1. Hospice CTI
Best Practice

2. Topics: Documenting Verbal Order from PointCare
Creating the Order in Workflow
Editing the Order Text
Approving the Order in Workflow
Obtaining the Signature (IDG)
Processing the Order as Signed (WorldView)

3. OBTAINING THE ORDER
The SOC nurse is responsible for obtaining the verbal order from the Medial Director and the Primary Physician during the SOC visit.
Details from the verbal order are documented in 2 coordination notes:
Hospice Verbal Certification Medical Director
Hospice Verbal Certification Primary Physician
The nurse should confirm that the primary physician entered on the coordination note matches the primary physician indicated by the patient on the consent forms.
Note: If the patient’s Medical Director and Primary Physician are the same, the clinician will just complete the coordination note for the Medical Director.
Template has been edited to include the date the verbal was received.

4. CREATING THE ORDER Create/ Edit Hospice CTI Order (X2)
These tasks should not be processed until the SOC documentation has been synced back from the nurse
Assigned to Clinical Director
During these tasks:
‘Copy Note Details’
Order Read Back = Yes
Confirm Physician on CTI order matches the physician indicated by patient on consent forms
Mention if physician is required to do the narrative, they can check the box to require that on order, otherwise it’s not required and the order does not contain an area for the physician narrative.

7. Hospice Verbal Certification Coordination Note
Order Description Before Note is Copied
Order Description After Note is Copied

8. Editing the Order Text

9. Editing the Order Text
The below text must be removed on all orders except for the Primary Physician order at Admission
**I UNDERSTAND THAT I WILL CONTINUE TO BE THE PATIENT'S HOSPICE ATTENDING PHYSICIAN, AND WILL WORK WITH THE HOSPICE MEDICAL DIRECTOR AND THE HOSPICE INDISCIPLINARY TEAM TO ENSURE COORDINATION OF CARE FOR THE PATIENT. I UNDERSTAND AFTER ATTEMPTS TO REACH ME OR AT MY DIRECTION IF I AM NOT AVAILABLE THE HOSPICE MEDICAL DIRECTOR MAY GIVE MEDICAL DIRECTION TO THE HOSPICE CARE TEAM. I UNDERSTAND THE HOSPICE MEDICAL DIRECTOR IS AVAILABLE AS A CONSULTANT TO ME AS THE HOSPICE ATTENDING TO ENSURE APPROPRIATE SYMPTOM CONTROL SERVICES ARE PROVIDED TO MY PATIENT.
I UNDERSTAND THAT I WILL PARTICIPATE IN THE DEVELOPMENT AND ONGOING UPDATES OF THE HOSPICE PLAN OF CARE FOR THIS PATIENT AND THAT I WILL BE WELCOME AT ALL TEAM CONFERENCES CONCERNING THIS PATIENT. ALL CARE PROGRESS SUMMARIES WILL BE FORWARDED TO ME ON A REGULAR BASIS. I UNDERSTAND THAT UPON RECERTIFICATION, THE MEDICAL DIRECTOR WILL PERFORM THE CERTIFICATION OF TERMINAL ILLNESS PER MEDICARE GUIDELINES.
I UNDERSTAND THAT THE HOSPICE PROGRAM IS PALLIATIVE, NOT CURATIVE, IN ITS GOALS. IT FOCUSES ON COMFORT CARE AND ALLEVIATION OF SYMPTOMS RATHER THAN AGGRESSIVE TREATMENTS OR LIFE-SUPPORT SYSTEMS.**

10. Editing the Order Text

11. APPROVING THE ORDER Review/Edit/Approve Hospice CTI Order (X2)
Assigned to Clinical Manager
During these tasks:
Check verbal order date against SOC/ SOE date to ensure it meets the requirements
Check the content of the order is appropriate for the physician listed
Make any other appropriate edits if needed
Approve Order

13. PROCESSING OUT THE ORDER
Process New Hospice Order to Physician
Assigned to Medical Records/ Order Processing
Methods of Communication:
Fax
Task is bypassed and order is automatically faxed
Website
Enforces Compliance
Task is bypassed and order is automatically sent
Hospice IDG
Mail/ Deliver
Signature will be on paper and will need to be tracked and manually processed
Any orders that are faxed, will be faxed automatically after approval, not giving the medical records specialist an opportunity to send to another platform (IDG, Provider Link, etc…). It may be best to send all order via Hospice IDG to ensure all the task generates. If they still need to fax the order, they can. All orders will be available for signature in Provider Link no matter how they are processed through workflow

14. Verifying Physician’s Communication Method
To check your physician’s preferred method of communication, you must access the Physician Table.
Edit the appropriate physician to find the field labeled ‘Notify New Orders Via’
Use the drop down to choose the method of delivery
Must be edited at physician level and branch level

15. Verifying Physician’s Communication Method
Select the physician whose profile you would like to edit
Notify New Orders Via: Interface
Physician level and office level

16. SIGNING THE ORDER Hospice IDG
Any unsigned orders can be accessed in the IDG console through the Review/ Approve Unsigned Orders
The physician can sign these during IDG meetings.
Any CTI orders will require a narrative to be completed before signing

17. Signing the Order Highlight the order to be signed
“Add Physician Narrative’’
Must be at least 10 characters

18. Adding the Narrative
After selecting ‘Add Physician Narrative’, they will be prompted with this screen
If the physician wishes, they can copy this narrative note, before saving, to use as their IDG note
Character limitation helps to ensure narrative note is in compliance

19. Signing the CTI Order
Once the Narrative has been added, the signature is required
Using the menu items at the bottom of the window, select ‘Sign Order’

20. PROCESSING IN THE ORDER
Electronic Signatures (Provider Link and IDG)
Electronically signed orders will automatically be processed as ‘Signed’ in HCHB
Electronic signature will show on order
Electronic attestation will show on order
Paper Signatures
Manually process in as ‘Signed’ in HCHB
Manually scan and attach to the patient’s chart
WorldView
Marks orders as ‘Signed’
Enters signed date into appropriate field in the order processing screen
Attaches order to chart
Medical Records best practice
Note: It is recommended that these tasks be processed by the Medical Records Specialist / Order Processing
We encourage our agencies to use World View to ensure all signed orders are being attached to the patient’s chart.

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