I am an UR nurse at a hospital that began using interqual back in 11/09. I was wondering how other hospitals "qualify" someone who is in the process of passing away and the doctor has ordered comfort measures only.
I have used interqual over 2 years, it is not possible to meet interqual unless they are having significant pain and on a narcotic, morphine/dilauded drip, or if they require >40% oxygen. Comfort care for comfort. They won't meet, but if they are medicare, as long as they met during their hospitalization, they shoul be covered. Never fudge on interqual just to make someone meet. If they don't meet, they don't meet.
One area that I've found helpful with dying patients is under the CNS/MS subset Neurologic deficit (unconsciousness and DNR/DNI). For IS-all you need is neuro assessments > 6x/24 hours and an acute onset or deterioration of a neurologic impairment. Doesn't work for all dying patients but I've used it quite a few times. Hope this helps.
You did not mention if the patient had been initially acute then the condition became comfort measures. Remember, InterQual provides a frame but other issues affect resource recovery for the spell of illness. You may have already max'd out the DRG and the reimbursement can be affected by contributing comorbids or those things which impact the weighted DRG. Does the facility may have a policy re: Lower level of care and if the patient is at a point where he can be moved to a hospice bed or a skilled nursing bed vs the patient is actively in transition and death is expected in hours? You can not make documentation exist for something that is not there but also you are part of a process and some facilities look at the cost of doing business with compassion where they can design it in. If the department has not taken a look at this as an identified group of patients, perhaps you have an opportunity to initiate a learning opportunity or a process improvement project?
If the patient is dying, refer them to hospice for general inpatient care at the hospital. The hospice have to have a contract with your facility but they foot the bill for the stay and meds, etc. Definately more cost effective and hospice is a huge benefit for the family. We do it often in my area.
Im new to using interqual. I don't think there is a way to make a dying pt meet criteria. Its really stretching it to get them to meet. I also worked with hospice for 15 yrs, and neuro checks are never ordered for a dying patient. There's no point in it. My supervisor likes for us to arrange discharge to an alternative level of care if they are not actively passing.