Date of Doctor of Nursing Practice Project Completion
Summer 8-12-2026
Faculty Advisor
Dr. Faith Strunk
Abstract
Purpose: To reduce 30-day caregiver-driven hospice revocations by implementing a tiered post-admission nursing visit protocol based on caregiver preparedness. Background: Caregiver distress and inadequate support contribute to hospice revocations and interruptions in care. Increased nursing contact during the first week of enrollment may improve caregiver preparedness and reduce crisis-driven hospitalizations. Methodology: An eight-week quality improvement project using the Plan-Do-Study-Act framework was implemented at a rural hospice agency. Caregivers completed a Caregiver Preparedness Survey to assign preparedness tiers and guide additional nursing visits during the first week. Process measures included survey completion and protocol adherence. Outcome measures included caregiver preparedness and 30-day revocation rates. Descriptive statistics, run charts, weekly chart audits, and interdisciplinary reviews evaluated implementation fidelity and outcomes. Results: During implementation, 31 patients were admitted and 17 met eligibility criteria. Fourteen caregivers completed the survey (82.4%). Two caregivers screened as moderate risk and received all additional visits, achieving 100% protocol adherence. Caregiver and staff feedback indicated improved preparedness and communication. A second PDSA cycle introduced an optional electronic survey to improve caregiver privacy and participation. The revocation rate increased from 15.9% at baseline to 19.4% during implementation. Implications: The intervention was feasible in this setting, achieved high protocol fidelity, and improved caregiver engagement. Early identification of caregivers needing additional support may improve caregiver preparedness. Longer implementation periods and larger samples are needed to evaluate effects on caregiver preparedness and revocation rates.
Keywords
hospice, quality improvement, caregiver preparedness, revocation
Recommended Citation
Jemma Lowak, "Reducing Live Discharges Using a Tiered Protocol in a Rural Hospice: A Quality Improvement Project" (2026). Doctor of Nursing Practice Final Project Abstract. 229.
https://digitalcommons.library.tmc.edu/dnp_abstract/229