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Hospice Nurses: Admission Tips You Can Use Right Now

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If completing a hospice admission gives you cold sweats, you’ll want to check out these expert hospice admission tips.

One of the most common frustrations hospice nurses have is related to how long it takes to complete hospice documentation. And at the top of the list is the hospice admission.

Whether you’re new to hospice or a veteran, there are things you can do to ensure your patient is admitted quickly and accurately.

Hospice Intake & Admissions

Before a patient is admitted to hospice, they must meet Medicare eligibility criteria. If the doctor believes the patient has six months or less to live, they can notify hospice for a consultation and/or admission.

Next, medical records are requested by the intake team. Then, documents from the referral source (i.e. doctor, hospital, nursing home) are added to the electronic medical record.

If your agency is still on paper then you will likely have a physical chart with this information. Regardless, there are key pieces of information that your intake team should obtain.

This includes:

  • Most recent doctor’s note
  • Recent hospital records
  • Insurance information (for verification)
  • Patient’s location for admission
  • Power of Attorney or Living Will (if available)

Disclaimer: Not all agencies follow the same process for admissions so make sure you know your agencies’ policies and follow them.

Hospice Admission Tips

Honestly, I’ve worked for an agency that had admission nurses while others did not. Regardless, at some point, you will complete a hospice admission. And, when the time comes, you should be prepared.

And these simple tips can help you save time during your next hospice admission.

1. Review Intake Information and Records

First, when you are assigned a hospice admission, you will receive notification from someone in your agency. Accept the visit right away so that you can take a quick glance and the records.

This will give you a chance to see if there is any additional information that you want the intake team to request. For instance, if the patient is being discharged from the hospital but there are no discharge papers on the chart, you can request those in advance.

You don’t want to wait until you get the patient’s home to review this information!

Here’s What to Look For:

  • Demographic information– You should dig deep into this information. I’m not just talking about the age and sex of the patient. You should look for clues regarding the patient’s functional and mental status. Who is the primary caregiver? Do they use assistive devices? Understanding these things will help you get ahead on the admission. Furthermore, it will reduce the time you spend at the patient’s home and after the admission sorting this out.
  • Admitting Diagnosis– What led up to the patient’s admission to hospice.  Review recent hospitalizations. You need to know if the patient meets eligibility criteria so this is great information to understand. Most patients are likely to have multiple health issues so make sure you understand which diagnosis is most appropriate. For example, failure to thrive is not a diagnosis that can stand alone for hospice admission. You need to know why the patient is failing to thrive. This might be the result of a stroke.
  • Medications– What medications is the patient taking?  Do they already have pain medications? For instance, hospice doesn’t cover medications that are not related to the hospice diagnosis. In this instance, you will want to be prepared to discuss medications that aren’t covered with the patient and family. It is also smart to know the generic names of medications. For instance, alprazolam is the generic name for Xanax. Also, what medications are likely to be discontinued once the patient is enrolled in hospice. For example, the medical director may want to stop vitamins and supplements. My point is that you want to be prepared.
Recommended Article: 3 Common Mistakes Hospice Nurses Make and How to Avoid Them
  • Wounds/Dressings– First, do a quick check to see if the patient has any skin issues. Then if the patient has wounds, you will want to make sure you have dressing supplies in your trunk before you head to the admission. You can also ask the hospital to send dressing supplies home with the patient. This will give you or the case manager at least a day to order supplies.
  • Foleys/Tubes-Does the patient have any tubes such as feeding tubes, CADD pumps, or Foley catheters? If the patient is on tube feedings, you will want to verify that they have feeding supplies available. Once, I had a patient who was discharged from the hospital on a new tube feeding with no supplies. They told the family that the hospice would supply the tube feedings. Unfortunately, the hospital did not communicate this to the hospice. And the patient had to wait until the next day before their feedings could continue. Needless to say, the family wasn’t very happy. So, make sure you always check the record and be prepared. This will save you time and frustration.

2. Tell the Patient/Family What to Expect

While there’s always some uncertainty that can occur during a hospice admission, there are some things you can control.  For instance, you can call the family. Notify them of your arrival time and also let them know what they can expect.

Nurse reviewing paperwork with patient
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Use these tips to ensure a smooth hospice admission

  1.  Call and introduce yourself. Additionally, let them know your estimated arrival time.  If the patient won’t be the one signing paperwork, then make sure the primary caregiver or POA is available to meet you. If the patient is in the nursing home, you still need the POA so don’t just show up at the nursing home and assume someone will be there. CALL FIRST!!!  Also, if the patient is coming home from the hospital, call the hospital to confirm the patient’s departure time. (this can also make it possible for you to get some sort of report from the nurse who has been taking care of the patient.) 
  2. Explain how long the visit will take. Honestly, this is an area where I’ve seen nurses spend way too much time. You should not be in the home for more than 1-2 hours if possible. The case manager, social worker, and other IDG members will work with the patient and family. Ideally, there should be a follow-up visit by the assigned case manager the next day. (Don’t hate the messenger!)
  3. Tell them items to have ready for you. For example, they should have all current medication bottles, insurance cards, POA, and living wills. This will give them time to locate these items BEFORE you arrive. Remember, your goal is to save time. You want to get in and get out without spending valuable time waiting around for them to find things.
  4. Ask for a quiet place to sit to complete paperwork. Each home setting is unique so make sure they understand that you will need a clean, quiet place to sign paperwork. I also like this because it sets the tone for the visit.

Recommended Article: What Successful Hospice Know That You Don’t

3. Gather What You Need Before You Leave

Paperwork– Most agencies have admission packets or booklets. If so, make sure you have one readily available. Also, you will want to have admission forms such as the election of benefits and the patient’s rights and responsibilities.

Stock your car– Now that you know more about your patient, you can make sure you have what you need in your trunk.  For instance, it’s always a good idea to have adult diapers, wipes, bedpans, and dressing supplies available. 

Hospice bag supplies– stethoscope, thermometer, BP cuff, pulse oximeter, and tape measure

Hospice Admission Tips Summary

Finally, let’s take a quick look at the top tips you can use to have a smooth hospice admission.

  1. Review the Record/Intake information
  2. Call the patient/family and let them know what to expect
  3. Gather supplies before you leave

Again, your role is to ensure they are eligible for enrollment. You don’t have to teach them everything and you don’t want to spend hours at the home. Ideally, you should try to wrap up in less than two hours because you will have at least a couple of hours of documentation to complete with you get home.

I’d also like to add, that these tips are a starting point, you should come up with a system that works for you. If you have a system, you will be much more efficient and save time.

Conclusion

Finally, if there are parts of the documentation that you complete in the home, do so. It’s best to start at the home or use an admission checklist that covers key items you will need to complete in order to close the chart.

What tips do you have for new hospice nurses for admissions? Leave them below.

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