HOSPICE
PULMONARY DISEASE
a. disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, e.g., bed to chair existence, fatigue, and cough (documentation of Forced Expiratory Volume in one second [FEV1], after bronchodilator, less than 30% of predicated is objective evidence for disabling dyspnea, but is not necessary to obtain).
b. progression
of end stage pulmonary disease, as evidenced by prior increasing visits to the
emergency department or prior hospitalizations for pulmonary infections and/or
respiratory failure (documentation of serial decrease of FEV1>40 ml/year is
objective evidence for disease progression, but is not necessary to obtain).
2. Hypoxemia at
rest on room air, as evidenced by p02 >55 mmHg or oxygen saturation < 88% (these
values may be obtained from recent hospital records) or hypercapnia, as
evidenced by pCO2 > 50 mmHg (this value may be obtained from recent hospital
records).
3. Cor
pulmonale and right heart failure (RHF) secondary to pulmonary disease (e.g.,
not secondary to left heart disease or valvulopathy).
4.
Unintentional progressive weight loss of greater than 10% of body weight over
the preceding six months.
5. Resting
tachycardia >100/min.
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