Hospice Breach Analysis Worksheet

A structured tool for identifying deviations from hospice standards of care, linking failures to harm, and organizing breach arguments with clarity and precision.

Hospice Breach Analysis Worksheet

A structured tool for identifying deviations from hospice standards of care, linking failures to harm, and organizing breach arguments with clarity and precision.

Hospice cases require careful evaluation of symptom management, communication, medication safety, and alignment with the patient’s goals of care. This worksheet guides attorneys through the critical steps of comparing what should have occurred to what actually occurred, identifying deviations, and determining whether those deviations contributed to preventable suffering or harm.

Use this worksheet during case screening, expert review preparation, deposition planning, and timeline reconstruction.

Patient & Case Overview
✔ Patient Information
Name
Age
Primary diagnosis
Hospice admission date
Setting (home, facility, inpatient hospice)
Baseline functional status
Baseline cognitive status
✔ Key Dates
Admission
Symptom escalation events
Medication changes
Active decline
Death
Expected Standard of Care
✔ Identify Applicable Standards
Hospice Conditions of Participation
Agency policies
Evidence-based symptom-management guidelines
Medication safety standards
Interdisciplinary team (IDT) requirements
Goals-of-care documentation
✔ Document What Should Have Happened
Required assessments
Visit frequency
Symptom-management interventions
Medication titration
Family communication
IDT coordination
Documentation expectations
Actual Care Provided
✔ Document What Actually Happened
Nursing visits
Symptom assessments
Medication administration
Provider involvement
Family communication
IDT notes
Documentation entries
✔ Identify Gaps or Inconsistencies
Missing assessments
Missed visits
Contradictory notes
Late entries
No documentation of family updates
No documentation of symptom reassessment
Identified Deviations (Breach Points)
✔ List Each Deviation Clearly
Delayed symptom management
Uncontrolled pain or dyspnea
Delayed medication titration
Poor communication with family
Inadequate monitoring
Failure to align care with goals
Insufficient visit frequency
Documentation failures
Medication errors
✔ For Each Deviation, Answer:
What should have occurred?
What actually occurred?
Why is this a breach?
What evidence supports this?
What was the expected outcome if handled correctly?
Causation Link
✔ Did the Deviation Contribute to Harm or Suffering?
Yes / No / Possibly / Unclear
✔ Describe the Connection
How the breach increased distress
How the breach delayed symptom relief
How earlier intervention could have changed the outcome
Whether suffering was foreseeable
✔ Supporting Evidence
Nursing notes
Medication logs
Family statements
IDT documentation
Timeline reconstruction
Timeline Reconstruction (Optional but Recommended)
✔ Build a Clear Sequence of Events
Admission
Symptom escalation
Medication changes
Family communication
Visit frequency
Active decline
Death
✔ Identify Delays
Delayed symptom response
Delayed medication titration
Delayed provider involvement
Delayed communication
Missed visits
Common Hospice Breach Indicators

These are the most frequent breach themes in hospice litigation.

Uncontrolled pain or dyspnea
Delayed symptom management
Poor communication with family
Inadequate monitoring
Medication errors
Failure to align care with goals
Documentation gaps
Insufficient visit frequency
Lack of anticipatory guidance
Failure to recognize active decline

Hospice Breach Analysis Identifies Regulatory, Clinical, and Documentation Failures

Hospice cases frequently involve allegations of regulatory noncompliance, deviations from the plan of care, failures in symptom management, and documentation gaps that create liability exposure. The Hospice Breach Analysis Worksheet evaluates clinical care delivery against Medicare Conditions of Participation, state regulations, internal policies, and accepted standards of hospice practice. Our clinical-legal team identifies breaches in care, supervision, documentation, and compliance that may support regulatory action, litigation strategy, or defense analysis.

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