Interprofessional Patient Conference Worksheet Purpose of Conference: Before the team meets (completed by each professional) Review the case Identify potential concerns of the patient/family Identify information or research required for your profession Identify potential priorities for your profession in the case conference
Profession-specific priorities:
Notes:
1. 2. 3.
Preparation for interview (discussed prior to the patient’s arrival) Set priorities to address in interview: Discuss identified priorities of each team member Negotiate 1-4 team priority issues to address in the conference Identify key team members for each priority
Priority #1
Priority #2
Priority #3
Priority #4
Names:
Names:
Names:
Names:
Clarify meeting processes: **Identify appropriate team roles required for each team member, in order to facilitate team process. **Not all roles may be employed in every meeting; however, assign roles to ensure that those process duties are filled when they are required. **All team members occupy both a team role, to contribute to team process, and a professional role.
Initiator: guides goal setting and facilitates meeting progress
Recorder: records the proceedings, provides notes to patient/family
Timekeeper: ensures that the team is on track and the meeting ends on time
Advocate: advocates for perspectives that are not heard, including the patient’s
Name:
Name:
Name:
Process Observer: comments on methods to enhance group process
Energizer: encourages and supports team members, where required
Participant: supports team members in their roles, where required
Name: Participant: supports team members in their roles, where required
Name:
Name:
Name:
Name:
Discuss: How will the team clarify and address the patient/family’s goals?
Notes:
How will the team clarify their roles for the patient/family? How will process issues be addressed during the meeting? (e.g. if the team is running out of time) How will the team know if the meeting is successful? Tentative Agenda (set in advance of the meeting): ** Align agenda with priorities, recognizing flexibility will be necessary to ensure that the patient’s goals are heard and addressed during the meeting Agenda:
Notes:
Follow-up required: