Authored by Danelle Willey, RDN
The Interdisciplinary Team, or IDT Team, in the community is the primary way of reviewing all Residents that are at risk, addressing the issues or concerns and coming up with the best plan of care. It is vital to the overall health of the Residents that the IDT team work together. The IDT Team is made up if the MD, Director of Nursing, Social Services Director, Director of Rehab, Treatment Nurse, Director of Food and Nutrition Services, RNA, CNA, Activities and the RDN. This groups of leaders and management in the community know everything there is to know about the Residents: what they do, what they like, where, what and how they eat, who they interact with, if they take or refuse medications or treatment. As the RDN we focus on the Resident’s weight changes and a large part of that is their intake of meals, snacks and supplements. We can ensure the best overall outcome for the Residents if we all work together and look at the Resident as whole. Asking questions and communicating regularly with the members of the IDT Team will only help us do our job the best we can.
Some tips for how to communicate effectively are:
- Make sure all members can make the IDT meeting.
- Discuss what the overall plan and goals of the Resident are.
- Ask activities if the Resident attends activities and what they eat or drink when they do.
- Ask the CNA or nursing if family members bring in food.
- Discuss with nursing the current medications and whether they are compliant with taking them.
- Ask the Treatment Nurse if there are any skin issues or if they turn regularly.
- Discuss with social services the different options for each Resident. Some may be looking to DC home or they may be long term in the community.
- Discuss with Rehab the goals and plans, if progress in therapy is being made, or if they need to extend therapy sessions.
- The RDN should voice their interactions and knowledge about the Resident’s PO intake of meals and fluids and if supplements are or could be beneficial.
All of these probing questions will help the Team understand what they need to do to help the Resident succeed. By first understanding the overall plan and goals of the Resident, we can work together to help them achieve their goals. The IDT team should meet weekly to ensure all at-risk or high risk Residents are being monitored and that proper interventions are in place and being followed up on. Open communication with the IDT team will help each department be successful with the care of the Residents. This will also lead to fewer clinical deficiencies during survey because the more documentation and communication there is to show that the Residents are being discussed and monitored, the less concerns the surveyors will have that the Resident are adequately being cared for. Better communication leads to better care and better care leads to a better community overall.