Sepsis as Hospice Diagnosis

duskyjewel · Sep 13, 2014

I've seen asystole as a terminal diagnosis and the patient was alive and on service. :)

Say wha.......?! I don't even....

I've seen sepsis as the diagnosis on many inpatient hospice patients where I work, but I certainly wouldn't say it's the most common. Usually the GIP is related to the cause of the sepsis, often wound care.

toomuchbaloney · Sep 14, 2014

Say wha.......?! I don't even....
I've seen sepsis as the diagnosis on many inpatient hospice patients where I work, but I certainly wouldn't say it's the most common. Usually the GIP is related to the cause of the sepsis, often wound care.

Are you saying that the terminal condition qualifying the person for hospice care was sepsis? Or are you saying that the condition that caused the GIP level of care was sepsis?

duskyjewel · Sep 14, 2014

Many of them were admits who came to us straight from hospital, who had never been on service before and were admitted by our ACs while in hospital. And yes, sepsis was their terminal diagnosis.

toomuchbaloney · Sep 16, 2014

Many of them were admits who came to us straight from hospital, who had never been on service before and were admitted by our ACs while in hospital. And yes, sepsis was their terminal diagnosis.

I have only seen sepsis used as supporting evidence for a hospice diagnosis of maybe AFTT or Debility, never as the hospice diagnosis itself.

MunoRN, RN · Sep 17, 2014

I have only seen sepsis used as supporting evidence for a hospice diagnosis of maybe AFTT or Debility, never as the hospice diagnosis itself.

My understanding is that AFTT is no longer an acceptable hospice diagnosis starting Oct 1. Many hospices have previously used sepsis a supporting medical condition for AFTT, which will now need to use the specific medical diagnosis that had been generalized as AFTT in the past.

toomuchbaloney · Sep 17, 2014

My understanding is that AFTT is no longer an acceptable hospice diagnosis starting Oct 1. Many hospices have previously used sepsis a supporting medical condition for AFTT, which will now need to use the specific medical diagnosis that had been generalized as AFTT in the past.

yes, no longer acceptable.

But is sepsis considered an appropriate hospice diagnosis? I just cannot think of one time that it was the actual admitting diagnosis even though it was the ultimate cause of death in many cases.

westieluv · Sep 18, 2014

I'm getting confused here between AFTT and Debility. Are they considered the same diagnosis but with a different name?

I was a hospice intake nurse a couple of years ago, and I was familiar with the hospice admitting diagnoses permitted to elect the Medicare Hospice Benefit. I remember debility, because that one was always kind of "sticky" and required a LOT of supporting data, but I only remember the term AFTT being used rarely, and only as an alternate, unofficial name for debility. Is it that different hospices simply prefer one name for it over the other?

Also, I am getting back into hospice in October, after being away for about two years. Are they really getting rid of debility as a Medicare diagnosis? That would be good to know, since that was such a catch-all term and sometimes the only diagnosis that really fit the scenario when someone was really just, as they say, "dying of old age".

toomuchbaloney · Sep 18, 2014

As far as I know AFTT is still a viable LCD but many providers prefer not to use it. I am not certain about Debility. Both were under scrutiny because too many hospice providers were using those dx to admit folks who were ill but not really within 6 months of death, so I understand.

I still can find nothing to support using sepsis as a hospice admitting dx. In my experience the person dying from the sepsis generally has another angry condition which was responsible for their overall decline toward death.

MunoRN, RN · Sep 18, 2014

I'm getting confused here between AFTT and Debility. Are they considered the same diagnosis but with a different name?
I was a hospice intake nurse a couple of years ago, and I was familiar with the hospice admitting diagnoses permitted to elect the Medicare Hospice Benefit. I remember debility, because that one was always kind of "sticky" and required a LOT of supporting data, but I only remember the term AFTT being used rarely, and only as an alternate, unofficial name for debility. Is it that different hospices simply prefer one name for it over the other?
Also, I am getting back into hospice in October, after being away for about two years. Are they really getting rid of debility as a Medicare diagnosis? That would be good to know, since that was such a catch-all term and sometimes the only diagnosis that really fit the scenario when someone was really just, as they say, "dying of old age".

Neither debility or AFTT will be allowed as the primary hospice admitting diagnosis. The specific medical condition must be used or the condition most likely to cause death in the case of multiple conditions.

I'm not really getting the rationale why many hospices haven't been using sepsis as an admitting diagnosis. Having a confirmed diagnosis of one of the most deadly medical conditions in the US would seem to be a logical basis for hospice.

toomuchbaloney · Sep 19, 2014

Neither debility or AFTT will be allowed as the primary hospice admitting diagnosis. The specific medical condition must be used or the condition most likely to cause death in the case of multiple conditions.
I'm not really getting the rationale why many hospices haven't been using sepsis as an admitting diagnosis. Having a confirmed diagnosis of one of the most deadly medical conditions in the US would seem to be a logical basis for hospice.

My only guess is that sepsis, outside of another serious and terminal condition, is generally treated with guns a blazing and the expectation is for a cure/recovery rather than decline toward death.

westieluv · Sep 19, 2014

My only guess is that sepsis, outside of another serious and terminal condition, is generally treated with guns a blazing and the expectation is for a cure/recovery rather than decline toward death.

That's what I was thinking too. Sepsis isn't like typical end stage illnesses in that it can be cured in most people with aggressive treatment. If they are too weak and compromised to overcome the sepsis, even with aggressive treatment, often it is because they are suffering from another life threatening illness, and that would then be their hospice diagnosis.

duskyjewel · Sep 19, 2014

Here's an example of what I've seen: a person with some medical problems but who is not terminally certified yet, gets a wound somehow. Or they have surgery and pick up a hospital-based infection in the surgical site. Attempts to heal the wounds and cure the infection fail, the point of too much organ damage to survive is reached, and the patient is signed on to hospice. Their previous medical issues are not what's killing them, it's the sepsis that has made them terminal.