Donald Pickett

Hospice Item Set (HIS)

Diagnoses

• G30.9

  Alzheimer's disease, unspecified

  terminal

• M62.81

  Muscle weakness, generalized

  2024-09-01

• R41.3

  Other amnesia

  2023-05-10

• I50.32

  Chronic diastolic (congestive) heart failure

  2022-07-22

• F02.80

  Dementia in other diseases classified elsewhere, without behavioral disturbance

  2021-03-15

• E11.9

  Type 2 diabetes mellitus without complications

  2020-11-04

Visit notes

• social servicesMSW9/1/2025, 1:30:00 PM

  Bereavement preparedness visit. Donald Pickett actively dying; remained at bedside briefly with family. Margaret, Thomas, and Thomas's wife all present, maintaining vigil. Family appears exhausted but united and drawing comfort from one another. Chaplain visited yesterday per family report and prayer was offered — family found this meaningful. Reviewed what to expect in final hours and reassured family that hospice nurse is available around the clock. Provided written bereavement resource materials and information regarding funeral home contact the family has pre-selected. Verified advance directive wishes — no 911 call, no resuscitation. Family verbalized understanding of process to contact hospice upon time of death rather than EMS. Encouraged family to rest in shifts. Emotional support provided; space held for grief expression. Thomas voiced gratitude for hospice team and relief that his father, given his Alzheimer's disease journey, is peaceful and pain-free. Will coordinate bereavement follow-up post-death.

• nursingRN8/29/2025, 4:00:00 PM

  Daily comfort visit. Donald Pickett minimally responsive — opens eyes briefly to voice but no other purposeful interaction. Respirations irregular, 10-14 per minute with occasional 10-15 second apneic pauses. Mottling noted to bilateral knees and lower extremities. Extremities cool to touch. Skin intact; no new breakdown. Oral care provided with moistened swabs; no aspiration attempt with oral intake at this time given swallowing absent. Glycopyrrolate 0.2 mg SL administered for mild gurgling secretions with good effect. Family present at bedside — Margaret holding patient's hand. Emotional support provided; explained that physical changes observed are consistent with active dying process in the setting of end-stage Alzheimer's disease. Encouraged family to speak to Donald, play familiar music, and maintain calm environment. Chaplain and MSW notified of patient's condition. Anticipatory guidance provided regarding imminent death. Will return this evening.

• incidentRN8/26/2025, 9:45:00 PM

  Incident note — acute agitation episode. Received call from caregiver Margaret at approximately 1545 reporting that Donald was moaning continuously, exhibiting facial grimacing, and thrashing in bed for approximately 45 minutes unrelieved by repositioning. RN arrived at 1610. Patient observed with significant terminal agitation, consistent with advanced Alzheimer's disease. Respiratory rate 24, audible upper airway secretions noted. Lorazepam 0.5 mg SL administered with caregiver observation; morphine 2 mg SL administered concurrently for comfort. Patient visibly relaxed within 20 minutes — respirations decreased to 18, grimacing resolved. Margaret and Thomas present; provided emotional support and education on terminal restlessness as a common end-of-life phenomenon in Alzheimer's. On-call MD notified; orders obtained to increase lorazepam PRN to 1 mg SL q4h PRN agitation. Comfort kit medications confirmed in home. Family instructed to call 24/7 line for any recurrence. Will increase visit frequency to daily.

• physicianMD8/22/2025, 2:00:00 PM

  Hospice physician face-to-face encounter conducted at patient's home for recertification documentation. Patient Donald Pickett presents with advanced Alzheimer's disease (G30.9). Clinical findings consistent with terminal prognosis: patient is bedbound, non-ambulatory, and largely non-verbal. Dependent on total care for all ADLs. Oral intake limited to minimal sips; weight loss estimated greater than 10% over prior 6 months per caregiver report. No purposeful communication observed during encounter. Swallowing impaired; aspiration risk high — family counseled on aspiration risk and consistent with comfort-focused goals, artificial nutrition not desired. Current medications: morphine sulfate 2 mg SL PRN q4h for dyspnea/pain, lorazepam 0.5 mg SL PRN q6h for agitation, glycopyrrolate 0.2 mg SL PRN for secretions. Plan continues comfort-directed care. Terminal prognosis supported. Recertification period authorized.

• social servicesMSW8/19/2025, 6:15:00 PM

  Psychosocial visit completed at patient's residence. Met with Donald Pickett's wife, Margaret, and adult son, Thomas. Family expressed significant grief and guilt surrounding the progression of Mr. Pickett's Alzheimer's disease, noting the long goodbye nature of the illness. Margaret tearful, stating she has been his sole caregiver for over four years and is exhausted. Validated her caregiver fatigue and normalized anticipatory grief. Provided information on respite care options and local Alzheimer's caregiver support group meeting weekly at community center. Assessed for spiritual needs — family identifies as Baptist and expressed interest in chaplain visit. Chaplain referral submitted to IDT. Advanced directive documents reviewed; POLST on file, consistent with current comfort-focused plan. Patient resting quietly in bed during visit, not interactive. Will follow up next week.

• nursingRN8/15/2025, 3:30:00 PM

  Initial hospice nursing assessment completed per admission orders. Patient Donald Pickett is a male with end-stage Alzheimer's disease, unspecified (G30.9), bedbound, minimally verbal — responds occasionally to his name with eye opening. Vital signs deferred per comfort-focused plan of care. Skin intact; coccyx area reddened but no open areas noted. Repositioning schedule reviewed with daughter-in-law, primary caregiver. PO intake markedly decreased; patient accepting small sips of thickened liquid with direct assist. Goals of care discussed — family verbalized understanding of hospice philosophy and desire to keep Donald comfortable at home. Medications reviewed; lorazepam 0.5 mg SL PRN and morphine sulfate 2 mg SL PRN ordered for agitation and dyspnea respectively. Caregiver instructed on symptom recognition and administration. IDT referrals placed for MSW and aide services. Follow-up visit scheduled in 3 days.