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Hospice Composite Measures: Addressing Values, Beliefs and Spiritual Concerns


Nurse using hospice software to document values, beliefs and spiritual concerns

Hospice provides an interdisciplinary approach toward holistic care for needs of the patient and caregivers, often using hospice software. Discussing spiritual concerns early in the hospice experience is an essential component of meeting the needs of patients and caregivers. The Quality Measure: Beliefs/Values Addressed is specifically focused on addressing spirituality and existential meaning for patients and caregivers who want this type of care to be included in their treatment plan.

As with the other treatment preference items in the Hospice Item Set (HIS), the goal of the measure is not to start and end with asking the patient and/or caregiver about spiritual/existential concerns, but it is instead meant to be the gateway to further discussion and exploration.

Documenting HIS Response in Hospice Software

The HIS question F3000A asks if the patient and/or caregiver was asked about spiritual/existential concerns. This question is very open-ended which allows for the clinician to determine, based on the patient and/or caregiver’s needs, how to best proceed with the discussion. Many patients may not consider themselves to be religious, but they do have existential concerns or questions regarding the nature of illness and suffering in their lives or how to find meaning and purpose at the end of their lives. These are existential and spiritual needs that should be addressed by the hospice interdisciplinary group using communication features in hospice software.

Additionally, unlike the other preference item HIS questions and quality measures, the HIS Manual version 2.01 states that this item can be asked of a caregiver who is not the patient’s legal representative. This question also allows the agency to take credit for attempting to have the discussion with the patient and caregiver, even if the patient and/or caregiver decline to participate in the discussion. Both the patient AND the caregiver must explicitly state they do not wish to discuss spiritual/existential concerns for the clinician to document the refusal in the hospice software.

Document Discussions in Hospice Software

For the date entry in F3000B, enter the date of the first documented discussion regarding spiritual and existential concerns. Although there may be many discussions, the HIS item is only asking about the initial documented discussion. Discussions that occur up to seven days prior to hospice admission that are documented in the clinical records can be used for evidence of the discussion on preference items and the date of the discussion. Ensure your agency is documenting the educational sessions and pre-admission visits in the hospice software to best report your performance on this measure. Discussions that occur during the comprehensive assessment period of five days after hospice election can also be noted in the Admission HIS document.

Prior to finalizing the Admission HIS for submission, the person responsible for reviewing the HIS should look in multiple documents in the hospice software for validating documentation of the spiritual/existential discussion. While it may be addressed in the initial RN assessment, this could also be documented in the psychosocial or spiritual counselor documentation. Enter the date into F3000B where you find the first documentation in the hospice software of the discussion or attempt to discuss spiritual/existential concerns.

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