Center to Advance Palliative Care

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Clinical Tools

Consult Triggers
Palliative Care Eligibility Screening Tool
Palliative Care Pathway Screening Assessment
Pediatric Palliative Care Referral Criteria
Palliative Care Consult Screening Tool (Geisinger)
Pilot Universal Screening Tool (St John Providence)
Palliative Care Screening Tool (St. John Providence)
Palliative Care Screening Tool (Med Center Central Georgia)
Patient Assessment
Palliative Care Initial Consultation Template (Hospice of the Bluegrass)
Palliative Care Initial Consultation (Fairview)
Palliative Care Initial Consultation Template (Midwest Palliative and Hospice Care Center)
Social Work Consultation Note (Central Baptist)
Palliative Care Progess Note (Mt. Sinai)
Family Conference Progress Note for EMR (VA VISN 3)
Family Conference Progress Note (Froedert Hospital)
Family Conference Progress Note (Fairview)
Family Conference Progress Note (Central Baptist)
Palliative Care Progress Note (Midwest Palliative and Hospice Care Center)
Family Conference Log (VA Medical Center, Bronx, NY)
Psychosocial Spiritual Assessment (Mt. Carmel)
Psychospiritual Assessment
Spiritual Care Assessment
A Guide for Conducting an ICU Family Meeting
Get-to-Know-Me Poster
Pain Assessment in the Non-Verbal Patient
Palliative Care Consultation Template (NSLIJ)
Institutional (Local) Policies and Treatment Guidelines
Pain Assessment and Management
Pain Management - Clinician/Caregiver - Controlled Analgesia
Use of Analgesics: Selection, Route, PCA
Medication Guidelines
Palliative Algorithms
Guidelines for Nutrition and Environmental Services
Non-oral Hydration and Feeding in Advanced Dementia
Orders for Withdrawal of Life Support (Puget Sound VA)
Withdrawal of Life Support Orders
Withdrawal of Mechanical Ventilation Protocol (Froedert Hospital, Medical College of Wisconsin)
Futility Policy (2007 - Froedert Hospital, Medical College of Wisconsin)
Guidelines for Use of Pentobarbital for Total Sedation and Ventilator Withdrawal (Froedert Hospital, Medical College of Wisconsin)
Managing Conflict
NSLIJ Palliative Care Physician Order Set
DNR Orders
Tube Feeding in Catholic Health Care (2008)
UCSF Policy on End of Life Care
Advance Health Care Directive Flowcharts (Fairview)
SQ Opioid Infusion Policy (VCU)
SubQ Opioid Hospital Policy (Froedtert)
Templated Order Forms
Physician Orders for Life-Sustaining Treatment (POLST)
Care of the Imminently Dying Patient (UCSF)
Levels of End-of-Life Care (Baptist Hospital of Miami)
Documentation of Physician Examination: Withdrawal of Life Sustaining Procedures for Incapacitated Patients (Baptist Hospital of Miami)
Clarification of End of Life Care Orders Prior to Anesthesia, Surgical, or Other Procedures (Baptist Hospital of Miami)
Deactivation of Cardiac Device (Baptist Hospital of Miami)
Levels of End-of-Life Care Policy (Baptist Hospital of Miami)
National Treatment Guidelines
ACP Clinical Guidelines
ACC/AHA 2005 Guideline Update for CHF
A Review of Quality of Care Evaluation for the Palliation of Dyspnea
ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant
Pocket Clinical Cards/Guidelines
The Family Goal-Setting Conference (MCW)
The Family Goal-Setting Conference (Mount Sinai Medical Center)
Communication Phrases in Palliative Care (MCW)
V.A.L.U.E. Card - Mnemonic for Family Conferences
Pain Card (Mount Sinai Medical Center)
Pain Card (University of Alabama at Birmingham)