Date of Graduation

Summer 8-16-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Dr. Cynthia Huff, DNP, RN, OCN, CRNI, CNL

Abstract

Problem: Staff nurses have difficulties standardizing documentation of patients’ measurable decline during the admission and recertification process to justify the need for hospice services. Context: According to Murrin (2016), the average Medicare compliance rate of hospice organizations is 86%. This quality improvement (QI) project aims to increase an outpatient hospice organization’s Medicare compliance rate of 66% to the average, nationwide level through standardization of documentation (Frontz, 2021). Interventions: The proposed intervention is to implement a QI project of the following assessment tools: Palliative Performance Scale (PPS), Functional Assessment Staging Tool (FAST) and Mid-Upper Arm Circumference (MUAC). Clinical nurses will attend a one–hour training class on tool implementation. Measures Post implementation, bi-weekly chart audits were conducted over the course of three months. In addition, bi-weekly check-ins were conducted at staff meetings to answer any questions and provide opportunities for feedback. Results The quality report revealed that of the 84 admission notes audited, 78 notes were found to include the three proposed assessment tools. Thus resulting in a successful implementation rate of 88.6%. Conclusions Given the actual implementation rate was 2.6% higher than the project goal of 86%, the assessment tool bundle may be useful in thorough, standardized hospice documentation. Moving forward, further research is necessary in other hospice organizations to correlate the assessment tool findings and mortality rates.

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