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
• 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
These are the most frequent breach themes in hospice litigation.