Hospice Nurses! Help!

[Nurseynurse2424]

I have a new director, who is non clinical. I was always taught that with a prospective patient - we receive an order for an eval and treat from their MD to go and do an eval/assessment to see if the patient qualifies for hospice service. 

With that said, it appears I am mistaken and I'm seeking clarity as I cannot find clarification from searching the web. My director is saying I cannot go and assess a patient (take vitals, touch in general) without the hospice consents signed. Is this true? I was under the assumption the MD order for Eval + treat covered the assessment? She says it just covers talking to the patient, family and reading their medical records. Does anyone have any written proof either way? I'm stressed about this. 

[FolksBtrippin, BSN, RN]

You can legally assess a patient for hospice eligibility before you get consent for hospice. But the agency can't bill for that, if it doesn't happen the same day as consents were signed. Most hospice docs want an RN to go out and do an in person assessment of the patients current status, before they certify for hospice.  Because they are supposed to take that stuff into account, and they rarely if ever go to patients homes to do that themselves. Normally this is the assessment you do before you call the doc and tell them yes, this lady is appropriate or no this lady is not appropriate from a nursing standpoint. 

An RN must do the "initial assessment" within 48 hours of consent being signed. If that doesn't happen, a whole new set of consents are needed. 

It sounds like your new director wants to take getting consent off your hands. That's okay, and may make your job easier, as long as they have an ethical person to do it for them. I would want a licensed social worker to do it, or another RN or someone else with accountability. 
 

Here is a breakdown of the process

https://allianceforcareathome.org/wp-content/uploads/Hospice_Admission_Map.pdf