The Mississauga Halton Palliative Care Initiative
Problem Identification Tool
The Problem Identification Tool uses “triggers” to prompt the early identification of potential problems.
Who?
o
Used by the patient’s primary nurse (at a minimum)
o
Other members of the patient’s interprofessional team are encouraged to use the tool, as necessary or helpful
What?
o
Used primarily in the home setting, and other settings as applicable or helpful
o
Not meant to replace professional skills and expertise or routine documentation
How?
o
Reviewed by the patient’s primary nurse at every visit, after completing ESAS and PPS
o
When new issues or significant changes are identified, results to be documented in the tool itself (which becomes part of the
patient’s care record) and verbally transmitted to the patient’s CCAC Case Manager
o
Process for addressing identified problems should be based on professional judgement and aided by the reference tools below, as
necessary
Other Reference Tools
o
Palliative Care Collaborative Care Plans (CCO)
o
o
The Square of Care (CHPCA)
Nursing Standards of Practice (CHPCA)
o
o
Edmonton Symptom Assessment Scale (ESAS)
Palliative Performance Scale (PPS)
Version: August 3, 2010
Problem Identification Tool (* See Palliative Report)
Domains of Care
Potential Problems
Domains of Care Potential Problems
1. Disease
Management
a. Primary Diagnosis
5. Spiritual
a.
6. Practical
a. Safety issues (e.g. falls)
b. Co-morbidities
c.
2. Physical
Spiritual distress
New medical complications
a. Uncontrolled symptoms (ESAS)
b. Declining PPS
b. Mobility
c.
c.
Wounds
Transportation
d. Fluids & Nutrition Issues
e. Bladder and bowel
f.
Symptom Management Kit
(to be requested at certain PPS,
e.g. 40%)
3. Psychological
a. Depression/anxiety
7. End of Life
b. Behaviours
a. Need for end of life care plan (place of death, plan for
pronouncement and certification, funeral/rituals)
c.
b. Need for change in symptom management approach
Patient/family coping
d. Difficult emotions
4. Social
a. Care at odds with cultural values
8. Bereavement
c.
Patient / family not prepared for death
a.
Risk for complicated grief
b. Excess caregiver burden
c.
Conflict between family
members
d. Financial issues (e.g. insurance,
ODB, etc.)
e. Legal issues
f.
Guardianship/custody
g. Isolation
Version: August 3, 2010