Disease Grid Jeopardy

Hospice Eligibility Criteria

100

Name of the scale used for measuring severity of cardiac disease?

NYHA (New York Heart Association)

200

Resting tachycardia >100/min is a qualifying factor for primary diagnosis? 

Pulmonary Disease

300

The ability to speak ≤6 words scored as what on the FAST? 

7a

400

Name 3 general decline measures used to help document to decline. 

1. 
   
   1. Recurrent or intractable serious infections such as pneumonia, sepsis or pyelonephritis;
   2. Progressive inanition as documented by:
      1. Weight loss of at least 10% body weight in the prior six months, not due to reversible causes such as depression or use of diuretics;
      2. Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes such as depression or use of diuretics;
      3. Observation of ill-fitting clothes, decrease in skin turgor, increasing skin folds or other observation of weight loss in a patient without documented weight;
      4. Decreasing serum albumin or cholesterol.
      5. Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption.
2. Symptoms:
   1. Dyspnea with increasing respiratory rate;
   2. Cough, intractable;
   3. Nausea/vomiting poorly responsive to treatment;
   4. Diarrhea, intractable;
   5. Pain requiring increasing doses of major analgesics more than briefly.
3. Signs:
   1. Decline in systolic blood pressure to below 90 or progressive postural hypotension;
   2. Ascites;
   3. Venous, arterial or lymphatic obstruction due to local progression or metastatic disease;
   4. Edema;
   5. Pleural/pericardial effusion;
   6. Weakness;
   7. Change in level of consciousness.
4. Laboratory (When available. Lab testing is not required to establish hospice eligibility.):
   1. Increasing pCO2 or decreasing pO2 or decreasing SaO2;
   2. Increasing calcium, creatinine or liver function studies;
   3. Increasing tumor markers (e.g. CEA, PSA);
   4. Progressively decreasing or increasing serum sodium or increasing serum potassium.
5. Decline in Karnofsky Performance Status (KPS ) or Palliative Performance Score (PPS) due to progression of disease.
   
   
6. Progressive decline in Functional Assessment Staging (FAST) for dementia (from 7A on the FAST).
   
   
7. Progression to dependence on assistance with additional activities of daily living (see Part II, Section 2).
   
   
8. Progressive stage 3-4 pressure ulcers in spite of optimal care.
   
   
9. History of increasing ER visits, hospitalizations, or physician visits related to the hospice primary diagnosis prior to election of the hospice benefit.

500

Tell me the 2 qualifying factors for cancer?

1. Disease with metastases at presentation OR
2. Progression from an earlier stage of disease to metastatic disease with either:
   1. A continued decline in spite of therapy; or
   2. Patient declines further disease directed therapy.

Medications for Comfort

100

When reviewing your patients medications and determining hospice coverage, what document should you refer to that helps guide hospice coverage? 

Formulary Medication List/Preferred Drug List

200

What drug is considered the gold standard for pain/dyspnea management in hospice? 

Morphine

300

What class of medications poses the biggest safety risk related to falls as patient progresses in their disease? 

Anticoagulants/blood thinners

400

If a patient is taking an opioid either scheduled or PRN, what other class/type of medications should be ordered?

Bowel regimen/meds to prevent OIC

500

Morphine is not the gold standard and should be reconsidered for patients' with which disease process/primary diagnosis? 

End stage renal disease 

(consider oxy, dilaudid)

Worst Case Scenario

100

Name the 3 hospice emergencies we have discussed? 

spinal cord compression, superior vena cava syndrome, acute fatal hemorrhage

200

Your patient is experiencing symptoms of slurred, non sensical speech, L sided facial droop and drooling. Pt has a primary diagnosis of CHF. Should patient be sent to ER and why? 

No - if patient/family in agreement with hospice philosphy we will treat symptoms for neurological event, but no aggressive measures are indicated. 

300

Your elderly patient with Alzheimer's lives at home with elderly spouse who's the PCG. The patient has now started exit seeking? What interventions should team plan for to help with disease progression? 

Look at facility/memory care placement, 24 hour caregiver rotation for oversight, locking exit doors, chime sound on all exit doors for safety, what else?

400

Your patient who has a primary diagnosis of COPD had a fall in home and sustained a deep, long laceration to R forearm that likely needs stitches/sutures. Should this patient need to revoke services for appropriate treatment.

No - we as the hospice are responsible for facilitating appropriate care. In this case, if stiches/sutures required, the hospice would facilitate transport for patient to ED, communicate with ED staff pt is on hospice services and is only seeking treatment related to laceration and pt remain on hospice services throughout visit to ER for treatment. Pt will then be transported back home with no disruption is hospice services. 

500

Your patient resides in a LTC facility with a primary diagnosis of breast cancer. Pt has struggled with pain management over last 48 hours with increased oral titrations ineffective is meeting patient's pain goal. The pain has now escalated to a place pt reports is not bearable. What should we do as the hospice to treat the patient's pain crisis?

Discuss GIP LOC with facility, if they are not able to provide care, discuss transfer to Hospice care center/IPU. 

Supporting the PCG

100

What is the level of care called that benefits the primary caregiver and provides a break from caretaking? 

Respite

200

Which discipline(s) should we always include in helping manage anticipatory grief? 

Social Worker and Chaplain

300

What extended team members can we use to help the PCG with support such as breaks for errands or naps, companionship with patient, other alternative therapies?

Volunteers and volunteer services 

400

Name of the of the common strains seen in relationships with those patients with primary diagnosis of end stage liver disease? 

Codependency, enabling, diversion, different types of grief, estrangement

500

Which primary diagnosis most often has the highest risk of elder abuse? 

Dementia(s) 

Non-Pharm Care Plan Interventions

100

What are 3 things we can train the patient with CHF to do to help with trouble breathing? 

Elevate HOB, oxygen, fan, energy conservation, breathing exercises, etc.