Communication and collaboration: IDT best practices
Continuing Education: Learing Objectives
After reading this article, you will be able to:
- Explain the value of efficient weekly or daily interdisciplinary team (IDT) meetings
- Describe the benefits and detriments of e-mail communication between IDT members
- Identify strategies for organizing the IDT
The goal at all SNFs should be the same: provide the best possible care to each and every resident in the building. Different facilities will have their own methods for achieving that goal, but a number of constants exist, namely the pivotal role played by the interdisciplinary team (IDT) and the need for consistent collaboration among the team's members.
While each team member has his or her own resident care responsibilities, it is important to remember that those responsibilities are tied to the tasks of others, in addition to the PPS reimbursement process. For that reason, IDTs must develop communication policies and procedures that will facilitate honesty and directness, as well as foster respect and teamwork.
Such an undertaking rests with the MDS coordinator, says Holly Sox, RN, BSN, RAC-CT, MDS coordinator at Presbyterian Communities of South Carolina in Lexington.
"I am a sports fan, so sports metaphors come easily to me. I see the MDS coordinator as the quarterback and captain of the interdisciplinary team. While all team members are vital to the function of the team and the assessment process, without a strong leader, the team will fall apart like my favorite college team does in the biggest games,” Sox says. "You have to know who's on the field at all times. You have to know what your resources are and be willing to ask for help when you need it.”
Knowing who's on the field means maintaining a system for tracking admissions, discharges, and transfers so that discharge assessments and entry tracking forms can be completed promptly, says Sox.
This can be overwhelming at times, so MDS coordinators can't be afraid to rely on other team members when necessary, especially the DON. In many cases, an IDT is only as strong as the MDS coordinator and DON's relationship, which must encompass a great deal of trust and respect.
"I'm a nurse first and foremost, and I think that in working side by side with the DON and assistant DON, I'm able to offer support and provide information that they need so they can do their jobs,” says Sox.
DONs and assistant DONs should reciprocate this attitude and provide MDS coordinators with the help and clinical information they need in order to complete their responsibilities with greater efficiency.
In addition, for DONs who supervise the MDS coordinator, it is important to recognize that in many cases, micromanaging becomes counterproductive. MDS coordinators are typically burdened with a lengthy list of responsibilities, so having to worry about those tasks under the watchful and untrusting eye of a DON-or any other manager, for that matter-can put undue stress on the MDS coordinator and result in missteps or errors that may otherwise not occur.
The same mentality needs to be held by the MDS coordinator in working with therapists, nurses, CNAs, and other members of the IDT, says Sox.
"You can't expect total subservience because it won't work that way. These are all professionals who have an expertise,” she says. "To go back to the football analogy, if I'm on the field and I want to throw a pass, I need to count on my receiver to catch the ball; I can't go catch it. I need to have trust in the people who are working with me and I need to treat them that way, because the team would just fall apart otherwise.”
Following a few simple best practices will allow your IDT to thrive, and thus improve the overall care of your facility's residents.
The benefit of efficient meetings
IDT staff members are quite familiar with weekly meetings, which are commonplace at most facilities. But how many staff members can honestly say that they are gaining valuable information from those meetings or that the time is being used efficiently and the issues discussed are resolved or instituted effectively?
Weekly meetings are absolutely necessary; however, facilities should aim to get the most productivity as possible out of every meeting.
Various IDT staff members should be actively participating in at least three types of meetings:
- A weekly Medicare meeting
- A weekly IDT/care plan meeting
- A brief, daily morning meeting
The weekly Medicare meeting is an opportunity for the IDT to review each resident and discuss his or her individual needs related to the skilled services being provided. Staff members can take this time to improve resident outcomes through a coordinated system of care delivery. The following IDT members should be present at the weekly Medicare meeting:
- MDS coordinator or RN assessment coordinator
- Nursing representative (usually the DON or assistant DON)
- Therapy representative
- Social services
- Medical records
- Other frontline staff, if needed, to discuss specific resident care concerns
Prior to the meeting, each discipline should prepare any necessary materials, which may include:
- The MDS coordinator's list of outstanding signatures required for assessment submissions
- Nursing's notes, discharge plans, and current medical statuses for residents
- Therapy's equipment needs and resident progress
- Social services' family concerns
- Accounting/billing's ancillary charges
- Medical records' missing or incomplete physician certifications and recertifications
During the Medicare meeting, each resident record should be reviewed in detail. This is often a good time to perform triple checks. Keep in mind that while nursing and therapy will occupy most of the discussion during the Medicare meeting, it is a venue for all disciplines and is critical to the success of your facility's Medicare program.
Just like the Medicare meeting, an IDT or care plan meeting should be held once a week in the same (or at least a similar) time slot. A substantial portion of the meeting should be devoted to devising or revising resident care plans with contributions from family members. While the MDS coordinator typically chairs the IDT/care plan meeting, the DON, who communicates directly with busy frontline staff members, should play an active role.
"The director of nursing communicates with and represents the nurses since it's very difficult for them to take time to be there,” says Joyce Gregory, RN, DSD, MDS coordinator at Sierra View Homes in Reedley, CA. "The director of nursing is extremely helpful. She's on the floor and is observing. I'm swamped with paperwork, but she's out there and is very aware of what's going on with the residents. She'll be helping the CNAs or out with the nurses checking on things. She's a hands-on person and it's very nice to have that kind of connection.”
It's that kind of working relationship that will keep an IDT on the right track and establish an agenda for the IDT/care plan meeting.
"The director of nursing and I, we're crossing paths frequently throughout the day and sharing with each other what's happening with our residents, so we have an idea of what has to be done,” says Gregory.
As is the case with the Medicare meeting, efficiency increases when key parties or disciplines go into the IDT/care plan meeting with set items to discuss. Some of those items will be unique on a week-to-week basis; others will be a constant part of the agenda.
"We tend to go through our MDS assessments. We usually have four to five that are scheduled per meeting and we use about 15 minutes per resident with the family members when they come in,” says Gregory. "We go through the care plan with the family and we involve CNAs and the director of nursing. As a team, we review the plan of care and see if we need to make any changes or problem solve.”
The daily morning meeting, often called a stand-up meeting, can be viewed as a less formal combination of the Medicare and IDT/care plan meetings. They should not last long, usually about 15 minutes at the most, but are very worthwhile in communicating important information to the IDT.
"We go over the 24-hour report from the day before with all of the clinical information. We go over the MDS calendar to see what's on the agenda for the day. We look to see if there have been significant changes to determine if a significant change in status assessment needs to be done,” says Sox.
Appropriate e-mail communication
In addition to serving as a daily catch-up, the morning meeting is a good time to make any necessary administrative announcements, such as changes to other meeting schedules, out-of-office notifications, or a listing of agenda items for meetings to be held later in the day.
Some facilities find it best to share these announcements and other IDT information over e-mail instead, which is perfectly acceptable. In using e-mail as a means of communication for the IDT, the key is to maximize effectiveness without overrelying on the technology. Despite the convenience of e-mail, many conversations are best suited for face-to-face interaction, and these should not be diminished or replaced.
"We tend to do a lot of face-to-face. I use e-mail for a number of the staff that are not IDT; although, with the IDT, I do communicate things like changes to assessments in an e-mail to IDT members who have input with the assessments,” says Gregory. "E-mail has its place, but I also find that face-to-face is extremely valuable.”
The amount of e-mail communication used between members of the IDT, as well as other staff, is often tied to the size of a facility. Gregory's Sierra View Homes (59 beds) and Sox's Presbyterian Communities of South Carolina (44 beds) are in the same size range.
Still, Sox says she finds e-mail to be extremely helpful when it comes to quick exchanges and mass communication, such as sending out weekly calendars to the IDT so that staff members know what they need to get done and can plan ahead. In fact, Sox says she uses e-mail more often now than at the larger facility she worked in previously, which just goes to show that use of the technology should be unique to the routines and needs of each facility.
Organization as an IDT priority
Even the best communication efforts-whether through e-mail, in face-to-face conversations, or during meetings-are all for naught if an IDT is not organized.
Think of organization as a prerequisite to efficient collaboration. It is the engine of the IDT vehicle. Without it, the other moving parts can only inch along at a snail's pace. Like an engine, organization is absolutely necessary for the highest levels of function to occur.
IDT teams-and in many cases, specifically the MDS coordinator-can facilitate organization in a number of ways.
A system for managing daily work is essential. A calendar, spreadsheet, or tracking tool can be used for keeping tabs on assessments. If operating in freehand, assessment reference dates (ARD) should be written in pencil, allowing for easy edits should the ARD change.
It's helpful to prioritize the daily workload by first completing items that are time sensitive-such as interviews, Care Area Assessments, and care plans-then tackling the OBRA assessments that are due, and lastly completing PPS assessments.
If the MDS coordinator and DON are organized, it should rub off on the remaining IDT members, each of whom should maintain calendars to track when assessments and care plans are due. All calendar updates should come from the MDS coordinator in order to ensure consistency.
Shift reports, completed by the nurses, are also a great way to keep everyone on the same page. "It helps with inter-shift communication,” Gregory says. "The director of nursing and I go and check them out to see what might help us. Charge nurses are aware that they can connect with us about any issues that are going on. For us, a lot of it is verbal interaction. If we have a concern, we tend to put our heads together rather often to try and decide how to address issues.”
CNA card systems are also helpful in communicating care plans to frontline staff.
"For the staff, morale is key. People know when the team isn't functioning well and it filters down to the direct care staff,” says Sox. "One of things we use here is a CNA plan of care that goes in the closet for each resident. We as the interdisciplinary team need to prepare a good care plan and then get that communicated to the staff members who are out there providing the care. And if we're not doing our job, then they're not going to have the information they need. That gets frustrating, especially if they're held accountable.”
Remember that organization paces collaboration, which an IDT must employ through steady communication in order to provide optimal resident care. "If we're not keeping up with each other, then important things get missed,” says Sox.