Hospice
Proficiency Scale
1 =
No Experience
2 =
Need Training
3 =
Able to perform with supervision
4 =
Able to perform independently
| Work Settings | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Home Hospice | |||||
| Inpatient Hospice | |||||
| Pediatric Hospice | |||||
| Home Health/Hospice Setting |
| Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Intake Assessment | |||||
| Assessment Interview | |||||
| Physical Exam | |||||
| Coping Status | |||||
| Environmental Status |
| Plan of Care | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Set Goals with Pt/Family | |||||
| Collaborate with Other Team Members | |||||
| Ensure Continuity of Care |
| Symptom Management | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| 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 | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Identify Source of Painq | |||||
| 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 | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Positioning Techniques | |||||
| Bed/Support Surface Selection | |||||
| Pressure Ulcer Staging/Management | |||||
| Response to Treatment | |||||
| Evaluate Factors that Impede Healing | |||||
| Educate Family on Positioning/Shearing |
| Pediatrics | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Developmentally Appropriate Assessment | |||||
| Parental/Sibling Support | |||||
| Pediatric Support Team Collaboration |
| Medication Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Equianalgesic Conversion Formula | |||||
| Titration of Opioids | |||||
| IV Pump Management | |||||
| Evaluate Effectiveness of Medications | |||||
| Family Management of Medications | |||||
| Disposal of Medications |
| After Death | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Facility Family/Cultural Rituals/Rites | |||||
| Patient Care after Death | |||||
| Coordinate Mortuary Services | |||||
| Bereavement Services |
| Compliance | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| 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 | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| 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 | Rating Stars (Click) | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Epic | |||||
| Cerner | |||||
| Eclipsys | |||||
| Allscripts | |||||
| McKesson | |||||
| Meditech | |||||
| Other Computerized System | |||||
| Computerized Physician Order Entry | |||||
| Bar Coding for Medication Administration |