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
Related Health Services Checklists
- Home Health Start of Care Assessment Checklist - FREE Download
- Psychiatric Assessment at Admission Checklist - FREE Download
- Physical Therapy Initial Evaluation Checklist - FREE Download
- Occupational Therapy Initial Evaluation Checklist - FREE Download
- Speech-Language Pathology Evaluation Checklist - FREE Download
- Social Work Assessment Checklist - FREE Download
- Dietary/Nutrition Screening Assessment Checklist - FREE Download
- Chaplain/Spiritual Care Assessment Checklist - FREE Download
Why Use This Palliative Care Assessment Checklist?
This palliative care assessment checklist helps healthcare teams maintain compliance and operational excellence. Designed for palliative care team professionals, this checklist covers 30 critical inspection points across 7 sections. Recommended frequency: initial/ongoing.
Ensures compliance with NCP Clinical Practice Guidelines, Joint Commission Palliative Care, NHPCO Standards. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Palliative Care Assessment Checklist cover?
This checklist covers 30 inspection items across 7 sections: Symptom Assessment, Goals of Care, Psychosocial Support, Care Coordination, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed initial/ongoing. Each completion takes approximately 30-45 minutes.
Who should use this Palliative Care Assessment Checklist?
This checklist is designed for Palliative Care Team professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.