology nurses can use the opportunity to assess and educate patients.
Assess the Need for an In-Person Appointment
If it is a follow-up appointment with a patient not currently undergoing treatment, consider changing it to a telehealth appointment or postponing to a later date. If the appointment is necessary and the patient is at high risk for developing serious complications from COVID-19, consider moving their appointment to a time of the day with fewer people around the clinic and building.
Assess Risk of Developing Serious Complications From COVID-19
Patients with cancer are already at high risk, especially those who are actively receiving treatment, including radiation, surgery, or antineoplastic medications, have a hematologic malignancy, or have a history of a blood or marrow transplant. Ask the patient the following questions:
- What is your cancer diagnosis?
- Are you actively receiving cancer treatment? If yes, when was your last treatment?
- Have you had a blood or marrow transplant?
Ask the patient about or review their chart for:
- Age (60 years or older)
- Comorbidities (e.g., lung disease, diabetes, heart disease)
- Recent white blood cell and absolute neutrophil count to identify neutropenia
- Current medications to identify immunosuppressive agents such as steroids
Follow your hospital’s policy on how to proceed with appointments for patients who are at increased risk to develop more serious complications from COVID-19.
Assess for Symptoms of COVID-19
Fever greater than 100.4°F (38°C), coughing, fatigue, sore throat, anorexia, myalgias, or shortness of breath may indicate COVID-19 infection. Digestive symptoms (e.g., diarrhea) and loss of smell and taste have also been reported. Symptoms can range from very mild to severe. Assess patients for symptoms that may require urgent in-person evaluation, such as difficulty breathing, persistent pain or pressure in the chest, change in mental status, or cyanosis.
Ask patients about their international and domestic travel within the past two weeks. If they report a combination of those symptoms, have traveled to a location with a COVID-19 outbreak, or were exposed to someone with a known COVID-19 infection, direct them to the appropriate medical provider for further evaluation or possibility of testing.
If their symptoms are severe, tell patients to go to the emergency department or call emergency services immediately. Call the emergency department ahead of time to alert them to prepare for a patient with possible COVID-19 infection.
Educate on Risk Reduction
The Centers for Disease Control and Prevention recommends that everyone, regardless of risk, practice the following behaviors during the pandemic.
- Stay home when you are sick.
- Wash your hands often. Wash for at least 20 seconds with soap and water; if soap and water is not available, use a hand sanitizer with at least 60% ethanol or 70% isopropanol.
- Do not touch your eyes, nose, or mouth with unwashed hands.
- Avoid crowded areas and sick people.
- Practice social distancing when you do need to get out in public, which means staying six feet apart.
- Clean and disinfect high-touch surfaces often.
- Avoid all nonessential travel.
- Stay informed with reliable local and state resources.
How are you managing patients by phone during the pandemic? Visit the ONS COVID-19 Community and let others know what's working for you.