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HOSPICE ADMISSION NURSING TRAINING

HCA/220 Pamela Kieslich Ellen Lipscomb October 7, 2012

OVERVIEW
After this training presentation the admission nurse will be able to: • Evaluate patients for hospice care. • Use “tools” for evaluation of patients. • Understand regulation and policies.

GOALS
• Timely evaluation of hospice referral patients. • Understanding common hospice diagnosis. • Assess patient to determine appropriate hospice diagnosis. • Charting of patient comprehensive assessment and plan of care. • All documentation is on time and complete according to CMS and state policy.

REFERRALS
Patient referrals come from many sources: • • • • Physician offices Family members Hospitals Other hospices

Company policy states referrals are addressed within 2 hours of initial call and patient evaluation completed within 4 hours.

THE REFERRAL PROCESS
• Referral received • Obtain physician order for evaluation • Request History & Physical (H&P) • Schedule evaluation with family

COMMON HOSPICE DIAGNOSIS
• Cancer • Cardiopulmonary • Liver Disease • End Stage Renal Disease • Alzheimer’s and related disorders • HIV/AIDS

CANCER
• Any malignant cancer that will no longer be treated with aggressive measures. • Laboratory tests confirm carcinoma/neoplasm.

CARDIOPULMONARY
• Congestive Heart Failure (CHF) • Coronary Artery Disease (CAD) • Acute Myocardial Infarction • Chronic Obstructive Pulmonary

Disease(COPD)
• Cystic Fibrosis

LIVER DISEASE
• End Stage Liver Disease • Cirrhosis – alcoholic and non-alcoholic • Hepatitis • Sclerosing Cholangitis

RENAL DISEASE
• End Stage Renal Disease • Chronic Renal Failure • Lupus Nephritis • Rapidly Progressive Glomerulonephritis

• Nephrotic Syndrome

ALZHEIMER’S AND RELATED
• Alzheimer’s • Dementia • Failure to Thrive • Huntington’s chorea

• Amyotrophic lateral sclerosis

HIV/AIDS
• Human Immunodeficiency Virus (HIV) • Acquired Immune Deficiency Syndrome (AIDS)

“TOOLS” TO DIAGNOSIS
• Body Mass Index (BMI)
– Ratio of height to weight

• Mid Muscle Area (MMA)
– Mid arm circumference and tricep skin fold

• Palliative Performance Scale (PPS)
– Determines functional status

“TOOLS” TO DIAGNOSIS (cont)
• Functional Assessment Stage (FAST)
– Determine functional and mental status of dementia patients

• New York Heart Association (NYHA)
– Determine heart failure level

• Pain Scale (0 – 10)
– Determine level of pain

• Pressure Ulcer Staging
– Determine severity of wounds

REGULATIONS & POLICIES
• CMS Section 418.54 • State Section 63-1-860

SUMMARY
• Admission nurse has the knowledge of:
– common hospice diagnosis – “tools” to help support diagnosis – CMS and state regulations