Daily notes are a major part of documentation and if you wait too long to do them it will feel like you are drowning in paperwork. After talking to several therapists and reading posts on Facebook groups, I sent out a survey to occupational and physical therapy groups to get some concrete data on how much time is spent with daily notes. When I talk about daily notes it’s not just the treatment note but it also includes attendance and medicaid billing which are typically done daily too. Some of you are probably thinking that it’s not that bad, it only takes 2-3 minutes to write a note, but when you have a caseload of 50 students that time adds up. When your caseload is high it’s a double whammy because it requires more time for notes and leaves you with less time in the day. If you say “l’ll do it tomorrow” it can slowly build up and you end up not having done any notes for a whole quarter (I may or may not have done this) and spend two whole days (not just work hours), if not longer, catching up.
The survey group included 66 OTs, 10 PTs, 6 COTA’s, and 1 PTA. The average caseload size was 52 (low end was 24 and two therapists had 100 which is crazy). Ninety one percent of the therapists complete a daily note, 79 percent do Medicaid billing, and 73 percent keep an attendance log. Which means that most therapists are using three different types of records either through an online program such as EasyIEP for medicaid billing, handwritten notes for treatment and goal progress, and if you work for a contract company they want another attendance form that is handed in monthly. That is three different forms of documentation for each child every day. If you take the average caseload of 52 kids (to make life simple we will make each kid 1 x week) and it takes about 5 minutes to do a daily note (which includes the various tasks of either logging onto a computer, shuffling through folders or binders, writing the note, marking the attendance, putting everything back, etc) it adds up to be about 260 minutes or 4 hours and 20 minutes a week. That’s almost a full work day just doing daily documentation on top of actually working with the kids, attending meetings, testing students, and writing reports. Where does one get this time? By taking it away from the kids we treat, but also and most importantly ourselves and our families which often goes unpaid. Fifty four percent of the therapists do them at the end of each day while only 18 percent do them at the end of each session. Twenty one percent of therapists complete their notes whenever they get a chance which includes at home without pay.
Now I’m sure you are already familiar with the numbers or your own experience working in schools and probably wondering, what can I do? The documentation needs to be done. Since developing Double Time Docs in 2018, one of the most frequent questions I have been asked is do you have anything for daily notes or progress reports and my answer was always no because at the time I didn’t think there was a way around it. It had to be done and it doesn’t take that long to do an actual note. If I were to develop a daily note system, I did not want to change a therapist’s habits and routines by adding more work. I looked at the therapist’s daily routine. Most of the time was spent on organization, looking for students folders or files, looking for goals, inputting data, etc. I thought about my treatment sessions and looked at daily notes as more of an attendance and progress note and then I realized that most students’ progress is slow. Progress usually happens in a span of several weeks, even months and sometimes years which is understandable and that’s usually why they are receiving services in the first place. Also, my treatment sessions are usually the same until progress is made so that there is consistency in expectations and routine for the students. For example, if a student needed to work on attending to a task and drawing simple shapes, my session would be playing with putty and drawing a picture. This routine would be pretty much the same for a couple of weeks until the child or myself got bored or the child made progress and the activity had to change.
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One day while driving on my 45 minute commute from work, where I do most of my thinking, it hit me. I believe I figured out how to streamline daily documentation and eliminate the repetitiveness by automating it. Keeping these two ideas (1. Progress is slow and 2. Sessions are consistent in routine), I thought to myself why can’t the notes be automated and instead of writing a daily note every day, why not complete them when something changes i.e. progression or regression, change of activity, student/therapist absent, etc and have a program that will automatically carry over the notes from the previous session. I also like simplicity, so I had to decide on what are the most important parts that the program would need and what therapists do and do not like about other programs. After talking to several therapists and using my experience, I narrowed it down to three main functions.
- It must be simple, functional, and easy to navigate.(Eliminate all the visual clutter)
- The goals have to be easy to access.
- It must keep attendance, daily notes, and the ability to see progress.
With all of this in mind, I developed Spednote. The best way to describe it is by giving you a simple example. I am unaware of an easy way to fill out demographic information on a student, so this would be an example with the caseload already set up. The goals are simple just for example purposes.
I tried to make the scheduling as easy as possible. I do realize that scheduling isn’t the therapist’s favorite part of their job which is why I wrote some strategies in this blog post. For the first several months, scheduling changes as often as the verdict on whether or not eggs are good for you or not, so I added the ability to drag students’ appointments from one day to the next straight on the calendar.
Another feature that I needed to add was the ability to access a student’s goals easily without searching for the student or opening up binders or looking online to check goals. From my experience many of the IEP or medicaid programs that school districts use don’t have easy access to goals. On Spednote, you can click on the student’s name straight on the calendar and the Quicknote feature shows up without even leaving the calendar itself. On the Quicknote you are able to address each goal for that student and change their progress based on that session. That information carries over to the following sessions, so that if your student’s skills maintain, you don’t even have to log into the program, it is done automatically. Since most of us are doing teletherapy, you can keep Spednote open in a different window during your sessions so that you can view the student’s goals without fumbling through papers and binders. Nothing is worse than realizing you forgot to address a goal at an IEP meeting.
On Spednote, you are able to graph and track a student’s progress based on their goals. You can see where the student progresses or regresses if you need that data for ESY or progress notes. For progress notes, you can just click a daily note that you feel is appropriate and use that information from the note as your progress note.
Stop drowning in daily notes and give yourself a life line with Spednote. Spend time doing things that you actually like doing such as playing outside while the software does your notes. Try it out for FREE until December 31, 2020 and see how easy it is to save time. If you have any questions or concerns please email firstname.lastname@example.org.
Illustrations by Icelin Gonzales: Instagram @bananatrashart; TikTok @banana.ers.
Jason has been a Pediatric OT for more than 19 years and has worked all over the country in many school districts. He’s the creator of Double Time Docs, an online software for pediatric OTs, SLPs and PTs that speeds up evaluation report writing by leaps and bounds.