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Whether you’re new to hospice or have years of experience, chances are, you’ve spent hours preparing for interdisciplinary group (IDG) meetings. What if you didn’t have to waste so much time on IDG? Let’s talk about the hospice IDG time wasters and how you can avoid them.
IDG is a time for the hospice team to discuss each hospice patient and to document their care plan.
Hospice IDG preparation can take hours, I’ve seen IDG meetings take even longer.
For instance, I’ve seen IDG meetings last 6 hours and even all day.
But why is this?
Simply stated, these meetings often turn into rambling sessions with multiple side conversations.
It’s not unusual for team members to come and go for things like printing documents or taking phone calls.
Did I mention the time spent getting orders and the countless documents to review and sign?
Scenarios like these often lead to burnout and cause nurses to question their future in hospice.
If this sounds familiar and you thought this is how it’s supposed to be, it’s NOT!
Let’s start by understanding the hospice IDG and how it works.
What is Hospice IDG?
When I started as a hospice nurse, I didn’t understand the purpose of the hospice IDG.
Also, I didn’t know the term IDG was used interchangeably with the term interdisciplinary team or IDT.
Admittedly, I was confused but didn’t want to ask because I felt like I should know what my preceptors were talking about.
The first step to understanding hospice is to understand the hospice IDG and its purpose.
The hospice interdisciplinary team (IDT) develops the patient’s plan of care and is focused on providing holistic care to the patient, family, and caregivers.
Members of the IDG include:
- Medical Director
- Physicians
- Nurses (RNs and LPNs)
- Home Hospice aides
- Medical Social Workers
- Chaplains
- Bereavement
- Therapists (speech, occupation, physical)
- Volunteer Coordinator and Volunteers
- Patient and Family (are not required to attend meetings)
Regulatory Compliance of IDG
CoP for IDGs is §418.56
First, hospices must comply with conditions of participation also known as CoPs. These guidelines established by Medicare require the interdisciplinary group to “review, revise, and document the individualized plan as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days.”
Some agencies refer to IDG as “team” and can meet more frequently than every 15 days. In fact, some hospice teams meet every week.
Hospice IDG Time Wasters and Barriers
Of course, you want to spend more time with your patients, right?
Understanding these common IDG timewasters can help you stay focused and keep IDG meetings productive.
Time Wasters include:
- Not understanding IDG member’s role
- Role blur (i.e. the nurse functioning as the social worker)
- Lack of knowledge of other’s professional expertise
- Negative team dynamics
- Administrative insufficiencies
- Not involving the whole team
- Being unprepared
- Ineffective reporting techniques
- Varying theoretical differences
- Technology (love it or hate it?)
How to Avoid Hospice Time Wasters
Ensure you understand the roles and expertise of the various disciplines on your team
Remember each member of the IDG also brings their own perceptions and experiences with them to their role.
Avoid side conversations as they can distract from the patients’ needs
This is not the time to make lunch plans nor is it the time to complain about your patient load.
Because most hospice team members work in the home and not in a group or office setting, it is not unusual to want to catch up at IDG.
Simply stated, this is not the time.
Each member of the hospice team is valuable and brings their own perceptions and experiences with them to their role.
Utilize and involve the entire IDG
For instance, I have seen many nurses in IDG reporting family dynamics and issues that they spent hours on when they could have made a referral to the social worker or chaplain to address those needs.
Address any conflict immediately and keep it moving
Personally, nothing is more frustrating to me than negative team dynamics.
If there are differences in opinions regarding care or role blur, this can lead to conflict.
Better yet, keep conflict out of IDG and work with your supervisor to address issues.
Ensure that all team members understand their roles related to patient care and hospice guidelines
For example, when an individual on the team offers advice that is beyond their scope of practice this can be confusing for the patient and their families.
For instance, the hospice aide makes a recommendation for increasing pain medication and does not defer to the nurse.
I have also seen agencies receive a deficiency because a member of the team made an adjustment to the plan of care without consulting the nurse.
Always come prepared!!!
Another important component of IDG is administrative support and preparation.
Furthermore, your agency should have a set agenda ready prior to the meeting and if possible, someone should be available to function as a scribe.
Most importantly, you should review your patients’ plan of care prior to IDG and come prepared to discuss how the patient meets hospice criteria, medication adjustments, pain/symptoms, and any other pertinent information.
Sample Hospice IDG Meeting Format
There is no single way to structure an IDG meeting.
For instance, hospice agencies may structure this meeting based on several factors such as staff availability, geographical location of patients and staff, or physical meeting space availability.
Some hospices may choose to have all team members present during the entirety of the meeting while others may schedule time slots for reporting based on individual nurse assignments.
While each has its benefits, the key is to make sure the communication is focused on the patient’s needs and individual plan of care.
Your nursing report should be concise and should not take more than 2-4 minutes per patient unless it is a complex situation with multiple issues to address.
IDG should follow the D.A.R.E structure
D-Deaths
A-Admissions
R-Recertifications
E– Evaluation
What to Discuss at Hospice IDG (D.A.R.E.)
- Deaths
- Review all deaths since the prior IDG.
- Identify whether bereavement has been accepted or denied
- Identify who will be followed by bereavement (i.e., spouse, child, caregiver)
- Discuss bereavement risk of those being followed
You should clarify who is responsible for making the initial contact after the patients’ death. This individual is the most logical person to provide this report in IDG and will help reduce the time spent trying to figure out if the contact has been made.
In my experience, the social worker or chaplain was often the team members reaching out to assess the bereavement risk and they reported on deaths at the IDG.
- Admissions
- The RN case manager provides a narrative report of all new admissions including diagnoses and how they meet hospice eligibility criteria.
- Review medications and prognostic indicators
- Discuss visit frequency and needs such as aide services and other psychosocial concerns
- Include all team members in discussion such as chaplain and volunteer coordinator
I have included a sample admission narrative note template below that you can use to save time when preparing for IDG. This is a lifesaver.
- Recertifications
- Discuss all patients who are nearing the end of their benefit period.
Remember: the 1st and 2nd benefit periods are 90 days each and each subsequent benefit period is 60 days.
- Review face-to-face visits: these are required starting in the 3rd benefit period and can only be completed by the hospice physician or nurse practitioner.
- If the patient does not meet criteria, discuss with family, and ensure they have the support and supplies they need at the time of discharge.
It is not a bad idea to see if the patient qualifies for home health prior to discharge.
- Evaluations
- Discuss all other current hospice patients on service
- Include the entire IDG in discussion and engage the hospice medical director
- Review medications for changes and/or new symptom management
- Identify additional needs such as spiritual, volunteer, aide
- Review visit frequency for the next to weeks and update plan of care
Three Ps to Ensure a Successful IDG
While I’m sure you would like to get some of your time back so that you can spend more time doing what you love; caring for patients. The following tips will help you get and stay on track.
- Preparation
- Presentation
- Practice
1. Preparation
First, come prepared to discuss your patient and how they continue to meet hospice criteria.
While it is encouraging to see that the patient ate, it is also important to note that the patient has not eaten well prior to this one time.
Negative charting is a term that you will want to become familiar with as you document for hospice. This is especially true in your hospice IDG notes and plan of care.
2. Presentation
Secondly, you should construct concise narrative notes for each new admission because this will ensure that you provide the details needed to establish hospice eligibility.
Keep this narrative note and it can be used for each subsequent IDG that the patient is discussed. This is a major time-saver!
Narrative Template should include:
- Name/Age
- Residence/Location of Care (NH, home, assisted live, or GIP)
- Admitting Diagnosis
- Events leading up to hospice admission
- Prognostic Scales used and their values
- Co-morbities
- Patient/Family Wishes
3. Practice:
Thirdly, the old saying Practice Makes Perfect, holds true for hospice IDG. The more you practice the steps above and incorporate them into your routine, the faster you will become and preparing for IDG.
Sample Hospice Narrative Note
Mr. Donut is 74 yo Caucasian male admitted to hospice on (Date) with a dx of Alzheimer’s dementia who resides at home with his wife. 3 recent hospitalizations for falls, hip fx, and most recently UTI. Patient requires total care for ADLs and has had a 30-pound weight loss in the last 6 months. Patient is speaking less than 6 intelligible words. Fast 7a, PPS 40 percent. Unrelated co-morbidities include HTN and hypercholesteremia. Family does not want patient to return to the hospital and wishes for comfort care only. Family signed DNR at hospital.
Conclusion
In conclusion, while it is not entirely possible to eliminate IDG, you can save time by understanding IDG and preparing in advance. Furthermore, it’s critical to include the entire hospice interdisciplinary team in the plan of care. Lastly, remember the team is there to support the holistic needs of the patient, family, and their caregivers.