Team Meetings & Hospice Nursing Diagnosis

[LookUp2Sky]

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!

[okielpn75, ASN, RN]

I find some of these posts amazing. Our RN "case managers", and I use that term LOOSELY, do not fill out the IDG forms or present the patients at IDG. They do fill out the goals part of the IDG but that is all..and all that requires is a few check marks. The LPN's are required to fill out each patients complete IDG, including their assessments and changes for each system. The LPN is also responsible for presenting the patient and explaining their changes and interventions made. Our RN's couldn't tell you a thing about our patients. I wish they were more active as they should be.

[tewdles, RN]

Geez okie..what are the "case managers" doing then?

[okielpn75, ASN, RN]

You tell me. They do start of care's and that's about the extent of it that I see. Even on the new admits the LPN is the one who orders DME and medications. Also the LPN does the follow up visit the next day and there is usually a mess for us to clean up. We truly are the case managers as the RN's with our company don't even see the patients.

[tewdles, RN]

yikes!

[4hymn]

Do you happen to know where I could get a copy of the Symptom Management Algorithms: A Handbook for Palliative Care / Edition 3 book by Linda wrede-Seaman? I am a new grad and will be taking an on call for a large hospice but the book is astronomically priced .

[nuangel1, BSN, RN]

ErinS said:

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.

I am relatively new to Hospice since 2/18 but have over 30 years experience .I agree with the above this is what our IDT meetings are like. My hospice averages 220 - 230 PT's .