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Best Practices


The following list provides links to valuable materials and helpful best practice reports and articles. We will update and add resources on a continuing basis.

Select to view and download the reports below:

Access to Hospice Care
Report on Admitting Practices of Massachusetts Hospices

The Standards and Best Practices Committee was appointed by the Board in 2002 and charged with "providing opportunities for examining standards, competencies and making recommendations to members that will improve end of life care.” The Committee surveyed hospices in Fall 2002 regarding their needs for "best practices” and current admitting practices. 21 out of 41 surveys were returned for a response rate of 51%. The Committee analyzed the survey data and has prepared the following information for each of the admitting practices: (...more)

APPENDIX - Access to Hospice Care

Determining Terminal Status
LCD for Hospice

This LCD describes guidelines to be used by National Government Services (NGS) in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits. Although guidelines applicable to certain disease categories are included, this LCD is applicable to all hospice patients. It is intended to be used to identify any Medicare beneficiary whose current clinical status and anticipated progression of disease is more likely than not to result in a life expectancy of six months or less. (...more)

Hospice General Inpatient Level of Care
Criteria, Service Guidelines, Reimbursement and Contracting

In Fall, 2007, the Federation's Board of Directors charged JoAnne Nowak, MD, Partners Hospice with chairing a task force to review, revise and update a Best Practice report on the General Inpatient Level of Care published in 2004. This report summarizes the recommendations of the Task Force assigned to develop the Best Practice paper on the General Inpatient Level of Care.

This report was accepted by the Federation's Board of Directors on June 25, 2008.(...more)

APPENDIX - Hospice General Inpatient Level of Care Report

Interdisciplinary Team Meeting
Promoting increased effectiveness of the IDT team meeting among Massachusetts Hospices

This report is a Best Practice paper of the Hospice & Palliative Care Federation of MA. It presents the findings of field and survey research on the status of interdisciplinary team (IDT) meetings among Massachusetts hospices and offers recommendations on how to improve the effectiveness of the ODT meeting. It concludes that the purpose of the team meeting is to develop an interdisciplinary Plan of Care that meets the evolving needs and goals expressed by the patient and family. The reports includes content from an educational conference held in April, 2004 that supports the implementation of a model of care planning focused on patient and family goals rather than a disease-based model. (...more)

APPENDIX - Interdisciplinary Team Meeting

Palliative Sedation Protocol

Palliative Sedation is the monitored use of medications (sedatives, barbiturates, neuroleptics, hypnotics, benzodiazepines or anesthetic medication) to relieve refractory and unendurable physical, spiritual, and/or psychosocial distress for patients with a terminal diagnosis, by inducing varied degrees of unconsciousness. The purpose of the medication(s) is to provide comfort and relieve suffering and not to hasten death. (...more)

APPENDIX - Palliative Sedation Protocol

Pronoucement of Death - Sample Policy

The purpose of this document is to establish the procedure for the registered nurse or nurse practitioner to follow when pronouncing a hospice patient's death at home or in a skilled nursing facility. This document is a sample policy only and is intended to provide general guidance.It is specifically understood that this document is not intended to provide legal, technical or other professional services or advice. Additionally, while this policy may be consistent with the laws of the Commonwealth of Massachusetts, it is not intended to interpret the laws of Massachusetts or any other state. (...more)

Pronouncement of Death - Massachusetts law (Chapter 46, Section 9)

Pronouncement of Death Form-302 Fact Book

Task Force on Ventilator Patients

This Task Force was established in October, 2000 after interested members of the Federation had met with representatives of Harvard Pilgrim Health Care to discuss ways in which their patients on ventilator support at home could benefit from hospice services. This was a need that had been expressed earlier by staff of the Palliative Care Services at MGH. (...more)

Terminal Delirium Quality Improvement Project: Comfort, Care and Dignity

Over the past 18 months, 23 of the Federation's hospice members participated in a Quality Initiative with Masspro, the CMS contracted Quality Improvement Organization program for Massachusetts.This pilot focused on improving the management of terminal delirium among hospice patients. However, the project provided education, consultation, and peer support to lead the hospices through a QAPI model that can be used for any future improvement project at their programs. (...more)

APPENDIX - Terminal Delirium Quality Improvement Project - Tool Kit

Tool Kit includes:

  • Tool Kit Cover Letter

  • Terminal Delirium Definition

  • Terminal Delirium Presentation
  • Terminal Delirium - Confusion Assessment Method
  • Terminal Delirium and Agitation Audit Tool
  • Training Resources for Hospice and Home Health Aides

Training Resources for Hospice and Home Health Aides
Caring for Patients at End-of-Life

The Hospice & Palliative Care Federation, in collaboration with the MA Council for Home Care Aide Servcies, has produced this report to support compliance with the new Medicare Hospice Conditions of Participation related to the supervision and training of home care and hospice aides.Included are a crosswalk of Medicare regulations for hospice and home health, basic and in-service training curricula, Surveyor Guidelines, and other useful resources. (...more)