Hospice Nursing Assessment Form Template
Streamline Patient Evaluation with Our Hospice Nursing Assessment
Managing end-of-life care can be overwhelming, especially when you're balancing multiple patient needs. This Hospice Nursing Assessment Form Template helps nurses systematically evaluate and document critical health information, ensuring patients receive tailored care. You'll benefit from easier charting, improved accuracy in patient assessments, and streamlined communication with the healthcare team, all while adhering to best practices for hospice documentation. Explore how this live template can simplify your workflow.
When to use this form
Use this assessment at admission, routine visits, recertification periods, and after any change in condition. It helps you capture pain, symptoms, medications, ADLs, safety risks, and caregiver capacity so you can update the plan of care and document decline. Nurses, medical directors, and families benefit through clearer goals, safer care at home, and faster decisions. When you need to confirm eligibility and craft the narrative, pair your findings with the Hospice certification of terminal illness form. If a patient is still on curative services or transitioning from home health, the Home health assessment form can complement your review and ease the handoff. The result is timely comfort measures and fewer avoidable crises.
Must Ask Hospice Nursing Assessment Questions
- What are the patient's goals and priorities for comfort and quality of life?
Clear goals align the plan of care with what matters most to the patient and family. This helps you choose interventions that reduce burden and avoid unwanted treatments.
- What is the current pain level, location, and pattern, and how well does the current regimen work?
Detail on intensity and timing guides safe titration and rescue dosing to prevent breakthrough pain. Tracking response shows trends and signals when to adjust the plan quickly.
- Which symptoms are present now (dyspnea, nausea, agitation, secretions), and what triggers or relieves them?
Knowing the biggest distress drivers helps you prioritize orders and non-drug measures. Trigger and relief patterns inform when to visit, teach, and adjust medications.
- What is the patient's functional status (ADLs, mobility, intake) and recent decline over days to weeks?
Functional change shows disease trajectory and supports the need for hospice-level services. It also guides equipment needs, fall prevention, and visit frequency.
- Who is the primary caregiver, their capacity and respite needs, and are there any home safety risks?
Caregiver readiness determines what support you must put in place for safe care at home. If help is needed, you can line up aides using the Home care aide registration form.
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