Understanding Hospice General Inpatient Care (GIP)

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General Inpatient Level of
Hospice Care
“You, Too, Can GIP”
 
“We need to trust that our patients are the
experts on their lives, culture, and experiences,
and if we ask with respect and genuine desire to
learn from them, they will tell us how to care for
them.”
Lipson, J. (1996)
 
Introduction
 
Lori Kenyon, RN, BSN
and
Mary Gallien MSW
with panel guests
Hospice Physician, Dr. Arun Vijay and Clinical
Manager, Krista Wassermann, RN, MSN
 
What is Hospice
General Inpatient Care? (GIP)
 
 
One
 of the 4 levels of Federal Medicare regulations
require a hospice to provide as a condition of
Certification.
 
GIP
 is intended as a 
short term intervention 
for
management of acute symptoms that cannot be
managed in another setting.
 
When is Hospice General
Inpatient Care? (GIP) considered
 
Initiated when other efforts for symptom
management have 
not
 been successful.
 
For patients who cannot comfortably
remain in a residential setting.
 
And
 who require skilled nursing care
around the clock to attain/maintain
comfort.
 
Patient Status That May
Lead to GIP Eligibility
 
Sudden deterioration
requiring intensive
nursing intervention
Uncontrolled pain requiring
frequent evaluation by
physician/nurse
Complicated technical
delivery of medication
requiring skilled nursing
assessment
Frequent
medication
adjustment
Wounds requiring
complex and/or
frequent skilled
dressing changes
Intractable GI symptoms,
Uncontrolled
nausea/vomiting
Delirium, with behavioral issues
Pathological
fractures
Unmanageable
respiratory distress
 
Skilled care required for unstable medical
conditions may include
 
Rapid onset of ascites or fluid
retention causing pain not
manageable in other settings
Frequent
Suctioning
Imminent death – 
ONLY
 if skilled nursing
needs are present
Recurrent
Seizures
Management
of
Dehydration
Patient Joe C is a 70 year old male with advanced colon
cancer; metastases with pulmonary and hepatic
involvement.
Joe was rushed to ER/ED due to radiating leg pain, chest
pain, persistent cough with hemoptysis, blood in stool,
incontinence unable to be managed in home.
Family wants all care treatment options possible. Patient
responding poorly to aggressive efforts, prognosis poor…
-
Unmanaged symptoms present
-
Ongoing decline
-
Pt safety concerns, family uncertain what
to expect, shocked at rapid decline.
 
What is 
not
 covered
under GIP
 
Care giver breakdown
 
For care that can be provided
in another setting
 
Imminent death 
WITHOUT
 a need for
aggressive symptom management
Betty Thompson – current
Hospice patient just arrived in
Emergency Room
 
Betty Thompson is an 82 year-old woman who lives in private
home with twin sister Barbara and many cats. She was recently
admitted to hospice with hospice diagnosis of dementia,
chronic Hep C requiring increased level of care needs. Sister
Barbara called 911 due to Betty’s increased weakness, refusal
to take medications and not allowing assistance with care.
Barbara is wheel chair bound and has trouble providing hands
on care.
 
Barbara was met in ED by hospice RN to be evaluated for GIP
admit and does not meet criteria.
 
Betty was stabilized, given appropriate medications, IV fluids
and sent home with alert to Hospice Care Team to f/u on
possible placement.
How is GIP different
from Routine Hospice Care?
 
GIP
Crisis stabilization in a Medicare certified
Hospital, Skilled Nursing Facility, or
inpatient hospice unit
 
 
Routine
Standard level of hospice care provided in
patients place of residence -- home, long
term care facility, assisted living setting,
or adult family home
 
 
 
GIP Referrals from hospital
may include:
 
Hospitalized patient with deteriorating health
status and unmanaged symptoms
 
Pt is no longer a candidate for further treatment,
but presents with skilled needs for symptom
management
 
Pt may have had an event (stroke, HA, seizures,
embolism, etc..) that has precipitated acute
symptom management needs
Referral To Inpatient
Hospice – GIP 
not
 met
 
If Hospice Criteria is met but GIP Criteria is
not
 met, then admission to Hospice can be
scheduled for the day patient discharges
from hospital to home or skilled facility.
 
Hospice Consults
&
Admitting Criteria
 
Referral comes from attending physician,
requesting evaluation for GIP status.
 
Hospice responds with GIP evaluation. . .
 
Hospice admit nurse coordinates admit visit with
family.
 
Once admitted, patient, family, physician, and
Hospice Care Team initiate plan of care.
 
Already in the bed
Already in the bed
--------------------
Hospital in-patient to Hospice GIP status.
 
Hospice Community patient
admitting to GIP in hospital setting.
 
 
Pt determined to have intractable symptoms
unmanaged in the home setting.
 
Hospice may arrange transport as needed,
POLST to accompany patient.
 
Hospice Triage or Care Team RN, contacts
hospital ER/ED Physician
 
Hospice Community patient
admitted to GIP in hospital setting.
 
Preliminary measures toward comfort are
addressed in the ER, and fully assessed by
a Hospice RN, preferably Care Team RN.
 
Determination made that GIP criteria is
met by Hospice RN.
 
Then patient is admitted to hospital
through ED/ER.
 
 
Getting into the GIP Bed
Community Patients to GIP
 
 
Confirm Insurance coverage for inpatient
care
Confirm Hospice Contract with hospital of
choice
Notify patient’s Attending Physician for
Hospice
Notify Hospice Clinical Manager and
Administrator On-Call (AOC)
 
Getting into the GIP Bed
At the Hospital…..
 
Confirm Attending Physician in agreement
to admit patient to GIP level of care.
Confirm patient’s hospice diagnosis is
related to the hospital admitting
diagnosis.
    Hospice diagnosis must appear among
 
the first 3 admitting diagnosis
Care coordination with MD, hospital staff
and family to determine to plan for
symptom management.
 
 
 
Getting into the GIP Bed
At the Hospital….cont.
 
Questions to Consider:
What is the most appropriate symptom
management to return patient to previous
level of care?
 
Is this symptom management consistent
with patient’s previous and current Plan
of Care and Goals?
 
AT THE HOSPITAL –
The 
most important 
non-clinical
notification
 
Financial Responsibility 
– Notify the
admissions/billing department of decision to admit
patient. GIP and forward any need forms to
confirm financial responsibility to billing office.
 
Clarity around financial responsibility is critical to
a smooth admit and transition to 
GIP
 in a hospital
or a Skilled Nursing Facility setting.
Hospice Team
for
General Inpatient Care
 
Hospice Team - GIP
 
 
 
 
E
xperienced Hospice Clinicians
 
 
Hospice Physicians
 
 
 
End of Life teaching/education to staff, patient,
  
and family members.
 
Maintains family goals toward developing Plan of Care
 
 
Hospice Team - GIP
 
S
ymptom management, emotional and
spiritual support
 
 
 
 
C
omfort care protocols in an acute
environment.
 
 
 
Discharge planning discussion with
patient/family 
 
initiated upon admission.
 
 
Hospice ensures that families can get formal
hospice bereavement services for 13 months
after the event of the patient’s death.
 
 
Guidelines for Attending Physician
 
Orders for hospice inpatient stay written by Attending
Physician
 
Comfort Care order set initiated in EMR by
physician/hospitalist
 
Routine follow up by Attending Physician during hospice
admission
 
 
 
 
 
Guidelines for Attending Physician
 
Signs Hospice Plan of Care
 
Daily contact with hospice team
 
Hospice team member(s) will visit patient
daily
 
Hospice Medical Director/Hospice physician
will be available as a resource
 
Hospice Physician
 
Provides onsite hospital consultations for; Goals
of care, Disposition recommendations, Care
Coordination and Symptom Management
 
PR/Consults for hospice as well as liaison for
hospice.
 
Coordinates with hospice pharmacists, Care
Team and staff around symptom management
challenges.
 
Care Team
Management/Support
Initial Encounter
 
 
 
 
Enter room together as a team when possible
 
Ask what family and patient understands about
disease process and prognosis?
Explain how addition of hospice care team to Hospital
team can benefit patient to provide best care.
Main Concerns
Goals of care
Patient assessment
Registered Nurse GIP role
Assessment
GIP: Head to toe assessment with focus on;
Psycho/social how is patient participating in conversation interaction with
RN, what are they saying, how they are saying it. Assess Pain levels, SOB,
unmanaged symptom concerns and changes since hospitalized. What has
worked/not worked.
Request to further assess, Nero, CV RRR, Lungs CTAB, work of breathing,
discomfort, signs and symptoms of anxiety, agitation – determine baseline
and goals
Is our patient eating, bowel care, mobility and independence, desire for
help/support, skin integrity
Active needs: increased suctioning, bolus dosing of medication, etc..
REVIEW WHAT I AM SEEING WITH FAMILY/THOSE PRESENT IF APPROPTIATE.
Discuss review, what is changing.
Registered Nurse GIP role
Charting
Clinical Note, EMR Note
“GIP Day 1, Day 2, Day 3 etc.…”
Supportive Data that the symptoms are ongoing:  Pt continues to
meet GIP eligibility for… “state the uncontrolled symptom(s)”
Ongoing Issues:
Patient response to current interventions; if any
Measureable outcome: pain ratings and quotes from patient family
Providing recommendations to manage symptoms and education
provided to staff and family.
Discharge plan: TBD
Coordinated care with: i.e.... Name Care Givers involved in
development of POC for comfort.
Please contact your Hospice Agency for symptom management needs,
changes in condition, or at time of death
MSW/GIP: Assessment,
Documentation, and Beyond
 
Precipitating Event prior to GIP status
Location/ Who is Present at this Visit
Initial MSW Assessment
or SW Assessment
 
Ideally the Initial Assessment includes the
 
RN and MSW in joint visit…
MSW-GIP Assessment
Documentation, and Beyond
 
Social Hx/Support Network
Neuro/Emotional/Behavioral Status
Communication Capacity/Ability–
Code Status
 
(if in question or not
completed)
MSW---GIP Assessment,
Documentation, and Beyond
 
Funeral Home
Financial Concern/Insurance
Resource/Counseling Provision
 
emotional adjustment counseling
 
reflective inquiry with patient and/or
 
family members
 
Written information given to go over in a
 
quiet moment at the bedside
MSW---GIP Assessment,
Documentation, and Beyond
 
Care Coordination
Disposition
Discharge to home setting
Discharge to SNF or AFH,
Timing of Discharge
Placement efforts
MSW---GIP Assessment,
Documentation, and Beyond
 
Should patient die in hospital setting
 
reassure family of care taken with
 
transition to mortuary care
 
Check with hospital staff to see if there is
 
a limit on time spent with patient after
death
Help family understand the role of the
Funeral Home for post-death tasks
Grief Support accessibility and follow up
Challenges
 
Family does not want patient to leave
hospital – no matter what
Family unavailable
Placement challenges, lingering, high
acuity of medication delivery, vent
Families not willing to try different
medications easily given in other
environments.
Discharge back to hospital
Chaplain GIP role: 
supports patient,
family, hospital staff, and Providence care team
throughout GIP hospitalization.
 
Assesses and identifies religious/spiritual goals,
challenges, and strengths
 
Provides supportive spiritual and emotional presence
 
Facilitates sacramental rites, faith community visits as
requested
Chaplain GIP role: 
supports patient,
family, hospital staff, and Providence care team
throughout GIP hospitalization.
 
Coordinates with hospital chaplain on handoff of
spiritual plan of care to hospice chaplain
 
Provides increased availability and prioritization of GIP
patients as needed
 
Ensures discharge handoff of spiritual plan of care to
hospice community team chaplain
 
Patient ready for discharge –
Home
 
Obtain orders for change to hospice routine
level of care
 
Update community attending physician
responsible for medication orders after
discharge.
 
Durable medical equipment; OT referral for
safety
 
Patient ready for discharge –
Home
 
Coordinate with infusion as needed, have
hospital physician write orders for
medications x1 week.
 
Provide needed education to a 
willing
 family
member on; care of drains, medication
administration, basic care as needed.
 
Provide Tuck-in visit
 
Patient ready for discharge –
Skilled Facility (SNF)
 
Obtain orders for change to hospice routine
level of care
 
Update community attending physician
responsible for medication orders after
discharge.
 
Durable medical equipment; OT referral for
safety
 
Patient ready for discharge –
Skilled Facility (SNF)
 
Coordinate with infusion as needed, have hospital
physician write orders for medications x1 week.
 
Provide 
REPORT
 to SN around patient care needs,
Goals of Care, DPOA, patient and family challenges.
Routine that has been effective. Patient likes dislikes
if  known.
 
Provide Tuck-in visit, check in with facility RN
 
Paint the Picture
(The picture you paint is the picture Medicare
will use to determine whether this level of care is
appropriate and reimbursable).
 
Pt with end stage pancreatic caner continues to meet GIP
criteria for pain poorly managed at home.
Unable to take PO medications due to nausea/vomiting.
Requires frequent nursing interventions and assessment to
ensure comfort.
Pain was 9/10 when arrived to HCC, now reports improved
at 6/10 with ongoing titration of dilauded infusion and
Q4H doses of SQ Haldol effective patient. denies nausea
at this time.
 
 
 
Thank You
 
References
 
National Hospice and Palliative Care Organization, A Clinical
Guide to Hospice General Inpatient Care (GIP) (2018)
Documenting to support General Inpatient (GIP) Hospice
Level of Care. (2018)
https://nhpco.org/sites/default/files/public/regulatory/GI
P_Tip_GIP_Sheet.pdf
 
Check-Lists: Admit, Discharge, Transfer
 
 
 
 
 
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Hospice General Inpatient Care (GIP) is a level of care in hospice settings intended for short-term management of acute symptoms that cannot be addressed in other settings. Initiated when other efforts for symptom management have not been successful, GIP provides skilled nursing care around the clock for patients needing intensive support to attain or maintain comfort. Eligibility for GIP is often associated with uncontrolled pain, deterioration requiring frequent evaluations, complex medical conditions, and other challenging symptoms. This level of care aims to provide comprehensive support for patients in their final stages of life.


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  1. General Inpatient Level of Hospice Care You, Too, Can GIP

  2. We need to trust that our patients are the experts on their lives, culture, and experiences, and if we ask with respect and genuine desire to learn from them, they will tell us how to care for them. Lipson, J. (1996)

  3. Introduction Lori Kenyon, RN, BSN and Mary Gallien MSW with panel guests Hospice Physician, Dr. Arun Vijay and Clinical Manager, Krista Wassermann, RN, MSN

  4. What is Hospice General Inpatient Care? (GIP) One of the 4 levels of Federal Medicare regulations require a hospice to provide as a condition of Certification. GIP is intended as a short term intervention for management of acute symptoms that cannot be managed in another setting.

  5. When is Hospice General Inpatient Care? (GIP) considered Initiated when other efforts for symptom management have not been successful. For patients who cannot comfortably remain in a residential setting. And who require skilled nursing care around the clock to attain/maintain comfort.

  6. Patient Status That May Lead to GIP Eligibility Uncontrolled pain requiring Sudden deterioration frequent evaluation by requiring intensive physician/nurse nursing intervention Complicated technical Frequent delivery of medication medication requiring skilled nursing adjustment assessment

  7. Wounds requiring complex and/or frequent skilled dressing changes Intractable GI symptoms, Uncontrolled nausea/vomiting Pathological Delirium, with behavioral issues fractures Unmanageable respiratory distress

  8. Skilled care required for unstable medical conditions may include Management of Dehydration Rapid onset of ascites or fluid retention causing pain not manageable in other settings Recurrent Seizures Frequent Suctioning Imminent death ONLY if skilled nursing needs are present

  9. Joe Carson Patient Joe C is a 70 year old male with advanced colon cancer; metastases with pulmonary and hepatic involvement. Joe was rushed to ER/ED due to radiating leg pain, chest pain, persistent cough with hemoptysis, blood in stool, incontinence unable to be managed in home. Family wants all care treatment options possible. Patient responding poorly to aggressive efforts, prognosis poor

  10. Joe Carson - Unmanaged symptoms present - Ongoing decline - Pt safety concerns, family uncertain what to expect, shocked at rapid decline.

  11. What is not covered under GIP Care giver breakdown For care that can be provided in another setting Imminent death WITHOUT a need for aggressive symptom management

  12. Betty Thompson current Hospice patient just arrived in Emergency Room Betty Thompson is an 82 year-old woman who lives in private home with twin sister Barbara and many cats. She was recently admitted to hospice with hospice diagnosis of dementia, chronic Hep C requiring increased level of care needs. Sister Barbara called 911 due to Betty s increased weakness, refusal to take medications and not allowing assistance with care. Barbara is wheel chair bound and has trouble providing hands on care. Barbara was met in ED by hospice RN to be evaluated for GIP admit and does not meet criteria. Betty was stabilized, given appropriate medications, IV fluids and sent home with alert to Hospice Care Team to f/u on possible placement.

  13. How is GIP different from Routine Hospice Care? GIP Crisis stabilization in a Medicare certified Hospital, Skilled Nursing Facility, or inpatient hospice unit Routine Standard level of hospice care provided in patients place of residence -- home, long term care facility, assisted living setting, or adult family home

  14. GIP Referrals from hospital may include: Hospitalized patient with deteriorating health status and unmanaged symptoms Pt is no longer a candidate for further treatment, but presents with skilled needs for symptom management Pt may have had an event (stroke, HA, seizures, embolism, etc..) that has precipitated acute symptom management needs

  15. Referral To Inpatient Hospice GIP not met If Hospice Criteria is met but GIP Criteria is not met, then admission to Hospice can be scheduled for the day patient discharges from hospital to home or skilled facility.

  16. Hospice Consults & Admitting Criteria

  17. Already in the bed -------------------- Hospital in-patient to Hospice GIP status. Referral comes from attending physician, requesting evaluation for GIP status. Hospice responds with GIP evaluation. . . Hospice admit nurse coordinates admit visit with family. Once admitted, patient, family, physician, and Hospice Care Team initiate plan of care.

  18. Hospice Community patient admitting to GIP in hospital setting. Pt determined to have intractable symptoms unmanaged in the home setting. Hospice may arrange transport as needed, POLST to accompany patient. Hospice Triage or Care Team RN, contacts hospital ER/ED Physician

  19. Hospice Community patient admitted to GIP in hospital setting. Preliminary measures toward comfort are addressed in the ER, and fully assessed by a Hospice RN, preferably Care Team RN. Determination made that GIP criteria is met by Hospice RN. Then patient is admitted to hospital through ED/ER.

  20. Getting into the GIP Bed Community Patients to GIP Confirm Insurance coverage for inpatient care Confirm Hospice Contract with hospital of choice Notify patient s Attending Physician for Hospice Notify Hospice Clinical Manager and Administrator On-Call (AOC)

  21. Getting into the GIP Bed At the Hospital .. Confirm Attending Physician in agreement to admit patient to GIP level of care. Confirm patient s hospice diagnosis is related to the hospital admitting diagnosis. Hospice diagnosis must appear among the first 3 admitting diagnosis Care coordination with MD, hospital staff and family to determine to plan for symptom management.

  22. Getting into the GIP Bed At the Hospital .cont. Questions to Consider: What is the most appropriate symptom management to return patient to previous level of care? Is this symptom management consistent with patient s previous and current Plan of Care and Goals?

  23. AT THE HOSPITAL The most important non-clinical notification Financial Responsibility Notify the admissions/billing department of decision to admit patient. GIP and forward any need forms to confirm financial responsibility to billing office. Clarity around financial responsibility is critical to a smooth admit and transition to GIP in a hospital or a Skilled Nursing Facility setting.

  24. Hospice Team for General Inpatient Care

  25. Hospice Team - GIP Experienced Hospice Clinicians Hospice Physicians End of Life teaching/education to staff, patient, and family members. Maintains family goals toward developing Plan of Care

  26. Hospice Team - GIP Symptom management, emotional and spiritual support Comfort care protocols in an acute environment. Discharge planning discussion with patient/family initiated upon admission. Hospice ensures that families can get formal hospice bereavement services for 13 months after the event of the patient s death.

  27. Guidelines for Attending Physician Orders for hospice inpatient stay written by Attending Physician Comfort Care order set initiated in EMR by physician/hospitalist Routine follow up by Attending Physician during hospice admission

  28. Guidelines for Attending Physician Signs Hospice Plan of Care Daily contact with hospice team Hospice team member(s) will visit patient daily Hospice Medical Director/Hospice physician will be available as a resource

  29. Hospice Physician Provides onsite hospital consultations for; Goals of care, Disposition recommendations, Care Coordination and Symptom Management PR/Consults for hospice as well as liaison for hospice. Coordinates with hospice pharmacists, Care Team and staff around symptom management challenges.

  30. Care Team Management/Support Initial Encounter Enter room together as a team when possible Ask what family and patient understands about disease process and prognosis? Explain how addition of hospice care team to Hospital team can benefit patient to provide best care. Main Concerns Goals of care Patient assessment

  31. Registered Nurse GIP role Assessment GIP: Head to toe assessment with focus on; Psycho/social how is patient participating in conversation interaction with RN, what are they saying, how they are saying it. Assess Pain levels, SOB, unmanaged symptom concerns and changes since hospitalized. What has worked/not worked. Request to further assess, Nero, CV RRR, Lungs CTAB, work of breathing, discomfort, signs and symptoms of anxiety, agitation determine baseline and goals Is our patient eating, bowel care, mobility and independence, desire for help/support, skin integrity Active needs: increased suctioning, bolus dosing of medication, etc.. REVIEW WHAT I AM SEEING WITH FAMILY/THOSE PRESENT IF APPROPTIATE. Discuss review, what is changing.

  32. Registered Nurse GIP role Charting Clinical Note, EMR Note GIP Day 1, Day 2, Day 3 etc. Supportive Data that the symptoms are ongoing: Pt continues to meet GIP eligibility for state the uncontrolled symptom(s) Ongoing Issues: Patient response to current interventions; if any Measureable outcome: pain ratings and quotes from patient family Providing recommendations to manage symptoms and education provided to staff and family. Discharge plan: TBD Coordinated care with: i.e.... Name Care Givers involved in development of POC for comfort. Please contact your Hospice Agency for symptom management needs, changes in condition, or at time of death

  33. MSW/GIP: Assessment, Documentation, and Beyond Precipitating Event prior to GIP status Location/ Who is Present at this Visit Initial MSW Assessment or SW Assessment Ideally the Initial Assessment includes the RN and MSW in joint visit

  34. MSW-GIP Assessment Documentation, and Beyond Social Hx/Support Network Neuro/Emotional/Behavioral Status Communication Capacity/Ability Code Status(if in question or not completed)

  35. MSW---GIP Assessment, Documentation, and Beyond Funeral Home Financial Concern/Insurance Resource/Counseling Provision emotional adjustment counseling reflective inquiry with patient and/or family members Written information given to go over in a quiet moment at the bedside

  36. MSW---GIP Assessment, Documentation, and Beyond Care Coordination Disposition Discharge to home setting Discharge to SNF or AFH, Timing of Discharge Placement efforts

  37. MSW---GIP Assessment, Documentation, and Beyond Should patient die in hospital setting reassure family of care taken with transition to mortuary care Check with hospital staff to see if there is a limit on time spent with patient after death Help family understand the role of the Funeral Home for post-death tasks Grief Support accessibility and follow up

  38. Challenges Family does not want patient to leave hospital no matter what Family unavailable Placement challenges, lingering, high acuity of medication delivery, vent Families not willing to try different medications easily given in other environments. Discharge back to hospital

  39. Chaplain GIP role: supports patient, family, hospital staff, and Providence care team throughout GIP hospitalization. Assesses and identifies religious/spiritual goals, challenges, and strengths Provides supportive spiritual and emotional presence Facilitates sacramental rites, faith community visits as requested

  40. Chaplain GIP role: supports patient, family, hospital staff, and Providence care team throughout GIP hospitalization. Coordinates with hospital chaplain on handoff of spiritual plan of care to hospice chaplain Provides increased availability and prioritization of GIP patients as needed Ensures discharge handoff of spiritual plan of care to hospice community team chaplain

  41. Patient ready for discharge Home Obtain orders for change to hospice routine level of care Update community attending physician responsible for medication orders after discharge. Durable medical equipment; OT referral for safety

  42. Patient ready for discharge Home Coordinate with infusion as needed, have hospital physician write orders for medications x1 week. Provide needed education to a willing family member on; care of drains, medication administration, basic care as needed. Provide Tuck-in visit

  43. Patient ready for discharge Skilled Facility (SNF) Obtain orders for change to hospice routine level of care Update community attending physician responsible for medication orders after discharge. Durable medical equipment; OT referral for safety

  44. Patient ready for discharge Skilled Facility (SNF) Coordinate with infusion as needed, have hospital physician write orders for medications x1 week. Provide REPORT to SN around patient care needs, Goals of Care, DPOA, patient and family challenges. Routine that has been effective. Patient likes dislikes if known. Provide Tuck-in visit, check in with facility RN

  45. Paint the Picture (The picture you paint is the picture Medicare will use to determine whether this level of care is appropriate and reimbursable). Pt with end stage pancreatic caner continues to meet GIP criteria for pain poorly managed at home. Unable to take PO medications due to nausea/vomiting. Requires frequent nursing interventions and assessment to ensure comfort. Pain was 9/10 when arrived to HCC, now reports improved at 6/10 with ongoing titration of dilauded infusion and Q4H doses of SQ Haldol effective patient. denies nausea at this time.

  46. Thank You

  47. References National Hospice and Palliative Care Organization, A Clinical Guide to Hospice General Inpatient Care (GIP) (2018) Documenting to support General Inpatient (GIP) Hospice Level of Care. (2018) https://nhpco.org/sites/default/files/public/regulatory/GI P_Tip_GIP_Sheet.pdf Check-Lists: Admit, Discharge, Transfer

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