A Common Set of ELDAC Clinical Tools

A blog post written by Paul Tait, Content Editor, ELDAC Project

Older Australians often experience complicated changes to their health, particularly as they approach the last 12 months of life. This frequently requires care to be provided across different healthcare settings and involve healthcare professionals from a variety of disciplines. Documenting clinical care in a standardised way ensures:

• A benchmark to which progress can be accurately monitored; and
• Good communication between healthcare providers.

Clinical tools assist in reliable assessment and interpretation of clinical information, supporting the decision-making process. Do this well and the next steps become clearer – be it a case conference, a prescription or a referral.

Within the End of Life Directions for Aged Care (ELDAC) project, three clinical toolkits - Home Care, Primary Care and Residential Aged Care – guide how healthcare professionals support the clinical care of older Australians living with a life-limiting illness, as well as their caregivers. Within each toolkit, links to a large number of clinical tools are embedded.

Ensuring consistency across the ELDAC project, the toolkit developers have identified twelve clinical tools (see Table 1) which are common to most. Consistency in the use of clinical tools across settings, as recommended by ELDAC, decreases complexity and variation for community-based health and aged care teams, regardless of where they are delivering care.

Clinical tools were included within this list, using the following criteria:

• Ability to be applied in the Australian context;
• Designed and validated for use with older people;
• Useful clinically;
• Avoiding tools requiring a paid subscription – noting that some clinical tools will require a one-off free registration;
• Intuitive to use by the relevant care providers across the aged care sector;
• Recommended by a peak body (for example, included within a health pathway); and
• Current.

It is likely that some organisations or providers may already recommend a standard a range of clinical tools. Where this is the case, the ELDAC common clinical tools should be seen as complementing these tools.

For more information about the common clinical tools, visit the ELDAC website, download the printable A4 factsheet, or give the ELDAC helpline a call.

Table 1. ELDAC Common Clinical Tools

ELDAC Domain		ELDAC Common Clinical Tool	Explanation	ELDAC Toolkit
				Home Care Toolkit	Primary Care Toolkit	Residential Aged Care Toolkit
Recognise End Of Life		1. Supportive and Palliative Care Indicator Tool (SPICT) *Requires free registration for access	Identify a person whose health is deteriorating for palliative care assessment and care planning.
Assess Palliative Care Needs	Physical Needs	2. Symptom Assessment Scale (SAS) (169kb docx)	Measure severity of distress of the following symptoms: (1) Difficulty sleeping; (2) Appetite problems; (3) Nausea; (4) Bowel problems; (5) Breathing problems; (6) Fatigue; and (7) Pain.
		3. Modified Borg Scale (mBORG) (181kb pdf)	Assess difficulty of breathing in a person able to communicate verbally or point.
		4. Mini-Nutritional Assessment Short-Form (MNA®-SF)(68kb pdf)	Identify an older person who is malnourished or at risk of malnutrition.
		5. Modified Resident's Verbal Brief Pain Inventory (M-RVBPI) (112kb pdf)	Assess pain multidimensionally in a person able to communicate. This can be undertaken weekly or at longer intervals.
		6. Numerical Rating Scale for pain (NRS) (47kb pdf)	Assess pain intensity in a person able to communicate verbally or point.
		7. Abbey Pain Scale (38kb pdf)	Measure pain in a person with dementia who cannot communicate verbally.
		8. Verbal Descriptor Scale (Pain Thermometer) (30kb pdf)	Assess pain intensity in a person able to communicate verbally or point, including a person with moderate to severe cognitive impairment.
	Psychosocial Needs	9. Confusion Assessment Method (CAM) - Shortened version (142kb pdf)	Identify a person with delirium.
		10. Kessler Psychological Distress Scale (K10) (64kb pdf)	Measure psychological distress.			Use Cornell Scale for Depression
		11. Cornell Scale for Depression (CSD) – available in the ACFI Assessment Pack (CSD pages 10-13 and pages 27-40; 829kb pdf).	Assess depression in a person with or without cognitive impairment.	Use K10	Use K10
	Caregiver Needs	12. NAT-CC – Needs Assessment Tool for Caregivers (148kb pdf)	Identify areas of concern for someone providing care to a person living with a chronic condition.			N.A.

Paul Tait, Content Editor, ELDAC Project