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Hospice Quality Measure: Managing Shortness of Breath


hospice nurse uses hospice software to document shortness of breath

The Quality Measure for Dyspnea Treatment encompasses both the timing of treatment once a patient has been screened as having shortness of breath, as well as allowing for multiple possibilities of pharmacologic and non-pharmacologic treatment measures. The screenings should also be documented in the hospice software. The quality measure also enables patients to have the option to decline treatment for shortness of breath. If treatment is declined, the agency is not penalized for encouraging patients to have autonomy in healthcare decision-making.

Documenting Treatment in Hospice Software

Once the screening for dyspnea has indicated the patient has shortness of breath, the Dyspnea Treatment Quality Measure is looking for treatment for shortness of breath to be initiated no longer than one day after the positive screening result. Therefore, the dates between Hospice Item Set (HIS) question J2030B (date of first screening for shortness of breath) and HIS question J2040B (date treatment for shortness of breath initiated) should be no greater than one day apart. Whenever possible, treatment should be initiated or declined by the patient on the same date that the patient is determined by the screening to have shortness of breath.

For HIS question J2040C – Type(s) of treatment for shortness of breath initiated, treatment options to look for in the clinical documentation are as follows:

  • Opiates
  • Other medication
  • Oxygen
  • Non-medication

Dyspnea Treatment Detail in Hospice Software

The HIS Manual version 2.01 is very detailed on which treatments for shortness of breath to include in the HIS Admission record. All pharmacologic dyspnea treatments need to be orders to the hospice to initiate or continue a treatment, and not orders that are carried over from another care setting. Also, comfort kit medications that the nurse has not instructed the patient/caregiver to begin using for shortness of breath do not count as an initiated treatment. Proactive education for future treatment is not an initiated treatment.

If there is an opiate or other medication ordered that does not have a documented indication of shortness of breath, these medications should not be indicated in J2040C. Both PRN and scheduled treatments should be included in J2040C as well.

Also, while there are not orders for non-medication interventions such as fans, positioning or education on energy conservation techniques, these are definitely effective non-medicinal treatments for shortness of breath and should be indicated when answering HIS question J2040C. Finally, only include treatments that were ordered on the date listed in J2040B and not treatments that started after that date.

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, including medication profiles, dyspnea plans of care, and narrative documentation for the presence of the new dyspnea treatments. 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 treatment question is warranted.

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