Do you visit hospice patients daily while in hospital?

[AtlantaRN, RN]

Initially, we would make "contact" (any member of the idt team could do this not just the nurse) a phone call to the patient (if coherent), family, nurse on duty at the hospital....now my job requires nurses make "daily visits" to the hospital....just a courtesy visit....

Does your agency do this? Some patients are going to hospitals out of our coverage area (because of their payor source), and it is a real strain on the weekend call nurse (myself)....

linda

[tewdles, RN]

I believe that the COPs require daily visits for GIP hospice patients, when they are being treated for their hospice diagnosis.

When they are in for an unrelated issue they require only a routine level of care which does not typically include daily visits.

[volsfan]

If the pt is in the hospital on INPATIENT STATUS and not outside the plan of care, the COPs (Alabama) require a member of the IDT to visit 6 days per week. You would need to check your particular state to see if it is different. Most hospices here require a 7 day per week nurse to visit b/c other members of the IDT cannot write physicians orders and if they are on inpatient status they most likely will need changes to their plan of care.

If the pt is in the hospital outside the plan of care then the COPs do not require the daily visits, just your routine weekly visit. I am assuming this is your case since they use to not require it and now they do. If this is so I would find out why they changed it. My guess; the loss of a pt to another hospice once they returned home or a family member upset b/c a hospice did not visit at all while they were there.

If the pt is going to the hospital outside your coverage area they should be discharged from service if it is more than a couple of days. The reason being is that you cannot manage their care if they are not in your service area. Once they are discharged from the hospital you could pick them back up.

[tewdles, RN]

We generally don't discharge because a patient is going to be outside our service area...we contract with a hospice in that area to provide support until they return home.

[AtlantaRN, RN]

thank you all for responding........he is in icu and it is not related.............

[ErinS, BSN, RN]

In short, yes. The reason for this is I have found that our patients that are in the hospital for a diagnosis other than their hospice diagnosis have a lot of problems with symptom management. For example, I had a patient who had been routinely getting scheduled Lortab, and instead of giving her more pain medication after breaking her hip they gave her less. Also it has been difficult for staff to understand what it means when someone is on hospice- there are definitely different goals for our patients.

[tewdles, RN]

In short, yes. The reason for this is I have found that our patients that are in the hospital for a diagnosis other than their hospice diagnosis have a lot of problems with symptom management. For example, I had a patient who had been routinely getting scheduled Lortab, and instead of giving her more pain medication after breaking her hip they gave her less. Also it has been difficult for staff to understand what it means when someone is on hospice- there are definitely different goals for our patients.

If a hospitalized patient requires daily visits because of unstable symptoms related to his hospice diagnosis you should change his status from routine to GIP anyway, right?

[Hospice Nurse LPN, BSN, RN]

I'm not sure how we handle visits for pts who are hospitalized for hospice related admits. The family usually signs a revocation if they decide to take the pt to the hospital. If they are in for unrelated admit, we make courtesy visits according to the POC. If it's a pt I'm really close to, I'll visit more often. I have a little more freedom with my schedule than the other nurses because I'm part time.

[tewdles, RN]

The bottom line is this....if they are in the hospital for symptoms or care related directly to their hospice diagnosis they must be identified as GIP level of care. When that happens both the reimbursement and the visit requirements change.

If they are in the hospital for something unrelated to hospice diagnosis....think of patient needing internal fixation of a fracture, hospice dx lung ca...they may not need daily visits, phone calls may suffice.

If their symptom status increases during the hospitalization you may have to visit more often. If their condition destabilizes significantly during hospitalization you may need to make them GIP and visit daily. They can have their cake and eat it too in many instances...