Saul Ebema, DMin

After many emails from hospice chaplains around the country asking for an IDT note template, here is one. While some hospice agencies do not take this part of hospice chaplain documentation seriously, IDT notes are critical for a hospice company’s survival and compliance.

The Hospice Conditions of Participation state that the Hospice Interdisciplinary Team (IDT) must meet 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.”

The hospice interdisciplinary team (IDT) serves a very important function in helping the hospice company provide better coordinated, comprehensive care that leads to improved care quality and enhanced patient & caregiver satisfaction.

The IDT includes hospice physicians, nurses, home health aides, social workers, bereavement counselors, chaplains, and trained volunteers who work together to address a hospice patient’s physical, emotional, and spiritual needs. This holistic approach for the hospice interdisciplinary team enables members of different disciplines to evaluate and provide feedback that helps improve the patient’s quality of care.

Since hospice care is a team effort, each discipline is required to have an IDT note to talk about their plan of care for the patient. That note has to articulate the importance of your visits to the patient and caregivers. What problems you are addressing and how you are addressing those problems. This documentation is at the core of your entire hospice team’s success.

NOTE: Since we are in the middle on the COVID-19 pandemic, some of you are wondering if you still have to write your IDT notes because you are not visiting patients. My answer is yes, you still have to do your IDT note.

This specific note can look like this; Chaplain is unable to meet this month’s visit frequency because routine visits provided by your hospice’s name (loving hands hospice) have been suspended per CDC recommendation to promote patient safety and limit exposure in order to assist in decreasing the possibility of COVID-19 spread. Hospice goals remain for patient’s spiritual needs to be met.

Some of you are comfortable writing IDT notes like this; “Chaplain continues to visit patient twice a month for spiritual support and the current plan of care is effective.” Please, don’t settle for that.

However, to show professionalism and expertise in our field of hospice chaplaincy, we recommend that your IDT notes should follow this template:

Patient’s age__________	Patient’s Gender__________ Chaplain’s visit frequency______________
Patient’s hospice Diagnosis__________________	What problems have you solved in the last two weeks?________
What will your visit look like in the next two weeks? ________	How is the family or POA coping?________________________

Based on the above template, your notes will look like this:

IDT Note Example One

Patient is a 58-year-old male with a hospice diagnosis of congestive heart failure. Chaplain’s visit frequency is twice a month with an occasional PRN (Per Required Need– visits are visits outside the required visit frequency). In the last two weeks, chaplain visited patient to offer spiritual support and to help counter his sense of social isolation. Patient is always in his room and often isolated from community but enjoys the one on one visits with the chaplain. During the last visit, patient however seemed depressed. Chaplain provided supportive counseling, empathetic listening, and validation. In the next two weeks, Chaplain will introduce the concept of a legacy project and work with patient and family on documenting the patient’s life story. Family continues to visit patient as often as they can and verbalized to the chaplain that they are coping well.

IDT Note Example two

Patient is an 80-year-old male with a hospice diagnosis of COPD. Chaplain’s visit frequency is three times a month with an occasional PRN. In the last two weeks chaplain visited patient twice. Although patient remained nonverbal and comfortable during those visits, the wife was extremely overwhelmed with the burdens of the patients care and declining health needs. In her own words, “I feel like I can’t do this alone anymore; none of my children come to help.” Chaplain legitimized and normalized her feelings to help reduce anxiety. Chaplain helped her realize that crying or being upset are normal reactions that need to be expressed. In the next two weeks, chaplain will continue to work with her and explore new ways of coping.

IDT Note Example Three

Patient is an 84-year-old female with a hospice diagnosis of unspecified severe protein-calorie malnutrition. Chaplain’s visit frequency is once a month with an occasional PRN. In the last two weeks chaplain visited patient for spiritual support and life review to help foster a sense of hope, and meaning. Patient enjoyed talking about her life and faith histories. Towards the end of the visit, she said, “recalling these memories make me realize that I have lived a good life.” Chaplain affirmed her feelings and prayed with her. Chaplain communicated with the family and they denied any needs at this point. In the next two weeks, chaplain will continue with the same plan of care.