HOSPICE AUDIT TOOL GIP (2)

Criteria

Yes

All members of IDG including attending physician (if any) involved in update to the plan of care decision to change level of care to GIP

Contracted facility is Medicare/Medicaid certified hospital, SNF, inpatient unit

LOS is short---term and temporary*

Date began:

LOC changed after pain/symptoms could be managed in another setting

Hospice Audit Tool ? GIP Level of Care 2017

HOSPICE AUDIT TOOL

GENERAL INPATIENT LEVEL OF CARE

No

N/A

Comments

Date ended:

24-hour nursing is available

CMS does not define short---term but CMS data in the 2014 Medicare Hospice Payment Reform: Analyses to Support Payment Reform indicates the average length of a GIP stay in 2012 was 5.5 days.

GIP

Reason

Documentation

Pain Mgmt./Control

Efforts attempted first:

Examples of eligibility:

Pain Requiring: nn Delivery of medication which may require skilled nursing care for calibration,

tubing change or site care/adjustment due to the complexity, nature of the

medication and it's delivery system. nn Frequent evaluation/assessments by nurse or physician. nn Aggressive treatment to control pain that cannot be accomplished within the

home setting.

Symptom Mgmt./Control

Efforts attempted first:

Examples of eligibility: Symptom changes:

nn Sudden deterioration requiring intensive nursing intervention. nn Uncontrolled nausea or vomiting. nn Pathological fractures nn Uncontrolled bleeding nn Frequent seizures nn Respiratory distress that becomes unmanageable. nn Transfusions for relief of symptoms. nn Traction and frequent re---positioning requiring more than one staff member.

nn Severe agitated delirium or anxiety or depression secondary to end---stage disease process.

nn Symptom management that requires frequent skilled nursing intervention. nn Symptoms related to imminent death only if cannot be managed in the home

setting.

Caregiver breakdown ONLY if the patient needs acute care that cannot feasibly be provided in another setting

Documentation includes specific treatments/procedures that the caregiver was delivering and that require the skills of a nurse.

Hospice Audit Tool ? GIP Level of Care 2017

Continued GIP eligibility

Examples of continued eligibility: nn Pain continues to require active treatment and frequent assessment that cannot be

provided in another setting nn Symptoms such as N/V, respiratory distress, open lesions, or ongoing

deterioration require active treatment and frequent assessment that cannot be

provided in another setting nn Ongoing mental status changes that require active treatment and frequent

assessment that cannot be provided in another setting

Discharge from GIP

Examples of discharge eligibility: nn Reason for admission resolved/stabilized nn Re---established caregiving situation, if applicable nn Transfer to another level of care(i.e. respite)

All of these reasons should be reviewed as a whole and not separately.

Yes No

Plan of care includes interventions used to manage care while at the GIP level of care

N/A Comments

Documentation includes effectiveness of interventions

Documentation includes patient response to treatment

Documentation addresses planning for safe discharge from beginning of care

Documentation addresses reason(s) care cannot be provided in another setting at least daily

Documentation does not use "patient is dying", "end---of---life care", "general decline" or "medication adjustment" to justify in---patient level of care unless documentation also explains why this cannot be treated in another setting.

Hospice Audit Tool ? GIP Level of Care 2017

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