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

All Clinical Resources

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  • 4AT Rapid Assessment Test for Delirium
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    The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally. It is free for download and use.

    Reference: MacLullich, A., Ryan, T. and Cash, H. (2014). 4AT Rapid Assessment Test for Delirium. Retrieved from http://www.the4at.com/

  • 5 Questions to Ask About Your Medications (for Adults)- Appendix K
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    5 Questions to Ask about Your Medications is a guide to help persons and their support network start conversations with health providers about their medications (168). Ensuring persons are active partners in their care, and ensuring they receive important information about their medications helps promote medication safety. It may be particularly helpful for persons to ask the following five questions about their medications when attending appointments with their primary care providers, communicating with their community pharmacist, and when preparing for a transition from hospital to home. The 5 Questions to Ask About Your Medications resource is available in 30 languages.

    Source: Reprinted with permission from: Institute for Safe Medication Practices (ISMP) Canada, The Canadian Patient Safety Institute (CPSI), Patients for Patient Safety Canada (PFPSC), et al. 5 questions to ask about your medications [Internet]. Toronto (ON): ISMP Canada; 2016. Co-published with CPSI and CFPSC. Available from: https://www.ismp-canada.org/download/MedRec/MedSafety_5_questions_to_ask_poster.pdf. 

    Registered Nurses' Association of Ontario. (2023). Appendix K of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 128 . 

  • Abbey Pain Scale
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    The Abbey Pain Scale is an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs, for example, patients with dementia, cognition or communication issues. The scale does not differentiate between distress and pain, so measuring the effectiveness of pain-relieving interventions is essential.

    Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002. This document may be reproduced with this acknowledgment retained.

    https://www.apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf

     

     

     

     

     

     

     

     

     

  • ABC (Antecedent, Behaviour, Consequences) Charting Template - RNAO Appendix L
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    This template is helpful in identifying and altering the antecedent and consequences to change behaviour.

    Registered Nurses’ Association of Ontario. (2012). Appendix L of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 113). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Source: Omelan, C. (2006). CME: Approach to Managing Behavioural Disturbances in Dementia. Canadian Family Physician, February, 52, p. 193 Reprinted with permission from the Canadian Family Physician

  • Algorithm for oral care - RNAO appendix F
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    An algorithm to guide oral assessment and intervention. The algorithm summarizes the recommendations to help oral care teams to understand how to implement them into practice.

    Registered Nurses’ Association of Ontario. (2020). Appendix F of Oral Health: Supporting Adults Who Require Assistance (2nd ed.). Toronto, Canada: Author.  (page 110). Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_Adults_Who_Require_Assistance_Second_Edition_final.pdf

     

  • Alternative to Restraints Decision (The Ottawa Hospital) - RNAO Appendix N
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    This decision tree from The Ottawa Hospital provides a visual decision making guide to determine risk and restraint alternatives.

    Registered Nurses’ Association of Ontario. (2012). Appendix N of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author. (page 116). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    All requests to adapt the Alternative to Restraints Decision Tree must be directed to the Ottawa Hospital, Department of Nursing Professional Practice

  • Approaches and Tools for Assessing Falls Risk - Summary of Findings – Appendix F
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    Appendix F - provides a summary of related approaches and tools for assessing fall risk. The tools are categorized as follows: gait and balance; general fall risk and fear of falls. It is important for the organization to review the findings to support selection of tools for settings and population(s) served noting that other tools are available that address specific risk factors.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix F of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.92-97)

     

  • Assessment and Screening Tools – RNAO Appendix G
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    An extensive list of validated assessment and screening tools. Tools not only assess for history of abuse but also assess for possibility of future abuse, and quality of care being given.

    Registered Nurses’ Association of Ontario. (2014). Appendix G of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. pp 105-110. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf

  • Attitudes, Skills, and Knowledge that are Beneficial for Communication in Dementia Care – RNAO
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    This table from Appendix K pages 152-153 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps us reflect on our own attitudes, skills and knowledge about dementia and provides tips for successful interpersonal skills with residents with dementia.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Bates-Jensen Wound Assessment Tool© (BWAT)
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    Bates-Jenson Wound Assessment Tool (BWAT) is a validated tool that measures the status of a wound. It is most appropriate for use by experienced wound-care clinicians as a discriminative tool to fully describe wounds during the initial wound assessment. 

    Retrieved from: https://www.woundscanada.ca/docman/public/health-care-professional/1428-bwat/file 

    Reference: Bates-Jensen, Barbara (2001). Bates-Jenson Wound Assessment Tool (BWAT). Copyright 2001 Barbara Bates-Jensen

  • Behaviour Monitoring Log, Penn Nursing Science - RNAO Appendix M
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    The Behaviour Monitoring Log from Penn Nursing Science helps determine the meaning of untoward events through examining patterns of behaviours/occurrences.

    Registered Nurses’ Association of Ontario. (2012). Appendix M of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 114-115). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Adapted from: Strumpf, N., Robinson, E.J.P., Wagner, J.S., & Evans L.K. (1998). Restraint-Free Care: Individual Approaches for Frail Elders. New York: Springer Publishing, pp. 44-46. Reprinted with permission from Penn Nursing Science.

  • Behavioural Supports Ontario - (DOS) Dementia Observation System©
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    The BSO-DOS© is an observational tool that helps to identify patterns of behaviour for care planning purposes. It is based on the former DOS. Simple registration is required to access this free tool. A user guide and resource manual are available.

    Behavioural Supports Ontario. (2019). Behavioural Supports Ontario - Dementia Observation System. Retrieved from https://brainxchange.ca/BSODOS

     

  • Behavioural Supports Ontario: Intervention Tool Kit - Central East LHIN
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    This intervention toolkit provides links to universally recognized behavioural assessment tools for common responsive behaviours. The toolkit describes possible behavioural causes and a range of strategies to help with care planning.

    Reference:Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee (n.d.) Central East LHIN Behavioural Supports Ontario Intervention Tool Kit, retrieved from http://centraleast.behaviouralsupportsontario.ca/Uploads/ContentDocuments/Intervention%20Tool%20Kit_Version%201_May_2016.pdf  

    Acknowledgements: This tool was created by the Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee. Acknowledgment to the Psychogeriatric Resource Consults of the Central East Region for developing this tool. Thank you to the Central East Long-Term Care Homes for contributing to the development of the tool.

    Disclaimer: Permission to use, copy, modify, and distribute this material for educational, research, and not-for-profit purposes, without fee and without a signed licensing agreement, is hereby granted, provided that the above copyright notice, this paragraph and the following paragraphs appear in all copies, modifications, and distributions. Contact Terry Donaghue, Technology Transfer & Industrial Liaison, Mount Sinai Hospital, & The Samuel Lunenfeld Research Institute, 600 University Avenue, Toronto, ON Canada M5G 1X5, Tel. (416) 586-8225, Fax (416) 586-3110, E-mail: donaghue@mshri.on.ca for commercial licensing opportunities.

  • Bereavement Risk Assessment Scale (BRAT)
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    The Bereavement Risk Assessment Tool, or BRAT, is a psychosocial assessment tool used by care teams to communicate personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement experience.

  • Best Possible Medication History Interview Guide- Appendix I
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    This interview guide from Alberta Health Services provides a list of questions health providers can ask when conducting a best possible medication history.

    Source: Reprinted with permission from: Alberta Health Services (AHS). Best possible medication history (BPMH) interview guide [Internet]. Edmonton (AB): AHS; 2014. Available from: https://www.albertahealthservices.ca/assets/info/hp/medrec/if-hp-medrec-provider-interview-brochure.pdf © 2014 Alberta Health Services. This material is protected by Canadian copyright law. Except as otherwise provided for under Canadian copyright law, this material may not be copied, published, or distributed without the prior written permission of the copyright owner. This material was originally published by Alberta Health Services and has been reprinted with permission.

    Registered Nurses' Association of Ontario. (2023). Appendix I of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 125.

  • Better oral health in residential care (staff education and training)
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    This oral health care planning guideline provides information on a standard protective care regimen, additional oral care treatment, oral care and changed behaviour and palliative care considerations. An Oral Health Care Plan guide is included.

    Government of South Australia. (2008). Better oral health care in residential: Oral health care planning guidelines. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/77fd7a004b3323958834ade79043faf0/BOHRC_Professional_Portfolio_Full_Version%5B1%5D.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-77fd7a004b3323958834ade79043faf0-nwm-H7C

    Source: Government of South Australia © 2012 SA Health

  • Bladder and Bowel Stroke Care Plans
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    This bladder and bowel care plan, developed by CorHealth is aimed at people with strokes, but is applicable to residents of long term care. It is one of a series of stroke care plans.

    Cor Health (2020) Bladder and Bowel Stroke Care Plans retrieved from Community Reengagement - CorHealth Ontario

  • Bowel and Bladder Continence Assessment
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    A comprehensive assessment of bladder and bowel function for LTC residents developed by the LTC BPC Project with Toronto Best Practice Steering Committee and Northwest Continence Collaborative (2005). Includes list of medications that affect continence and treatment options.

    Reference: Toronto Best Practice Committee and Northwest Continence Collaborative (2006). Bladder & Bowel Continence Assessment.. Toronto.

    Sources: AHCPR. 2006. Urinary Incontinence. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.10079. ; Brigham & Women’s Hospital. 2004, Urinary incontinence http://www.brighamandwomens.org/medical/HandbookArticles/Urinaryincontinence.pdf. ; The Hartford Institute for Geriatric Nursing. 2001. Urinary incontinence. http://www.hartfordign.org/publications/trythis/issue11.pdf. ; IC-5 Continence Project, 2005, http://www.hospitalreport.ca/projects/QI_projects/IC5.html.  Rehabilitation Nursing Foundation. 2002. Constipation. www.rehabnurse.org. ; RNAO. 2005, Preventing Constipation; Prompting Continence. http://www.rnao.org/bestpractices.  ; Royal Women’s Hospital. 2005. Urinary incontinence, http://www.rwh.org.au/rwhcpg/womenshealth.cfm?doc_id=3661.  ; Singapore Ministry of Health. 2003, http://www.moh.gov.sg/cmaweb/attachments/publication/Nursing_Management_of_Patients_with_Urinary_Incontinence_1-2003.pdf.  U.S. National Library of Medicine and U.S. National Institute of Health. 2006. Drugs, supplements. < http://www.nlm.nih.gov/medlineplus/druginformation.html 

  • Braden Risk Assessment Scale
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    The Braden Scale can be used to assess a resident’s level of risk for developing pressure injuries by evaluating six areas of risk: sensory perception, moisture, activity, mobility, nutrition, and friction or shear.

    Reference: Braden Scale (1988). Retrieved from http://www.education.woundcarestrategies.com/coloplast/resources/BradenScale.pdf

    © Copyright Barbara Braden and Nancy Bergstrom, 1988

  • Brief Pain Inventory (BPI)
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    Purpose of the BPI tool is to assess the severity of pain and the impact of pain on daily functions. The tool can be used for patients with pain from chronic diseases or conditions such as cancer, osteoarthritis and low back pain, or with pain from acute conditions such as postoperative pain.

    Assessment areas included are severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours or the past week.

    The BPI copyright is held by Dr Charles S. Cleeland (1991). The copyright applies to the BPI and all it's derivatives in any language.

    Retrieved from http://www.npcrc.org/files/news/briefpain_short.pdf 

  • Broset Violence Checklist Tool - RNAO Appendix G
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    This tool is used to assess the residents’ level of confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects- as present or absent.

    Registered Nurses’ Association of Ontario. (2012). Appendix G of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 99-100). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Source: Almvik, R. & Woods, P. (April 2003). Short-Term Risk Prediction. The Broset Violence Checklist. Journal of Psychiatric and Mental Health. Nursing, 10(2), pp. 236-238

    Reprinted with permission from John Wiley and Sons

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

  • Care Ontario Palliative Care Toolkit for Indigenous Communities
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    Guide and Algorithm to guide assessment and management of cancer related anxiety.

    Cancer Care Ontario. (2013). Palliative Care Toolkit for Indigenous Communities. Retrieved from https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/palliative-care/toolkit-aboriginal-communities

     

  • Checklist of Nonverbal Pain Indicators (CNPI)
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    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

  • Clinical Indicators of Decline – RNAO Appendix E
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    Diseases such as chronic obstructive pulmonary disease or congestive heart failure run a more fluctuating course and result in death in a less predictable timeframe than diseases such as renal disease or dementia. Each exacerbation can lead to remission (and future exacerbation) or death; knowing which will occur on any given admission is extremely challenging. General indicators of poorer prognosis (life expectancy of only weeks to many weeks) include poor performance status, impaired nutritional status and a low albumin level.

    Registered Nurses’ Association of Ontario. (2011). Appendix E of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp103-105 .

  • Comfort Plan Mental Health And Addiction Program - RNAO Appendix T
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    This tool helps the resident and caregiver discuss individualized behavioural triggers and preferred measures of response.

    Registered Nurses’ Association of Ontario. (2012). Appendix T of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 125). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Reprinted with permission from St. Joseph`s Health Care. Hamilton, Ontario

  • Communication During Patient Hand-Overs
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    This article looks at communication as being a key culprit in compromising patient safety in hand-over. Suggestions are given for strategies on how to approach hand-overs from shift to shift consistently, how to include patient and family along with potential barriers

    Reference: World Health Organization. (2007) Patient Safety Solutions. Communication during patient handovers. 1 (3). Retrieved from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/patient-safety-solutions/ps-solution3-communication-during-patient-handovers.pdf?sfvrsn=7a54c664_4&ua=1

  • Comparison of the Clinical Features of Delirium, Dementia, and Depression – RNAO Appendix D
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    This helpful table from Appendix D (page 127) of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps to distinguish among delirium, dementia and depression where features are often similar or overlapping.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Components and Example of Universal Falls Precautions – Appendix K
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    This table lists common components of universal falls precautions that health care organizations can determine which precautions are applicable to their setting.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix K of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.113)

     

  • Comprehensive Geriatric Assessment (CGA) Toolkit
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    The Comprehensive Geriatric Assessment (CGA) Toolkit is comprised of multiple resources for the personalized and person-centred care of the elderly. This link will take you to the page where you will find descriptions and possible signs and symptoms of the different types of abuse. A description and link for the Elder Assessment Instrument (EAI): Screening tool for elder mistreatment is provided, as are interventions that should be carried out based on the findings of the conducting clinician. Additional resources like hand-outs, videos and other tools are also available in the toolkit.

    Reference: https://www.cgakit.com/elder-abuse

     

  • Comprehensive pain assessment mnemonic (OPQRSTUV): Appendix C
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    This tool demonstrates how the mnemonic OPQRSTUV, can be used to conduct a comprehensive pain assessment. Note that this assessment may not be the most appropriate tool for all presentations of pain.

    Reference: Registered Nurses’ Association of Ontario. (2025). Appendix C of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author. pp. 81. 

    Source: Adapted from: Fraser Health. Hospice palliative care program: symptom guidelines [Internet]. Surrey (BC): Fraser Health; 2019. Available from: https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Hospice-palliative-care/SectionsPDFs-for-FH-Aug31/9524-01-05-FH---Sym_Guide-Intro-v05FINAL.pd

  • Coping Agreement Questionnaire (CAQ) - RNAO Appendix I
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    The 5 questions in this tool are used to assess care preferences of patients if they become upset or have difficulty dealing with emotions.

    Registered Nurses’ Association of Ontario. (2012). Appendix I of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 102-103). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Copyright NY State Psychiatric Institute, Reprinted with permission from David J. Hellerstein, MD.

  • Debriefing Form: Patient Debriefing Tool following Restraint/Seclusion - RNAO Appendix X
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    This debriefing tool provides examples of questions to ask the resident after they have been restrained or secluded.

    Registered Nurses’ Association of Ontario. (2012). Appendix X of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 139). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Used with permission: Stone Institute of Psychiatry, Northwestern Memorial Hospital Chicago, IL

  • Dehydration Risk Appraisal Checklist
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    A one time, single resident risk assessment for dehydration based of the University of Iowa Dehydration BPG.

    References:

    Mentes, J. C. & The Iowa Veterans Affairs Nursing Research Consortium. (2004). Evidence-Based Practice Guideline: Hydration management. Iowa City, IA: The University of Iowa Gerontological Nursing Interventions Research Center Research Translation and Dissemination Core.

    Mentes, J. C. & Iowa-Veterans Affairs Research Consortium. (2000). Hydration management. Journal of Gerontological Nursing, 6-15.

  • Delirium Risk Factors and Interventions – RNAO Appendix G
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    Appendix G from pages 133-134 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies risk factors and related interventions for delirium.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Domains of Issues Associated with Illness and Bereavement
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    The recommendations within this BPG focus on quality of life, emphasizing a holistic approach to care that incorporates the person’s individuality and preferences, and that recognizes the person and family as the unit of care. Figure 2 identifies complex issues persons and their families may face when receiving palliative care, which are categorized into eight equally important domains.

    https://bpgmobile.rnao.ca/sites/default/files/Figure%202%20Domains%20of%20Issues%20Associated%20with%20Illness%20and%20Bereavement.pdf 

     

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

  • Elder Abuse: Assessment and Intervention Reference Guide
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    NICE (National Initiative for the Care of the Elderly) provides information tools and online resources for older adults covering caregiving, elder abuse, legal and financial matters, end-of-life planning, and physical and mental health. 
    The following provides access to NICE's online library of resources and Information Tools addressing elder abuse issues specifically for seniors in Canada.

    Retrieved from: https://www.nicenet.ca/elder-abuse

  • Example classification system: Appendix H
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    This resource from the Nation Pressure Injury Advisory Panel (NPIAP), is an example of a validated classification system used to classify pressure injuries.

    Source: © National Pressure Injury Advisory Panel September 2016 Source: Reprinted with permission from the National Pressure Injury Advisory Panel (NPIAP). Pressure injury and stages [Internet]. Schaumburg (IL): NPIAP. 2016. Available from: https://cdn.ymaws.com/npiap.com/resource/resmgr/NPIAP-Staging-Poster.pdf 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix H of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 102.

  • Example of malnutrition screening tool: Appendix J
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    This resource from the Canadian Nutrition Society, is an example of a nutrition screening tool which can be used to identify those who may be at risk for malnutrition.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix J of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 104-105.

     

  • Example preventative care bundle: Appendix F
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    Appendix F is an example of a preventative care bundle which may be used to educate residents, family and caregivers. It features the SSKIN bundle (Skin inspection, Surface, Keep moving, Incontinence & moisture and Nutrition).

    Source: Reprinted with permission from: Wounds Canada. Pressure injury prevention: SSKIN bundle [Internet]. North York (ON): Wounds Canada; [date unknown]. Available from: https://www.woundscanada.ca/health-care-professional/education-health-care-professional/11-patient-caregiver/741-sskin-bundle

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix F of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 99.

  • Example wound care frameworks: Appendix E
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    This resource illustrates two examples of wound care frameworks: the wound bed preparation paradigm, reprinted with permission from Sibbald RG, Elliott JA, Persaud-Jaimangal R, et al. Wound Bed Preparation 2021. Adv Skin Wound Care. 2021 Apr 1;34(4):183–95.

    And, the wound prevention and management cycle, reprinted with permission from Orsted HL, Keast DH, Forest-Lalande L, et al. Best practice recommendations for the prevention and management of wounds. In: Foundations of Best Practice for Skin and Wound Management. A supplement of Wound Care Canada; 2017. 74 pp. Available from: https://www. woundscanada.ca/docman/public/health-care-professional/bpr-workshop/165-wc-bpr-prevention-and-management-of-wounds/file 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix D of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 97-98.

  • Exercise and Physical Training Interventions – Appendix H
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    Table 18 summarizes different approaches to exercise and physical training interventions with varying degrees of effectiveness.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix H of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.104-107.)

     

  • Experience of Being Restrained (SEBR) Interview Tool - RNAO Appendix E
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    This interview guide Subjective Experience of Being Restrained (SEBR) can be used with patients in hospital and then in nursing homes.

    Registered Nurses’ Association of Ontario. (2012). Appendix E of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 94-96). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Copyright 1986 University of Pennsylvania School of Nursing

    Website: www.nursing.upenn.edu/

  • Falls Debriefing and Action Plan – Example from St. Joseph’s Healthcare, Hamilton
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    Example of a form for documentation from St Joseph’s Healthcare Hamilton on falls debriefing and action plan.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix J: Example: Falls debriefing and action plan from St. Joseph's Healthcare Hamilton (Ontario, Canada) of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.111-112.)

     

  • Flow Chart for Delirium, Dementia, and Depression – RNAO
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    This flow chart from page 33 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) provides a concise and systematic overview of the best practice recommendations.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Flow Chart for Falls Prevention and Injury Reduction
    Show description [+]

    A flow chart that summarizes the steps, context, and considerations in falls prevention and injury reduction.

    Registered Nurses’ Association of Ontario.  (2017).  RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.24)
  • Frommelt Attitude Toward Care of the Dying Scale - RNAO Appendix G
    Show description [+]

    This scale's purpose is to determine how nurses feel about certain situations in which they are involved with patients. All statements concern nursing care given to the dying person and/or his/her family. Where there is a reference to a dying patient, assume it refers to a person who is considered to be terminally ill, with six months or fewer to live.

    Source: Folmelt, K. American Journal Hospice Palliative Care (Vol. 8, Issue 5) pp. 37-43 Copyright 1991 By Sage Publication

    Registered Nurses' Association of Ontario. (2011). Appendix G of End-of-Life Care During the last Days and Hours. Toronto, ON: Author pp. 108-109

    Retrieved from http://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf

  • Geriatric Depression Scale (GDS) Long Form
    Show description [+]

    The Geriatric Depression Scale, is a screening tool used to assessment depression in older adults. It is available in both long form and short form versions and also in multiple languages. The link below is for the long form.

    Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983; 17:37-49

    Retrieved from: https://integrationacademy.ahrq.gov/sites/default/files/2020-07/Update%20Geriatric%20Depression%20Scale-30.pdf

     

     

  • Geriatric Depression Scale (GDS) Short Form
    Show description [+]

    The Geriatric Depression Scale, is a screening tool used to assessment depression in older adults. It is available in both long form and short form versions and also in multiple languages. The link below is for the short form.

    Reference: Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983; 17:37-49.

    Retrieved from:  https://integrationacademy.ahrq.gov/sites/default/files/2020-07/Update_Geriatric_Depression_Scale-15.pdf

     

     

  • Historical-Clinical-Risk Management: 20 (HCR-20) - RNAO Appendix H
    Show description [+]

    This assessment tool is used primarily by mental health professionals to “estimate” a persons’ probability of violence.

    Registered Nurses’ Association of Ontario. (2012). Appendix H of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 101). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Reprinted with permission from Ronald Roesch, Professor, Director of Mental Health Law and Policy Institute, Simon Fraser University

    Website: http://kdouglas.wordpress.com/hcr-20/

  • Holistic management of wound-related pain: Appendix K
    Show description [+]

    A two-page summary of the European Wound Management Association (EWMA) guidance on holistic management of wound-related pain. It includes a decision-aid to guide holistic management of wound-related pain.
    Source: Reprinted with permission from: The European Wound Management Association. Holistic management of wound-related pain. J Wound Management. 2024; 24 (1 Sup 1). Available from: http://https://ewma.org/wp-content/uploads/2024/04/A4_Holistic-one-page_030424.pdf

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix K of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp 106-107.

     

     

  • Hospice Palliative Care and Medical Assistance in Dying (MAiD) in Canada
    Show description [+]

    This guide is intended to help health care/hospice palliative care professionals and volunteers to have a conversation with and/or respond to patients or their families around Medical Assistance in Dying (MAiD).

    Reference: Palliative Care and Medical Assistance in Dying (MAiD) in Canada (2017, June). Retrieved from https://www.chpca.ca/wp-content/uploads/2019/12/chpca-maid-booklet-eng-12page-final-web.pdf

  • How to perform an oral assessment in long-term care: The normal mouth: Part 1
    Show description [+]

    This 25-minute video demonstrates how to perform an oral assessment of the "normal mouth" on residents living in long-term care. It is part 1 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts). 

    Retrieved from: https://www.youtube.com/watch?v=sgFlgumtbJE&t=419s

    Registered Nurses' Association of Ontario, 2015

     

  • Incontinence - Associated Dermatitis Intervention Tool (IADIT)
    Show description [+]

    This IADIT tool is an excellent resource on skin care for incontinent people. It has clear pictures, definitions and short descriptions of skin changes and rashes.

    Copyright © 2008 Joan Junkin. All rights reserved. Please send request for permissions to IADIT@medbiopub.com.  

    1. Bliss DZ, Zehrer C, Savik K, et al. Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study. Ostomy Wound Manage. 2006;52:46–55.

    2. Institute for Healthcare Improvement. Prevent Pressure Ulcers: How-To Guide. May 2007. Available at: http://www.ihi.org/nr/rdonlyres/5ababb51-93b3-4d88-ae19- be88b7d96858/0/pressureulcerhowtoguide.doc  

    3. Gray M, Bliss DB, Ermer-Seltun J, et al. Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007;34:45-54.

    4. Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J Wound Ostomy Continence Nurs. 2007;34:260-269.

  • Inlow's 60 second diabetic foot screen: Appendix D
    Show description [+]

    This screening guide provides a systematic method that can be used by health providers for foot ulcer prevention and ongoing screening after an ulcer or complication occurs. 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix D of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 104-105.

  • Intentional Hourly Rounding – Example from Fraser Health, British Columbia, Canada
    Show description [+]

    Example signage of Intentional Hourly Rounding Poster from Fraser Health, British Columbia, Canada.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix K of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.115)

     

  • Interventions for Depression – RNAO Table 5
    Show description [+]

    This table from page 76-77 of the Delirium, Dementia, Depression in Older Adults: Assessment and Care BPG (2016) reviews interventions for depression, including psychotherapy, psychological/social and antidepressants.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Interventions for Falls Prevention and Injury Reduction – Appendix G
    Show description [+]

    Table-14, 15, 16 and 17 summarize evidence from the reviewed literature on specific fall prevention and injury reduction interventions. They are organized according to the benefit of the interventions. Health-care providers use clinical judgment to determine if interventions apply to their settings.

    • Table 14: interventions with strong evidence of benefit.
    • Table 15: interventions that have potential benefit.
    • Table 16: interventions with mixed findings.
    • Table 17: interventions with insufficient evidence of benefit.
    Registered Nurses’ Association of Ontario.  (2017).  Appendix G of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.98-103)

     

  • IWGDF risk stratification system: Appendix E
    Show description [+]

    The IWGDF risk stratification system allows health providers to establish foot screening and examination frequency based on resulting risk categories.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix E of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 106.

     

  • List of Risk Factors – Appendix E
    Show description [+]

    Tables 10, 11 and 12 list of risk factors that include fall risk factors, health conditions associated with increased risk of falls, and factors associated with increased risk of falls injury.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix E of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.88-91.)

     

  • Medication Resources – Appendix I
    Show description [+]

    Table 19 provides a list of medication resources for use in fall prevention and reduction of injury from falls.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix I of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.108.)

     

  • Mini-Cog™ - Instructions for Administration and Scoring
    Show description [+]

    The Mini-Cog is a brief screening instrument to determine memory recall and clock drawing ability. A positive screen would suggest more in-depth assessment for cognitive impairment. Mini-Cog instrument, instructions and scoring are provided.

    Reference: Borson, S. (n.d.). Mini-Co. Retrieved from https://mini-cog.com/

    Mini-Cog™ © S. Borson. All rights reserved. Reprinted with permission of the author solely for clinical and educational purposes. May not be modified or used for commercial, marketing, or research purposes without permission of the author (soob@uw.edu). v. 01.19.16

  • Montreal Cognitive Assessment (MoCA)©
    Show description [+]

    A useful tool for assessing early stage dementia.  For more information or feedback on MoCA© contact Dr Z. Nasreddine at info@mocatest.org.

    Nasreddine, Z.  (2003). Welcome to the Montreal Cognitive Assessment.   Quebec, QC, Canada: Center for Diagnosis & Research on Alzheimer’s disease.  Retrieved from www.mocatest.org.  Copyright Dr Z. Nasreddine 2003 to 2013 - The Montreal Cognitive Assessment - MoCA© - All rights reserved.

  • Mutual Action Plan (MAP) Behaviour Profile - RNAO Appendix O
    Show description [+]

    The Mutual Action Plan (MAP) takes into account the resident's individual style of learning and communicating.

    Registered Nurses’ Association of Ontario. (2012). Appendix O of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 117-118). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    MAP Behavioural Profile - Draft 2009/11/18 adapted from: Safe Management Group Inc. 2008. Copyright 2009, Ontario Shores Centre for Mental Health Sciences. All rights reserved.

    Reproduction in whole or in part by any means without written consent of Ontario Shores is prohibited by law.

  • My Transitional Care Plan©- Appendix H
    Show description [+]

    My Transitional Care Plan© summarizes information to facilitate successful transitions in care for older adults presenting with, or at risk of, responsive behaviours or complex mental health, substance use or neurological conditions (166). It provides a synopsis of essential information that should be communicated to members of the interprofessional team to prepare and facilitate a transition in care. The tool is written in first person to promote person-centred care, and health and social service providers should collaborate with persons and their support network when completing the form. My Transitional Care Plan© can be built within an electronic health record. The form is also available in French (166).

    Registered Nurses' Association of Ontario. (2023). Appendix H of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp 123-124

    https://ltctoolkit.rnao.ca/sites/default/files/resources/My%20Transitional%20Care%20Plan%C2%A9-Appendix%20H.pdf

    Source: Reprinted with permission from: Behavioural Supports Ontario (BSO). 

  • Non-pharmacological Approaches to Management of the Behavioural and Psychological Symptoms of
    Show description [+]

    This Table from page 61 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) describes non- pharmacological approaches to use to minimize behavioural and psychological symptoms of dementia.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Numeric Pain Scale (NRS)
    Show description [+]

    A pain rating scale used to determine a persons level of pain.

    • Scored 0-10 with the anchors of 0 being ‘no pain’ and 10 being ‘pain as bad as it can be’ Used in adults, older adults, and adolescents and children over age 8.
    • Well established evidence of reliability, validity, and ability to detect change
    • No equipment is needed to administer this measure
    • High feasibility (quick and easy to use)

    Reference: McCaffery, M., Beebe, A., et al. (1989). Pain: Clinical manual for nursing practice, Mosby St. Louis, MO

  • Observation and Documentation Record: 12-hour Emergency Use of Chemical Restraint, Seclusion &
    Show description [+]

    This observation and documentation record is when chemical restraints, seclusion and/or mechanical restraint are used.

    Registered Nurses’ Association of Ontario. (2012). Appendix W of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 131-138). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Copyright Centre for Addiction and Mental Health (2009). This material is prepared solely for internal use at CAMH. No part of this document may be reproduced in any form for publication without the permission of CAMH

  • Opioid Manager
    Show description [+]

    The Opiod Manager condenses key elements from the Canadian Opiate Guideline into a workable format for prescribing opiates for persons with chronic, non-cancer pain.

    Reference: National Opiod Use Guidelines Group (2010), Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Practice Toolkit, Opioid Manager. Retrieved from http://nationalpaincentre.mcmaster.ca/opioidmanager/

    © 2016 McMaster University

  • Oral care auditing tool - RNAO
    Show description [+]

    This is a comprehensive collection of audits to review oral care in long term care. It contains instructions and audits on: dental equipment; Denture and denture supplies; Oral care supplies in residents’ care caddie; Oral care practices; POC/Flowsheet; Actual Resident Assessment of oral care; Admission Process; Levels of assistance and behaviours; Annual Assessment; Quarterly Assessment; Annual evaluation of oral care education; and Resident and Family Information.

    MacDonald, I. (2016). Oral Care Auditing Tool. Toronto, ON: Registered Nurses Association of Ontario - Oral Care Community of Practice 2015-16.

     

  • Oral care community of practice data collection tools (RNAO)
    Show description [+]

    This booklet is a group of tools that long term care or other health care organizations can use to collect baseline data on the status of oral care. Tools included are: RAI-MDS indicators; audits for oral supplies and care on charts; and an oral health knowledge survey.

    MacDonald, I. (2015). Oral care community of practice data collection tools. Toronto, ON: Registered Nurses Association of Ontario.

     

  • Ostomy Documentation Tips – Wound Care Advisor
    Show description [+]

    This article on the Wound Care Advisor website provides clear and concise instructions for documenting the condition of ostomies. It reviews what to assess in an ostomy: general characteristics; stoma; effluent; peristomal skin; appliance and accessories; etc.

    Reference: Wound Care Advisor. 2016. Ostomy-Documentation-Tips. Accessed Aug. 22, 2017 at https://woundcareadvisor.com/ostomy-documentation-tips/

    Copyright: Information in Apple Bites is courtesy of the Wound Care Education Institute (WCEI), © 2016. Apple Bites, Ostomy2016 Journal Vol5 No6, clinical journal, ostomy, tips, wound infections

  • Overactive Bladder Medication
    Show description [+]

    This resource from the Canadian Continence Foundation provides a list of some medications used for overactive bladder treatment.

    Retrieved from: https://static1.squarespace.com/static/65a5be5a40b6451450a341e1/t/66576f2b08d96963095e44db/1717006123689/OABEn-2016.pdf

     

  • Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)
    Show description [+]

    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: https://gerocentral.org/wp-content/uploads/2013/12/Pain-Assessment-Checklist-for-Seniors-with-Limited-Ability-to-Communicate-PASLAC.pdf

  • Pain Assessment in Advanced Dementia (PAINAD) Scale
    Show description [+]

    This resource from Interior Health, is a pain assessment tool useful for scoring pain levels of people with dementia who are unable to verbally express their pain. It focuses on assessing behaviours and provides a score rating of mild, moderate or severe pain levels.

    Retrieved from: https://www.interiorhealth.ca/sites/default/files/PDFS/810310-pain-assessment-advance-dementia-scale.pdf

    Warden, V., Hurley, A. & Volicer. L. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. JAMDA, 4(1), 9 -15. Horgas, A., & Miller, L. (2008). Pain assessment in people with dementia. American Journal of Nursing, 108(7), 62-70.

     

  • Palliative Performance Scale (PPS), Version 2 - RNAO Appendix D
    Show description [+]

    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.

  • Palliative Prognostic Index (PPI) - RNAO Appendix D
    Show description [+]

    PPI relies on the assessment of performance status using PPS, oral intake, and the presence or absence of dyspnea, edema or delirium.

    Registered Nurses’ Association of Ontario. (2011). Appendix D of End-of-Life Care During the Last Days and Hours.  Toronto, Canada: Author. p 101.  Copyright (2008), with permission from Elsevier.

  • Palliative Prognostic Score (PaP) - RNAO Appendix D
    Show description [+]

    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

     

  • Part 2 - Oral Assessment in LTC: Unhealthy changes and common abnormalities
    Show description [+]

    This 25-minute video shows a range of unhealthy changes and common abnormalities that can be found during oral assessments of residents living in long term care homes. How to do an oral assessment is reviewed. It is Part 2 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts).

    MacDonald, I. & Peachman-Faust, T. (2015). Part 2 - Oral assessment in LTC: Unhealthy changes and common abnormalities. [Video file]. Retrieved from  https://www.youtube.com/watch?v=fsQF-ElrwZk

     

  • Part 3 - Best practices for oral care interventions in LTC
    Show description [+]

    This 30-minute video demonstrates how to brush another persons teeth and describes interventions for various oral care problems found in residents in long term care. It is Part 3 of the RNAO Long-Term Care Best Practices Program - Oral Assessment Series (3 parts).

    MacDonald, I. & Peachman-Faust, T. (2016). Part 3 - Best practices for oral care interventions in long term care. [Video file]. Retrieved from https://www.youtube.com/watch?v=fp5oXYNHQp4

     

  • Personal De-escalation Plan (The Massachusetts Department of Mental Health) - RNAO Appendix R
    Show description [+]

    This individualized de-escalation plan considers cause and effect and solutions focused on the resident’s strengths.

    Registered Nurses’ Association of Ontario. (2012). Appendix R of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 122-123). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Reprinted with permission from The Massachusetts Department of Mental Health

     

  • Photographic Wound Assessment Tool (PWAT) – Revised
    Show description [+]

    The Photographic Wound Assessment Tool© (PWAT) Revised is a valid and reliable tool for assessing wound status over time, recognizing that standardized equipment and a consistent technique should be used with serial wound photography.

    Reference: Hodgkinson, Bowles H, Gordey L, Parslow N, and Houghton P. 2010. Photographic Wound Assessment Tool (PWAT) Revised. http://www.southwesthealthline.ca/healthlibrary_docs/B.9.3b.PWATInstruc.pdf

  • Post-Fall Assessment Resources and Example – Appendix J
    Show description [+]

    Table 20 is a description of resources available to support post fall assessments.

    Registered Nurses’ Association of Ontario.  (2017).  Appendix J of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. (p.109-110)

     

  • Pressure injuries in people with dark skin tones: Appendix I
    Show description [+]

    Pan Pacific Pressure Injury Alliance outlines some considerations for risk assessment and treatment of pressure injuries in people with dark skin tones. Additionally, it includes classification based on the NPIAP/EUPAP classification system with examples of each stage in people with dark skin tones.

    Source: Reprinted with permission from: Pan Pacific Pressure Injury Alliance (PPPIA). Pressure ulcers in people with dark skin tones: PPPIA; 2014. Available from: https://talleygroup.com/medias/documents/PPPIA-Pressure-Ulcers-in-People-with-Dark-Skin-Tones-PosterA3L-01604484440.pdf   Reference:

    Registered Nurses’ Association of Ontario, (2024). Appendix I of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 103.

     

     

  • Pressure Injury Staging Illustrations - NPUAP
    Show description [+]

    This webpage provides links to illustrations for each of the new pressure injury stages.

    Copyright: These illustrations can be downloaded by clicking on the links below directly to your computer at no cost, if for educational purposes. There is no cost to use these illustrations; however donations to support the work of NPUAP are graciously accepted. For profit uses of the drawings are subject to a charge, please contact Jen Bank for more information. **Use of drawings is permitted for educational purposes only.

    Reference: National pressure ulcer advisory panel (n.d.). Pressure Injury Staging Illustrations. Retrieved from http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/

  • Pressure Ulcer Scale for Healing (PUSH Tool)
    Show description [+]

    Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a valid and reliable tool to assess the change in status of pressure ulcers over time.

    The link takes you to the NPUAP website where you will find the tools and information on use and copyright.

    • PUSH Tool (web version)
    • PUSH Tool (PDF version)
    • Reprint Agreement (PDF)
    • Information and Resgistration Form
    • Instructions for Using PUSH
    • Copyright Policy and Contract

    Reference: National Pressure Ulcer Advisory Committee (1998). Accessed Sept. 14, 2016. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/push-tool/

  • RAI-MDS© and P.I.E.C.E.S.™ Integration Job Aid
    Show description [+]

    The provincial RAI-MDS© and P.I.E.C.E.S.™ Integration Working Group have developed a Job Aid that allows for the streamlining of the RAI assessment and the P.I.E.C.E.S. 3-Question Assessment and Care Planning Framework.

    Retrieved from: http://piecescanada.com/index.php?option=com_content&view=article&id=27&Itemid=30

  • Risk assessment tools: Appendix G
    Show description [+]

    Examples of 4 pressure injury risk assessment tools, however this list is not an exhaustive. These tools were identified, by the expert panel and external reviewers or through the systematic review process. The most common, valid, and reliable wound assessment tools for use in adults are the following (not in order of importance):

    Braden scale; Norton scale; interRAI Pressure Ulcer Risk Scale (PURS) and the Waterlow scale.

    Source: Table adapted from Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline 2019. interRAI PURS Pressure Ulcer Risk Scale (PURS) from Canadian Institute for Health Information. interRAI Home Care (HC) Outcome Scales [job aid]. Ottawa, ON: CIHI; 2024

    Reference: Registered Nurses’ Association of Ontario, (2024). Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 100-101.

  • Risk Factors and Signs of Depression – RNAO Table 4
    Show description [+]

    This table from page 71 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) looks at predisposing and precipitating risk factors as well as signs of depression.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Safety Plan Interventions - RNAO Appendix P
    Show description [+]

    This document outlines interventions that can be used with residents exhibiting signs of aggression, disorientation, frequent falls and or inappropriate behaviours.

    Registered Nurses’ Association of Ontario. (2012). Appendix P of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 119-120). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Used with permission from Caressant Care

  • Safety Plan Women’s Program Centre for Addiction and Mental Health (CAMH) - RNAO Appendix S
    Show description [+]

    This tool helps the resident identify their responses to stress and their individualized coping strategies.

    Registered Nurses’ Association of Ontario. (2012). Appendix S of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 124). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Copyright Centre for Addiction and Mental Health (2008). Reprinted with permission from CAMH

  • Sample oral care plans - RNAO Appendix K
    Show description [+]

    This document provides two examples of oral care plans for long-term care. 

    Registered Nurses’ Association of Ontario. (2020). Appendix K of Oral Health: Supporting Adults Who Require Assistance (2nd ed.). Toronto, Canada: Author.  (pages 120-121). Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_Adults_Who_Require_Assistance_Second_Edition_final.pdf

     

  • SBORS, Observation Reporting Tool for Skin and Wound Care
    Show description [+]

    SBORS Observation Reporting Tool for Skin and Wound Care can be used by personal support workers (PSW) to document the: situation, background, observation and recommendation/suggestion.

     

    Adapted from Waterloo Wellington HPC Consultation Services (2017). SBORS. Palliative Care Canada ECHO Project. (2022) SBORS. Personal Support Worker Community of Practice Series. Barbara Braden and Nancy Bergstrom. (1988) Braden Scale

     

  • Self-screening tool example: Appendix F
    Show description [+]

    This self-screening tool provides a systematic method for foot ulcer prevention and ongoing screening, which can be used by individuals and care partners.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix F of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 107-112.

  • Short-Term Assessment of Risk and Treatability Tool (START) - RNAO Appendix F
    Show description [+]

    This tool evaluates the client risk and treatability related (i.e. violence, self-harm, suicide, absconding, substance use, self-neglect, and victimization).

    Registered Nurses’ Association of Ontario. (2012). Appendix F of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 97-98). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Reprinted with permission from British Columbia Mental Health & Addiction Services

  • Siderail and Alternative Equipment Intervention Decision Tree - RNAO Appendix Q
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    This decision tree can be used to this determine if a siderail is a restraint or if alternatives are available.

    Registered Nurses’ Association of Ontario. (2012). Appendix Q of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 121). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Source: Talerico, K. & Capezuti, E. Myths and Facts About Side Rails: Despite Ongoing Debates About Safety and Efficacy, Side Rails Are Still a Standards Component of Care in Many Hospitals. So How Do You Determine Their Safe Use? AJN: American Journal of Nursing, Volume 101, Issue 7, pp. 43-48. Reprinted with permission from Wolters Kluwer Health

  • SIGECAPS
    Show description [+]

    SIGECAPS is a mnemonic used to recall the most frequent symptoms of depression (prescription for energy capsules).

    Reference: adapted from "The patient who is depressed" in Psychiatry in Primary Care by Raymond W. Lam, (CAMH, 2019).

     

     

     

  • Signs and Symptoms of Dehydration Checklist
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    A one-time, single resident assessment for 30 signs and symptoms of dehydration.

    Author and Date unknown

  • SPIKES: A Six-step Strategy for Delivering Bad News
    Show description [+]

    To facilitate sharing information about prognosis with the patient during end-of-life care discussions, clinicians can use the "SPIKES" process (Setting up, Perception, Invitation, Knowledge, Emotions, and Strategy and Summary).

    Registered Nurses’ Association of Ontario. (2011). SPIKES: A Six Step Strategy for Delivering Bad News (Baile et al., 2000, p. 305-307) of End-of-Life Care During the Last Days and Hours.Toronto, Canada: Author. p 30.

  • Spiritual Assessment Tool - Faith, Importance, Community, Address (FICA)
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    This tool is utilized when exploring the spiritual aspects of end-of-life.  ©1999 Christina Puchalski, M.D.

    Retrieved from  The George Washington Institute for Spirituality & Health https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool 

  • Stoma Problems
    Show description [+]

    This information from the Colostomy Association in Britain provides practical suggestions for the most common stoma problems such as Ballooning; Constipation/Diarrhoea; Odour; Pancaking; etc.

    Web Address: Colostomy Association. 2017. Stoma Problems. Accessed Aug. 22, 2017 at: http://www.colostomyassociation.org.uk/index.php?p=201&pp=3&page=Problematic%20Stomas

    Reference: Colostomy Association. 2017. Stoma Problems. Accessed Aug. 22, 2017 at:  http://www.colostomyuk.org/information/stoma-problems/ 

  • Suggested Topics for Educational Programs for Nurses and Other Health-Care Providers – RNAO
    Show description [+]

    This table from pages 83-84 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) informs nurse educators of relevant content for designing education sessions for those caring for clients with delirium, dementia and depression.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Suicide Assessment and Prevention for Older Adults
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    This clinician pocket-card provides suicide information and is based on the Canadian Coalition for Seniors Mental Health national guideline: The Assessment of Suicide Risk and Prevention of Suicide

    Reference: Canadian Coalition for Seniors Mental Health (2000). National Guidelines for Seniors Mental Health- The Assessment of Suicide Risk and Prevention of Suicide Brochure. Retrieved from http://ccsmh.ca/wp-content/uploads/2016/03/CCSMH_suicideBrochure.pdf  

  • Suicide Assessment and Prevention for Older Adults - CCSMH
    Show description [+]

    This clinician pocket card supports assessment resources for the assessment and prevention of suicide in older adults. The Geriatric Suicide Ideation Scale and the Harmful Behaviours Scale mentioned on the clinician pocket-card can be used by health care providers with appropriate training.

    Reference: Canadian Association of Mental Health (CAMH) Clinician Pocket Care Suicide Assessment and Prevention for Older Adults (2015). Retrieved from http://ccsmh.ca/wp-content/uploads/2016/03/CCSMH_suicideBrochure.pdf 

  • Suicide Prevention and Assessment Handbook - CAMH
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    The CAMH Suicide Prevention and Assessment Handbook is a quick, comprehensive and interactive starting point for staff across all clinical programs on the subject of suicide assessment and management. It provides key clinical information, current CAMH tools and resources, and further population-specific resources.

    Reference: Canadian Association of Mental Health (CAMH). (2015). Retrieved from https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/suicide/Documents/sp_handbook_final_feb_2011.pdf 

  • Supportive and Palliative Care Indicator Tool
    Show description [+]

    Supportive and Palliative Care Indicator Tool SPICT™ helps clinicians identify people with one or more general indicators of poor or deteriorating health and clinical signs of life-limiting conditions for assessment and care planning.
    A single page tool that includes general (i.e. weight loss, hospital admissions, etc.) and broad specific disease indicators (i.e. breathlessness at rest for heart and respiratory disease). Also includes an assessment paradigm.

  • Symptom Management Algorithm- Pain in Adults with Cancer
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    Symptom Management Algorithm for pain in adults with cancer developed by Cancer Care Ontario.

    Cancer Care Ontario (2018) Symptom Management Algorithm- Pain in Adults with Cancer retrieved from https://www.cancercareontario.ca/en/symptom-management

  • The Confusion Assessment Method (CAM)
    Show description [+]

    The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment.

    https://geriatrictoolkit.missouri.edu/cog/Confusion-Assessment-Method-delirium.pdf

    The Hartford Institute for Geriatric Nursing, 2019. Donna McCabe, DNP, APRN-BC, GNP

    © 2003 Sharon K. Inouye, MD, MPH Inouye, S., van Dyck, C., Alessi, C., Balkin, S., Siegal, A. & Horwitz, R. (1990).

  • Tools to Support Early Identification for Palliative Care
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    Tools to Support Early Identification for Palliative Care. The aim of this document is to support providers and system level leadership in earlier identification of patients who would benefit from palliative care.

    Retrieved from: https://www.ontariohealth.ca/sites/ontariohealth/files/palliative-tools-support-earlier-identification.pdf

  • Transdisciplinary Patient/Client Continence Assessment Tool - RNAO
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    A detailed, 8 page assessment of urinary and bowel continence issues that can be completed by a staff. Treatment options are suggested and a client record sheet is included.

    Reference: Registered Nurses’ Association of Ontario (2006). Transdisciplinary Patient/Client Continence Assessment Tool. Toronto, Canada: Registered Nurses’ Association of Ontario. Retrieved from: http://ltctoolkit.rnao.ca/sites/default/files/resources/continence/Continence_AssessmentTools/RNAO_TransdisciplinaryPatientClient_Continence.pdf

  • Types of Dementia – RNAO Appendix E
    Show description [+]

    Appendix E pages 128-130 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies the major types of dementia and a description of each.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

  • Urinary Tract Infections and Dementia
    Show description [+]

    This resource highlights a treatment plan for an elderly person with a diagnosis of memory impairment who develops a urinary tract infection that results in delirium. 

    © 2022 Alzheimer's Society.

  • UTI Program (PHO) - Assessment Algorithm for UTIs in Medically Stable Non-catheterized
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    This is a one-page algorithm that is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It clearly describes signs and symptoms of UTI’s and promotes ‘watchful waiting’ as an acceptable alternative before treating probable UTI’s. Is suitable for posting on a bulletin board.

    Reference: Public Health Ontario (PHO). 2019. Assessment algorithm for urinary tract infections (UTIs) in medically stable non-catheterized residents. Accessed Mar. 13, 2019. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Assessment_Algorithm.pdf

    © 2019 Ontario Agency for Health Protection and Promotion

  • UTI Program (PHO) - Asymptomatic Bacteriuria Fact Sheet
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    This PHO resource provides basic facts about asymptomatic bacteriuria

    Reference: Public Health Ontario, 2014, Asymptomatic Bacteriuria Fact Sheet. Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx

  • UTI Program (PHO) - Frequently Asked Questions for Residents and Families
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    This resource can be used by health care providers at the long-term care homes (LTCHs) when consulting or meeting with friends and families of residents who have questions about a LTCH’s approach to managing suspected UTIs.

    Reference: Public Health Ontario (PHO). Revised 2016. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-faq-residents-families.pdf?sc_lang=en