The longer I work as a hospice registered nurse, the more I understand the value of documenting to support and prove hospice eligibility. Sometimes, we don’t see the forest for the trees as we are out there caring for our terminally ill patients, but if our documentation does not support eligibility, the impact can be far more significant than whether a patient is admitted, recertified, et al.; it can lead to a financial catastrophe for the hospice agency leading to layoffs and or termination of staff. Suppose we genuinely care about our patients and our families. In that case, it is our responsibility to document to paint a picture that supports the patient correctly has a terminal condition and is heading towards death within a time frame typical of the disease process and progression.
In the last few years, I came across Shelley Henry, RN, CPHRM, CHPN—President—The Amity Group, on Facebook, where she posts tips for hospice nurses several times per week. It is from Shelley that I learned to start documenting “disoriented x3” vs. “oriented x1” and the value of negative-based presentations, as being terminally ill involves negative (downward) changes of condition.
This led me to obtain two of Shelley’s developed products: “A Hospice Nurse‘s Guide to Hospice Documentation” and “A Supplemental Guide to Hospice Documentation” as part of the Hospice Documentation Master Bundle. Pictures on the Internet rarely provide enough information to ascertain true value. Let me share my review of these two products with you, as I firmly believe they can help hospice nurses bloom.
Unboxing
The two books came packaged in a protective plastic slip, keeping them clean and moisture-free. I was pleasantly surprised that the size of the main book — A Hospice Nurse‘s Guide to Hospice Documentation — is pocket-sized to fit into a scrub pocket, and the A Supplemental Guide to Hospice Documentation, while slightly larger, would fit perfectly into a small bag. The primary book is 5.5″ tall by 4.5″ wide. The supplementary guide is 8.5″ tall by slightly shy of 6″ wide.
A Hospice Nurse’s Guide to Hospice Documentation
Pages 1 through 7 cover major areas often missed in the orientation of new Hospice nurses and include information I only picked up over the years. Pages 8 and 9 are gems in their own right because you are educated quickly on phrases to avoid and how to start thinking about phrases that support eligibility. Pages 9 to 11 start laying the groundwork for the Local Coverage Determination (LCDs) that follow. Pages 12 through 29 are amazing in that you are given the key LCD points with the secret sauce that ties it together as to what key areas to document the progression of the disease, showing the patient is not only appropriate but is having a decline, supporting continued hospice eligibility. Pages 30 to 36 are scales often used in the field, and having all of this in a guide that fits into one’s scrub pocket means there is no reason to forget the book.
A Supplemental Guide to Hospice Documentation
This supplemental book is intended to be used with Hospice Nurse’s Guide to Hospice Documentation. This past Wednesday, July 12, 2023, the compliance training group reviewed my recertification note and a routine visit note for two patients, giving me kudos for how well both notes were written. Still, as I review the suggestions and examples in the supplement book if I utilized the suggested tips, phrases, and ways to think and write… it would be an A++ vs. an A. Imagine for those new nurses who nurses whose had years of nursing in other fields where it was more common to use words like “stable,” “no apparent distress,” and other expressions that mirror “within normal limits” where such words in hospice can end eligibility!
Every major terminal illness is covered, with one page covering key areas such as neuro, pain, mobility, skin, elimination, nutrition, self-care, and affect, followed by a complete example note incorporating those areas. Each area is color-coded so that when you read the complete narrative note, you can picture the patient and situation in ways that support continued hospice eligibility.
Conclusion
Whether you are a new hospice nurse or an experienced one like me, I hope you desire to prove and support continued hospice eligibility for your patients and families. In my years as a hospice nurse, I’ve always felt the training on what words and phrases to support hospice eligibility was weak compared to the training received in other areas of nursing. Now, you can get the education you need in a portable setup that you can take, use as you see fit, and bloom!
Disclaimer
The author is not related to Shelley Henry or any family member, is not employed or otherwise contracted by the Amity Group, and will not receive any financial benefit from anyone purchasing these products. None of the links on this page are affiliate links.
