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Hospice Composite Measure: Screening for Shortness of Breath

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Dyspnea, or shortness of breath, is a highly prevalent symptom among many patients at the end of life and should be properly documented in the hospice software. In some diseases, it is more common to find shortness of breath than pain. Dyspnea is often undertreated and causes distress for the patient and their caregivers who watch the patient struggling to breathe. The goal of this quality measure is to measure how often agencies are performing dyspnea screenings for patients with the hopeful end goal of improving outcomes for patients who are struggling to breathe.

Documenting Dyspnea in the Hospice Software

The Dyspnea Screening quality measure is looking for the presence of a screening for dyspnea HIS question J2030A, and if present, the documentation of the severity of the dyspnea for the patient. If there is documentation that the patient has shortness of breath but no documentation of the severity of the shortness of breath is present, then the appropriate answer to J2040A is “No,” as per the HIS Manual version 2.01 there was not a screening for dyspnea completed. Also, in answering J2030C – Did the screening indicate the patient had shortness of breath? – dyspnea screening considers not only the current shortness of breath during the visit, but also historical patient or caregiver reports of distress with breathing as well as the clinician’s documented observations in the hospice software of signs of dyspnea.

As with the Pain Screening quality measure, timing of the initial dyspnea screening can be confusing. In the Hospice Quality Reporting Program: Specifications for the Hospice Item Set-Based Quality Measures, CMS describes the Dyspnea Screening Measure as the percentage of patient stays during which the patient was screened for dyspnea during the initial nursing assessment, and states that this is done within two days of admission to hospice. The apparent discrepancy between the initial nursing assessment and two days is explained by the Conditions of Participation for timing of the initial RN assessment.

The State Operations Manual Appendix M – Guidance to Surveyors states that the agency must complete an initial assessment within 48 hours of the election of hospice care. For most agencies, the election date and date when the initial RN assessment is completed are the same date, but there is an option for the RN to complete the initial assessment within 48 hours of the election. Best practice for meeting the timing requirements for the Dyspnea Screening quality measure would be to complete the Dyspnea Screening on the initial RN assessment for the patient, whether it is scheduled for the same day as the election date or within 48 hours of the election.

Finally, make sure prior to approving the Admission HIS for submission that all narrative documentation in the hospice software is reviewed to look for additional supportive documentation for the presence of the dyspnea screening. It is acceptable for the HIS to make edits to the HIS document if additional information is located showing a more accurate answer to the dyspnea screening question is warranted.

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