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Interprofessional Team Communication in Treatment Planning - Coggle Diagram
Interprofessional Team Communication in Treatment Planning
Care Issue #1: Medical Management
Disciplines Involved
Social Work
Assist with insurance to ensure affordability of medication
Pharmacy access
Addressing any financial barriers to obtaining medication
Facilitate coordinator with home health agencies for central line monitoring
Nurse Practitioner
Continue PCP and oncology appointment as necessary
Share records between teams to update with clinical status, labs or recommendations.
Manage central line care.
Educate on proper precautions and when to seek care.
Assess pain
Refer to pain management if needed
Immunosuppression precautions
Home healthcare
Provide dressing changes
Monitor vital signs
Assess oral health.
Assistance with medication administration
Pharmacy
Patient education and safety
Removing drugs no longer appropriate for treatment
Education on side effects and when to notify provider
Arrange refill delivery service to reduce travel
Review medications for any errors
Discharge Plan
Medication reconciliation
Education for patient and caregiver
Complete medication list with dosage and frequency
Ensure proper transportation is set up
Care Issue #2: Oral Hygiene
Disciplines Involved
Dental
Mucositis care
Ongoing dental monitoring
Collaborate with medical team
Oral hygiene training
Social work
Ensuring oral health materials are accessible
Discharge plan:
Educational material provided on oral hygiene routine
Provide a list of future follow-up appointments
Care Issue #3: Psychosocial and Supportive Resources
Disciplines involved
Social Work and Case Management
Facilitate an appointment or potential lodging assistance
Transportation for oncology/medical and dental appointments (Medicaid could offer)
Psychiatry
School work
Work with Carlos’s school to help make sure he has the resources and other accommodation needs for potential absences.
Screen for anxiety and depression for both Carlos and mom.
Address coping skills
Family support resources could include local or regional support networks for Carlos and his mother
Discharge Plan
CBT + Talk therapy for both Carlos and his mom
Print out future appointments with accommodations in place
Communicate with school to have a plan in place for Carlos' return