True or False
Prognostication is based on an educated assumption if a disease takes its normal course
What is true
These two physicians certify the patient as terminally ill with a six month or less prognosis
Who are the Hospice Medical Director and Attending Physician
An 82 yo female with a PMH of Senile Degeneration of the Brain, previously residing at home with her son, PPS was 60%, attended a senior day program 5 days per week and activities. FAST 6A. She experienced a fall 2 weeks ago.
Since the fall, she is bedbound, developed pneumonia, experienced a 5lb weight loss and has become incontinent of bowel and bladder. She is no longer interested in meals and eats only 30% of 2 meals. She is more confused but still able to carry on a conversation.
This patient could fit into this category.
Hospice eligibility is based on terminal ______
What is prognosis
These items are not required to conduct an evaluation but this is
What are H&P or other patient related records
What is an order
The nurse determines eligibility at the initial evaluation after completing the assessment, review of medical history and discussion with family
What is false
The nurse gathers information to provide to the HMD to determine eligibility
This person is considered the local authority on hospice
Who is the hospice Medical Director
An 81 yo male patient with a PMH of COPD presents with disabling dyspnea at rest despite being treated with bronchodilators, sats 85% on RA, requires continuous O2 at 3L NC. PPS is 40% and is only able to pivot from the chair to bed, experiences exertional dyspnea that requires 5 mins to recover to baseline. He has been hospitalized 3 times during the past 6 weeks for respiratory infections. This patient could meet under this guideline.
What is LCDs, Perfect Fit
Patients in this diagnosis group have the most predictable prognosis and disease trajectory if not treated
What is Cancer
The RN must contact these two individuals to determine eligibility and to certify as terminally ill a the time of the admission
Who are the Hospice Medical Director and the Attending Physician
During the initial evaluation, the daughter states, "I was told I can take my father to the hospital if it is necessary."
What is true
Discuss
The FAST Scale was developed to help prognosticate which form of Dementia
What is Alzheimer's
A 90 yo female with a PMH of HTN, DM and osteoarthritis previously residing at home experienced a significant fall. She presented to the ER and was found to have a complete R Hip Fx. During her 4 day hospital stay she was determined to not be a candidate for surgical repair. She has declined to a PPS of 30%, now incontinent of bowel and bladder, AMS, eating only bites and sips. She has lost 6 lbs and now weighs 99 lbs.
This could demonstrate a case for this guideline.
What is Physician's Judgement
A 56 yo female with Stage IV Lung CA, lives at home alone, is referred to hospice. She is a known heroin abuser. She frequently asks for Oxycontin and has refused the Methadone prescribed to her. Pill counts are frequently inaccurate and she has been instructed on numerous occasions that she cannot receive early refills. There is suspicion that she is selling or abusing the Oxycontin. This would be the next step for the hospice after exhausting med changes, control measures, and counts.
What is stop prescribing narcotics
After speaking to the Clinical Manger, the evaluating RN should contact this person next if they are unable to collect enough data to present to the HMD for certification
Who is the attending or referring physician
The LCDs require all disease specific criteria to be met before a patient can be admitted into hospice
What is false
A 92 yo female patient with a PMH of CHF and HTN, previously residing independently at home experiences a fall, a 15 lb wt loss, decrease in PPS from 60% to 40%, a recent hospitalization for UTI requiring IV antibx, over the last month. Her lab values are Cr- 3.5, Na 121. She has been treated with ACE, Beta blockers and Diuretics, upon evaluation she has no SOB or edema post hospitalization. Could she be considered eligible for hospice?
What is yes
How so,
Discuss her diagnosis
A 64 yo male with a PMH of Liver Disease and ETOH abuse, CRF, PVD, COPD, DM and depression presents with ascites, requiring paracentesis q 2 weeks. He has been hospitalized within the last 3 weeks for hepatic encephalopathy. PPS 40, Bilateral non-healing and worsening LE ulcers requiring WD clinic mgmt., currently being treated with antibx. He is a current smoker and sats 89-92% on RA, desats with exertion.
Lab values- INR 1.3, albumin 2.7, Cr. 2.8
This patient could meet under this guideline.
What is Close Fit, Significant Co-morbid disease
Hospice receives a referral on a patient that has a dx of schizophrenia, he has not been deemed incompetent to make decisions and is the primary decision maker for himself in the group home. The hospice RN evaluates the patient for Lung Ca and he meets criteria. She is concerned about his ability to sign the consents. She would take these steps before leaving the group home.
What is speak to the facility SW and request documentation to support his competence
Discuss
These two things give hospice permission to speak or meet with a patient or family
What are a referral or direct request from the patient or family
Discuss order
In order to admit a patient into hospice you must first have the H&P and diagnostic work up regardless of patient presentation on evaluation
What is false
A cardiac patient could potentially be admitted with CHF if their EF is 50% due to this diagnosis
What is Diastolic Heart Failure
****DAILY DOUBLE****
Name the 4 Ways to Determine Eligibility
What are-
Perfect Fit, LCDs
Close Fit, Rapid Decline
Close Fit, Significant Co-Morbid
Physician Judgement
Before contacting APS on any case that is not causing imminent danger to the patient, the hospice should do this first
What is ensure they have utilized all resources to aid the patient and family in coordinating interventions and developing an effective care plan
This item is the most important part of an evaluation
What is an in-person assessment by the RN, NP or MD