Implementing and sustaining evidence-based practices in long-term care.

Assessment Tools

Canadian Hospice Palliative Care Association Square of Care and Organization - RNAO Appendix K

A comprehensive, holistic assessment of individuals and their families at end-of-life.

Reprinted with Permission from Canadian Hospice Palliative Care Association.  Registered Nurses' Association of Ontario.  (2011). Appendix K of End-of-Life Care During the Last Days and Hours. Toronto, ON: Author.  pp. 114-115. 

Palliative Prognostic Score (PaP) - RNAO Appendix D

PaP uses the Karnofsky Performance Scale (KPS) and 5 other criteria to generate a numerical score from 0 to 17.5 to predict 30 day survival (higher scores predict shorter survival).

Registered Nurses’ Association of Ontario. (2011).  Appendix D of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp. 102-103.  Copyright (1999), with permission from Elsevier.

Reprinted from Journal of Pain and Symptom Management, Vol. 17, No. 4, Maltoni, M, Nanni, O, Pirovano, M., Scarpi, E., Indelli, M, Martini, C, et al., Successful Validation of he Palliative Prognostic Score in Terminally ill Cancer Patient, 240-247

 

Palliative Performance Scale (PPS), Version 2 - RNAO Appendix D

PPS may be used for several purposes. It is an excellent communicatiuon tool for quickly describing a patients current functional level.

The Victoria Hospice Palliative Performance Scale (PPS, version 2) is an 11-point scale  communication tool for describing the current functional level and appears to have prognostic value.  The PPS provides a framework for measuring progressive decline over the course of illness.  If you wish to print any of these tools for your use, please go to https://victoriahospice.org/wp-content/uploads/2019/12/PPSv2-English-Sample.pdf to download a copy of Victoria Hospice's reprint and use permission request form.

Victoria Hospice Society. (2001) Clinical Tools. Retrieved from hhttps://victoriahospice.org/wp-content/uploads/2019/12/PPSv2-English-Sample.pdf.

 © Victoria Hospice Society, 2006.

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Edmonton Symptom Assessment System (revised version) - ESAS-r - RNAO Appendix F

The revised Edmonton Symptom Assessment System (ESAS-r) is available in multiple languages and is designed to assist in the assessment of 10 common symptoms: pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, well-being and constipation. It conveys the individual’s description of the severity of a symptom based on a scale ranging from 0 to 10. 

Registered Nurses’ Association of Ontario. (2011). Appendix F of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp. 106-107. 

Pressure Ulcer Risk Scale – RNAO Appendix K (Risk Assessment)

This tool identifies seven areas related to PURS assessment. A high score indicates high risk for pressure ulcer.

Registered Nurses’ Association of Ontario. (2011) Appendix K of Risk assessment and prevention of pressure ulcers: Guideline Supplement. Toronto, Canada. P.40. Retrieved from:

http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
 

 

Checklist of Nonverbal Pain Indicators (CNPI)

The Checklist of Nonverbal Pain Indicators (CNPI), was designed to observe and measure pain behaviors in cognitively impaired elders.

Retrieved from: https://www.caltcm.org/assets/Pain-file/checklist%20nonverbal%20pain%20indicators.pdf

Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs. 2000 Mar;1(1):13-21. Horgas AL. Assessing pain in persons with dementia. In: Boltz M, series ed. Try This: Best Practices in Nursing Care for Hospitalized Older Adults with Dementia. 2003 Fall;1(2). The Hartford Institute for Geriatric Nursing. www.hartfordign.org

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Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)

PACSLAC is a tool to observe and assess both common and subtle pain behaviours. Copyright © Shannon Fuchs-Lacelle and Thomas Hadjistavropoulos. The PACSLAC may not be reproduced without permission. For permission to reproduce the PACSLAC, please contact the copyright holders (Thomas.Hadjistavropoulos@uregina.ca).

Retrieved from http://www.geriatricpain.org/content/Assessment/Impaired/Pages/default.aspx

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