Team Meetings & Hospice Nursing Diagnosis

[LookUp2Sky, ASN, RN]

I have a couple of questions, and I'm hoping someone can help me out! During our bi-weekly team meetings each patient is discussed. Each discipline is able to add their input. When it comes my turn, as case manager, I am sometimes at a loss for words! (Hard to imagine for me-LOL). However, I always want to be concise and accurate on my statement of the current problem for that particular patient and what intervention we are currently working on for them. I have noticed in the meeting that other case managers are giving a full report on each of their patients at every team meeting. These meetings are running 2-3 hours for a total census of 20-30 patients.

I would like some feedback on what others feel need to be discussed or reported. Also, is there any reading/reference material that gives nursing interventions for death/dying/hospice?

Thanking you in advance. May we all continue to aspire to inspire!

[hospicevet 20, ASN, RN]

I used to work for a large for-profit hospice, and cost containment was a huge issue. We were expected to give report in IDG in 3-5 minutes, and if there weren't any big changes, to say "no big changes." We would briefly talk about any meds that were added or DC'd, any new or resolved symptoms, and then turn it over to the next team member, in our case, the social worker. It really helps if you write out a little blurb before IDG to make sure you don't spend a lot of time trying to remember stuff, and it helps to weed out the fluff---things like "the wife asked me about prognosis, she's stressed, etc." The team already knows this, and there's no need to go over it. We had people on the team who used to use the IDG to process their emotions, and it isn't the place. Going out for coffee afterwards if you have time, always a good idea.

[hospicevet 20, ASN, RN]

Oh, and Oxford Textbook of Palliative Medicine, by Doyle, Hanks, and MacDonald. Also Symptom Management Algorithms: A Handbook for Palliative Care, by Linda Wrede-Seaman, M.D.

[LookUp2Sky, ASN, RN]

Thank you for your fast, efficient response! Now that's what I'm talking about-LOL. Seriously, I appreciate the advice. I did adopt your idea of a quick little blurb before team begins and that definitely helps. Your response will help me to narrow it down.

Thanks again!

[tewdles, RN]

As a hospice case manager you should be reviewing the nursing plan of care for you patients in the IDT discussion...you address each problem you have identified for the patient and the progress toward goals. This does not have to be a long winded discussion and it is possible for the entire team to provide their report in a few minutes for a well managed patient who is not near death.

It is important to remember that the biweekly IDT is the forum for anticipating needs as much or moreso than reviewing the previous 2 weeks. This is where you plan for the frequencies that you anticipate will be required, you plan for the respite or discharge or travel of the patient, and when you plan for the "next step" in the symptom constellation that is suggested by the current trajectory of symptoms.

Each team member should be preparing their presentation for IDT prior to the actual meeting. Most hospices that I have worked for require that presentation to be a part of the written record, so most have a place where this can be accomplished proactively and then reviewed and added to during the review.

All of the disciplines should be reporting on any open problems or goals...Nursing, Medicine, Social Work, Pastoral Care, Volunteers, and even Bereavement (especially if there are anticipatory or pediatric needs prior to death of the patient).

30 patients ought not take more than about 90 minutes unless you have a bunch of people with symptom management issues. If you have complicated cases it is helpful for the team members to discuss the case and have a plan in mind BEFORE the meeting when possible...this allows us to simply review and discuss quickly without shortcutting the actual care delivery or plan itself. Many discussions which are lengthy in IDT can be an "off table" discussion and the person who is responsible for the flow of the meeting should be stepping in to divert them to a more focused approach with an invitation to continue their dialog outside of the meeting.

The IDT is the place where the PROFESSIONAL hospice RN Case Manager formalizes his/her role as the discipline responsible for advocating for the goals and outcomes that the patient has identified.

[LookUp2Sky, ASN, RN]

Tewdles - Thank you very much for your most professional reply. If you are not writing for any textbooks...maybe you might want to consider it!

I am an "older" case manager, but only 2 years into hospice, and am always looking for ways to improve/enhance care for our patients. Your insight is very much appreciated!

[ErinS, BSN, RN]

There are actually very specific medicare guidelines on what your IDT meetings should include. As Tewdles said, your IDT should be concise and focused on your patients plan of care, ie. your patient's goals. In our hospice we write IDT notes the morning before IDT for our own patients, and then report based on notes and add any additional info or changes to plan of care. Our notes are based on the following info:

Level of care (example: routine care in daughters home)

Symptoms (example: needing increased ms for dyspnea, weaker, 1 fall, abx for UTI, etc)

Pain management (example: pain well managed on ms contin and roxanol)

Family coping (example: daughter at risk for caregiver burnout, son will be caring for pt beginning next week)

Satisfaction

Changes to plan of care

Changes to visit schedule

Anyways, our IDT generally covers 35-50 patients in 120-150 minutes. This includes a moment of reflection of chaplain provides, an educational overview on a specific disease provided by our MD, and a review of deaths since last IDT.

[LookUp2Sky, ASN, RN]

Thank you, ErinS. Thanks to everyone's help, I may be getting on the right track.

I think that there have been so many new additions of case managers, as well as our clinical coordinator, things have gotten a little off-track. Or perhaps it's me trying to utilize the time in the most efficient manner for the patients' sake. Nevertheless, this has been truly helpful. My next one is this Tuesday, and I am working now on my notes for that meeting (thanks to all of you).

I am still searching for Medicare Guidelines which are more specific. I currently have a packet of information which is general in nature...what hospice covers as far as social worker visits, nursing visits, etc. I have yet to find the specific information related to IDT Meetings, what is covered for trach/vent patients, supplies in the way of briefs, etc. I am a detail person, and also go by the book where my license and Medicare are concerned. So, I will continue asking and searching!

In the meantime, thanks again! Have a blessed Christmas!

[NightNurse,RN, ASN, RN]

When do you prepare for IDT? Is time allowed in your scheduled hours or on your personal time? "LookUp2Sky" if you do find specific Medicare Guidelines for IDT, please share. I have trouble with our care plans, they just seem more general than hospice specific. Anyone know a good source that is not electronic/computerized?

[LookUp2Sky, ASN, RN]

Hi NightNurse - I prepare for our IDT meetings on my own...usually, the night before, as they are first thing on Tuesday mornings. Most other case managers do not prepare any kind of notes. I find though, that is too easy for me to get off track if I don't have some of the specifics written down.

Thank you for responding. I'm still searching for Medicare/Hospice information. I have been browsing the Medicare website, but have not found anything specific yet. I will let you know if/when I do.

I hope you have a great start into your new year! Talk to you soon.

[tewdles, RN]

Join NHPCO - Search for info on Interdisciplinary Groups. Every thing you need to know is in there.

[LookUp2Sky, ASN, RN]

Tewdles - Thank you so much. I will take your suggestion, and check that out. Would like to say too, that since receiving input from you (and others), that I have felt more productive and on task at these meetings.

Thank you very much for your advice/suggestions!