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time, hospice care is provided in a variety of settings including the patient’s home, inpatient facilities including a nursing home, or a combination of venues.. Special Requirements:Staff needs to be oriented in the special situations that arise in dealing with a patient in their own home. Respect for the patient and their surroundings is of utmost importance. Being empathetic to even the smallest of concerns is the mark of a well-trained care-giver. There must be an emphasis on maintaining a quality of life that the patient as well as the family feel comfortable with.Since the patient is treated by such a wide variety of workers, there are weekly case management meetings which are mandated by Medicare, but often also influenced by hospital policy to ensure quality of care. It

is at this time that information is shared by all who have had contact with the patient and any concerns are addressed. This helps for the staff to work out their feelings as well – because in hospice care where you may treat a patient for a year or more, bonds begin to form. Reports, Statistics, and Records:I would like to spend a bit of time on this subject in consideration of the nature of our program. As director of the hospice program, one duty that would fall on you is the compilation of statistics, the submitting of reports, and the overseeing of the legal medical record.Since hospice keeps it’s own legal medical record on their patients, their relationship with the medical record department is very limited. If a hospice patient checks in to the hospital, there must be

a release of information from hospice to the hospital in order to share information.Upon death, however, the hospice record is integrated with any hospital records into one main file which is archived according to hospital policy on deceased charts.Statistics compiled by this department include those reportable to the Montana Hospital Association such as number of referrals and number of Medicare patients. Reportable to Medicare are unduplicated patient days, social security numbers, diagnosis, and other demographic information. Hospital statistics may typically include patient days, cost of supplies and equipment broken down through the different disciplines, pharmacy costs, and number of visits with the patient. Also implemented would be a quality assurance program which

gathers input from the patient in the form of a pain questionnaire. A questionnaire is also given to the family after the patient dies to evaluate their satisfaction with the way that hospice treated the patient as well as the family unit.In your folder, you will se on the right side an intake check list which is completed by the supervisor. When all necessary forms are in the chart, hospice care officially begins.(Review info in chart)Along with these forms, there will also be nursing notes, medication orders, doctors orders, among other forms that are typical for an inpatient record in an acute care setting.JCAHO Standards:In reviewing Joint Commission’s Accreditation manual for Health Care Organizations, I came across many standards that directly apply to hospice care. You

can see on your handout a sampling of a standard from different sections in the manual.For the first section I am covering, Rights , Responsibilities, and Ethics (RI) under the treatment section is RI.1.2 which reads: [The organization has a functioning process in place to address and respect patient rights: the process is supported by a framework that includes the following mechanisms:] Mechanisms for the individual and, when appropriate, the family to receive sufficient information on the individual’s responsibilities in the care processThis can be implemented in hospice by informing, assessing, educating patient and their families in their responsibilities in the care process such as administering pain medications or treatments.The next section I am covering is Assessment

(PE). The standard I am looking at is PE.1.2 which reads:The scope and intensity of any further assessment is determined by the patient’s diagnosis, condition, need and desire for care and services, response to previous care, and the care or service setting.Implementing this standard in hospice would be for hospice patients and families, the bereavement assessment begins at admission, and is updates as appropriate during the patient’s time in the program, at the time of death, and during bereavement follow-up.Next is Care, Treatment, and Services (TX). Standard TX1.2.2 reads:When applicable to the care provided, the physician or other authorized individual reviews and revises therapeutic and diagnostic orders as necessary.So, the provision of Hospice care is in accordance