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Hospice

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Work Settings

Home Hospice *

Inpatient Hospice *

Pediatric Hospice *

Home Health/Hospice Setting *

Assessment

Intake Assessment *

Assessment Interview *

Physical Exam *

Coping Status *

Environmental Status *

Plan of Care

Set Goals with Pt/Family *

Collaborate with Other Team Members *

Ensure Continuity of Care *

Symptom Management

Urgent Assessment of Symptoms *

Reduce Symptoms to Level Acceptable to Pt. *

Report Symptoms/Management to Provider *

Treat Underlying Cause *

Severity Scale *

Management of Nausea *

Management of Constipation *

Management of Fatigue *

Anorexia/Cachexia *

Restlessness *

Educate Family on Symptom Management *

Pain Management

Identify Source of Pain *

Pain Severity *

PAINAD Scale for Non Verbal Patient *

Reduce Pain to Level Acceptable to Patient *

WHO 3 Step Ladder *

Non-Pharmacologic Management of Pain *

Pharmacologic Management of Pain *

Effects of Pharmacologic Treatment *

Nociceptive/Neuropathic/Mixed Pain *

Management of Nociceptive Pain *

Management of Neuropathic Pain *

Educate Family on Pain Management *

Wound Care

Positioning Techniques *

Bed/Support Surface Selection *

Pressure Ulcer Staging/Management *

Response to Treatment *

Evaluate Factors that Impede Healing *

Educate Family on Positioning/Shearing *

Pediatrics

Developmentally Appropriate Assessment *

Parental/Sibling Support *

Pediatric Support Team Collaboration *

Medication Administration

Equianalgesic Conversion Formula *

Titration of Opioids *

IV Pump Management *

Evaluate Effectiveness of Medications *

Family Management of Medications *

Disposal of Medications *

After Death

Facility Family/Cultural Rituals/Rites *

Patient Care after Death *

Coordinate Mortuary Services *

Bereavement Services *

Compliance

Scope and Frequency of Services *

Medicare/State Regulations for Hospice *

Document Progression of Decline *

DME Authorization & Documentation of Need/Order *

OASIS-C *

Professional Knowledge and Skills

Identify Source of Suffering *

Palliative Care Philosophy *

Patient/Family Directs Goals of Care *

Maximize Quality of Life *

Cultural Diversity *

Supervision of Ancillary Staff *

National Patient Safety Goals/Core Measures *

Fall Risk Assessment/Prevention *

Infection Prevention *

Isolation Precautions *

Interpretation and Communication of Lab Values *

EMR

Epic *

Cerner *

Eclipsys *

Allscripts *

McKesson *

Meditech *

Other Computerized System *

Computerized Physician Order Entry *

Bar Coding for Medication Administration *

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