When you are beginning the search for hospice care for your loved one, you will see that many providers state that they offer compassionate care – maybe even the best hospice care available. If everyone is saying it, how do you know if it is true? In this blog we will explore which metrics matter in a hospice search and why.
We are in a social media era so, naturally, Google reviews are a great first choice when you are researching hospice care near you. Bristol Hospice had a national score of 4.7/5 in 2023, an exceptional rating when you consider that caregivers are providing reviews at the worst time in their lives. You can take your search a step further than Google Reviews, you can drill down into an organization’s HIS Scores.
HIS Scores, or the Hospice Item Set, is a comprehensive assessment completed at each patient’s admission. This assessment contains 7 elements, including a discussion with patients and families about their goals of care, spiritual needs, pain, and the comfort of their breathing. Hospices are scored on how well they complete these assessments. At Bristol Hospice, we earned a score of 99.6% in 2023, far exceeding the national average of 93.2%. Let us explore the 7 elements measured and what they mean to patients and caregivers.
Treatment Preferences
When a patient is leaving curative care and beginning end of life care some of the first questions a hospice must explore are about the patient’s and family’s treatment preferences and goals of care. The founders of the hospice movement were deeply committed to the idea that the care team’s goal should be to help you meet your goals. So, good hospice clinicians must engage in conversations about what patients and families want and don’t want as their disease progresses to ensure that care is always delivered in a way that is individualized and effective. Medicare has asked that all hospices ask about preferences around CPR, intubation or other life-sustaining measures, and hospitalization preferences within the first 5 days of care.
As an organization, 99.9% of our patients were proactively asked about their preferences during this time – the national average is 91.6%.
Beliefs / Values Addressed
Spiritual and emotional care is important to Bristol Hospice. When a patient’s spiritual needs are met and their values are respected, it creates an additional layer of peace during the transition process. This measure is not only whether we ask about their preferences, but also whether we followed through with their wishes during transition and after they pass away.
As an organization, we scored 99.9% out of 100% for this score – the national average is 99.5%.
Pain Screening
The pain screening assessment is very important when a patient is beginning hospice care. It’s important to not only understand their level of pain, but we also need to build a treatment plan that is congruent with the patient’s wishes. To receive full credit for the pain screening, a Registered Nurse must utilize a pain rating scale that has been scientifically proven to provide consistent, standardized pain rating. This is a crucial first step in ensuring that we meet every patient’s goals for comfort and pain management.
As an organization, we scored 99.9% out of 100% for this score – the national average is 98.3%.
Pain Assessment
Once the pain screening is complete, a Registered Nurse must complete a comprehensive pain assessment. This is an exploration of any pain the patient ever experiences, not just what is happening in the moment. The nurse will attempt to learn about the pain’s location, frequency, duration, character, what reduces the pain, what increases the pain, and how the pain is impacting the patient’s ability to engage in activity and enjoy life. This information is crucial for developing a pain management plan that helps each patient to meet their goals for both comfort and energy levels. At Bristol, we are very aware that initiating pain medication can be a hard decision for patients and families, and we are committed to working together to find the right level of pain control for each patient.
As an organization, we scored 99.8% out of 100% for this score – the national average is 98.3%.
Dyspnea Screening
When the Hospice Item Set was initiated by Medicare, they found that dyspnea (the medical term for shortness of breath) was frequently present in hospice patients, but that hospice nurses were not consistently recognizing or responding to this distressing symptom. At Bristol, we are committed to ensuring that all patients are evaluated for any shortness of breath by a Registered Nurse within 48 hours of admission to care.
As an organization, we scored 99.9% out of 100% for this score – the national average is 94.8%.
Dyspnea Treatment
If the screening above finds that a patient does experience shortness of breath, then the Registered Nurse must collaborate with a physician and patient/responsible party to develop a plan to alleviate this symptom. Sometimes, these treatments are based on medications, but they almost always include non-pharmacological methods of making patients more comfortable. Sometimes, the patient declines to receive any specific treatment for shortness of breath, and that is okay too. The most crucial thing is that the patient is empowered to make the decisions that meet their goals.
As an organization, we scored 99.9% out of 100% for this score – the national average is 99.0%.
Opioid with Bowel Regimen
Opioids are often an essential part of the treatment plan for a patient on hospice, but they often come with side effects that must be considered. Some patients find that these medications make them sleepier, or they complain of feeling more confused. These medications will never be prescribed without discussion and patient consent. The Bristol team will always strive to use the lowest effective dose and will communicate closely with the patient and family to evaluate the patient’s response to the medication. Unfortunately, one of the most common side effects of opioids is constipation, which can become severe and distressing if not adequately treated. The Hospice Item Set evaluates how many patients who were prescribed opioids on hospice admission also had a bowel regimen in place to ensure that opioid-induced constipation does not cause distress.
As an organization, we scored 99.6% out of 100% for this score – the national average is 97.4%.
Our Patients Are the Heart of What We Do!
The voice of the caregiver is not only valuable, it is crucial to choosing a hospice provider. Based on our scores, scores that were based off surveys by patients and families across our nation, we can definitively state that our patients are the heart of what we do. Are you searching for hospice care in your area? Reach out to our team today, we will help you through the process of beginning end of life care.
