Hospice GIP – General Inpatient Level of Care

Potential Indicators of GIP

• Uncontrolled Pain or pain that requires frequent and/or escalating doses of IV opioids
• Respiratory distress
  • Needs frequent suctioning/trach care
  • Needs Bipap/requires weaning or titration
  • Expectation of respiratory distress after withdrawal of respiratory support
  • High Flow oxygen requirements
• Nausea and vomiting requiring IV antiemetics
• Severe Delirium/Agitation requiring frequent assessment and management by staff
• Seizures requiring frequent monitoring and/or IV medications to control
  • Seizure prophylaxis with IV medications for patients unable to take medications orally
• Complicated wound care requiring frequent or painful wound changes
• Other symptoms that cannot be managed effectively in the home or other settings
• CMS states that dying, in the absence of significant symptoms, does not qualify as GIP

Documentation prior to GIP

• Severity of symptoms
• Effectiveness of (or lack of) current therapies to control symptoms
• Amount of prn medications in last 24 hours to control symptoms
• If patient not requiring IV medications to control symptoms, why you feel they need GIP
• Inability to transport appropriate GIP patients to a dedicated hospice inpatient unit
  • Vitals unstable
  • High oxygen requirements