Thursday, December 18, 2014

A new template for hospice Chaplains to use...Your thoughts?

In many cases a Chaplain documents a narrative style describing what happened in a visit. That is fine as far as it goes, but it can leave out gaps of information that are essential: pain score and scale used; observations of decline; and interventions employed to reach the Goal/Expected Outcome. I have been ok with Chaplains using a narrative style, but have grown uncomfortable with continuing with that simply because of the demands of auditing firms that review hospice charts. Years ago I learned to document using the FAIERS template. F=Focus or purpose of the visit; A=Assessment of patient; I=Interventions used; E=Education presented to patient; R=Response of patient to the visit; S=Subsequent visit information. I mulled switching to this tool, but can’t through such things as Assessment and Education. A Chaplain is not licensed to perform an Assessment. A Chaplain may only observe or record such things as pain levels and decline. As far as Education is concerned, this seems to be intertwined with the Interventions we use and would be a waste of valuable time on the part of the Chaplain. While one can pronounce this acrostic of FAIERS, it seems inadequate for our use. Instead, I wrote the following to more fully describe what happens when a Chaplain visits a patient or a family member/caregiver: Purpose of the visit—The Chaplain can state that this was a routine visit to comply with the terms of the Plan of Care or state that this was an On Call visit or a Return visit due to an emergency or whatever description that fits the circumstance of the visit. Observation—Again, Chaplain do not assess, they observe. A. Pain level/scale B. Decline—MAC C. Spiritual concern(s) Intervention(s) A. What interventions did you use to address the spiritual concern(s)?—The Chaplains have 21 possible Interventions from which to choose for this section. They should have already have chosen one or two from the Initial Spiritual Assessment (this is the only place Assessment can be used). B. What evidence can you give that this helped the patient?— Response of the patient/family-- I will provide our Chaplains with plenty of examples of verbiage to use to document this piece. Subsequent visit—This section should be brief and summed up in one sentence. A. To fulfill the terms of the POC B. Within 30 days Your comments are welcome. This is not an easy process and one I approach lightly. Bless you, Chaplains, for your fine work. You are God’s hands of peace and support.

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