Hospice Recertification SOAP Notes for Peripheral Vascular Disease Patients
For PVD patients on hospice, recertification SOAP notes must document progressive functional decline, symptom burden, and terminal prognosis through systematic assessment of disease progression, pain management, cardiovascular comorbidities, and quality of life deterioration to justify continued hospice eligibility.
Subjective Assessment
Document specific symptom progression and functional decline:
Pain characteristics using comprehensive assessment: Site (location of ischemic pain—typically distal extremities, rest pain in feet), Onset (timing and progression), Character (burning, aching quality), Radiation patterns, Associated factors (claudication distance, rest pain frequency), Timing (nocturnal worsening), Exacerbating/Relieving factors (dependency, elevation), and Severity scoring 1
Walking impairment and claudication: Quantify distance before symptom onset, presence of ischemic rest pain, and progression of functional limitations 2
Wound status: Document any nonhealing wounds of legs or feet, their progression, and impact on mobility 2
Cardiovascular symptoms: Assess for concurrent coronary artery disease symptoms, as PVD patients have 2-4 times higher prevalence of coronary disease and significantly elevated cardiovascular mortality risk 3, 4
Quality of life impact: Document psychosocial distress, sleep disruption from rest pain, and limitations in activities of daily living 2
Objective Assessment
Physical examination findings demonstrating disease progression:
Vascular examination: Document abnormal lower extremity pulse examination, presence of bruits, capillary refill time, and temperature changes 2
Skin integrity: Record presence and progression of ulcerations, gangrene, or tissue loss indicating critical limb ischemia 2
Functional status: Measure and document decline in ambulation distance, need for assistive devices, or bedbound status 2
Vital signs: Blood pressure assessment is critical as 35-55% of PVD patients have concurrent hypertension, which increases risk of myocardial infarction and stroke 4
Pain assessment at rest: Document pain localized to lower leg or foot and its association with upright or recumbent positions 2
Comorbid conditions: Assess for heart failure, renal dysfunction, or other end-stage cardiovascular disease manifestations, as PVD is a marker for systemic vascular disease 3, 5
Assessment/Plan
Establish terminal prognosis and hospice appropriateness:
Prognosis documentation: PVD patients have 3-5 fold increased cardiovascular mortality compared to age-matched controls, with two-thirds of cases progressing asymptomatically until critical stages 3, 5
Disease trajectory: Document progression from intermittent claudication to rest pain to tissue loss, indicating terminal phase 2, 3
Functional decline: Quantify decline in performance status and increasing care needs 2
Symptom management plan:
Pain control: Document current analgesic regimen with both regular and breakthrough medications prescribed, as 77% of end-stage cardiovascular disease patients experience pain 2, 1
Cardiovascular medication management: Continue therapies that maintain quality of life while avoiding those causing severe debilitation; consider de-escalation of aggressive interventions based on goals of care 2
Interdisciplinary approach: Document involvement of hospice nursing, home health aides, social work, counseling, and bereavement services as required by Medicare-certified hospices 2
Caregiver support: Address respite care needs and family education on disease progression 2
Follow-up and monitoring:
Recertification justification: Document continued decline or lack of improvement despite palliative interventions, supporting terminal prognosis of 6 months or less 2
Communication plan: Ensure patient and family understand disease progression and have appropriate contact information for symptom management concerns 2
Goals of care alignment: Confirm patient-driven, family-centered care philosophy with focus on comfort rather than curative treatment 2