Palliative Care Assessment Checklist
Comprehensive palliative care assessment including symptom management, goals of care discussion, and psychosocial support.
- Industry: Healthcare
- Frequency: Initial/Ongoing
- Estimated Time: 30-45 minutes
- Role: Palliative Care Team
- Total Items: 30
- Compliance: NCP Clinical Practice Guidelines, Joint Commission Palliative Care, NHPCO Standards
Symptom Assessment
Physical symptoms
- Pain assessed and managed?
- Dyspnea assessed?
- Nausea/vomiting assessed?
- Fatigue assessed?
- Other symptoms addressed?
Goals of Care
Care planning
- Prognosis discussed?
- Patient/family goals explored?
- Treatment options reviewed?
- Advance directives discussed?
Psychosocial Support
Emotional and social needs
- Coping and adjustment assessed?
- Spiritual needs assessed?
- Family support assessed?
- Social work referral if needed?
Care Coordination
Interdisciplinary care
- Palliative care team communication?
- Primary team updated?
- Hospice discussed if appropriate?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Related Healthcare Checklists
- Physical Therapy Initial Evaluation Checklist
- Occupational Therapy Initial Evaluation Checklist
- Speech-Language Pathology Evaluation Checklist
- Social Work Assessment Checklist
- Contrast Media Administration Safety Checklist
- Hospital Safety Daily Leadership Rounds Checklist
- Nursing Sensitive Quality Indicator Data Collection Checklist
- Interpreter Services Documentation Checklist