Paediatric Templates - Excel

Document Sample
Paediatric Templates - Excel Powered By Docstoc
					National Clinical Content List for Sharing
Program NPFIT               Document Record ID Key
me
Sub-Prog Clinical Content
/ Project Assurance

Prog.      Alan Perkins     Status                   Approved
Director
Owner     National Clinical Version                       4.11
          Content
          Requirements
          Board
Author(s) Lindsey Blaket/ Version                    4/30/2010
          Munish Jokhani Date
                                                        17f86d3d-8250-4fdb-be99-c916857d4340.xls ReadMe
                                                                  RESTRICTED MANAGEMENT




RESTRICTED MANAGEMENT

Document Purpose

This document is the current list of nationally approved clinical content (Tools) that may be incorporated into NPfIT systems.

Its purpose is to provide an update to interested parties about national clinical content work being undertaken by NHS CFH.

Should you wish to make use of any of the items listed in this document, you must first email clinicalcontent@nhs.net

Column Descriptions

Content Name : Assessment tool name
Content Purpose – used to assess or record: A short description of purpose of the content.
Content Setting - used predominantly in / : Describes the settings in which content may be used e.g. Acute
Available format of National Prototype : This is not a tracker of status from paper to system incorporation. It is the format in which the content was assured,
e.g. paper, PDF or electronic.

Document Status
This is a controlled document.
Whilst this document may be printed, the electronic version maintained in Sharepoint is the controlled copy.
Any printed copies of the document are not controlled.




                                                                              Page 2 of 14
                                                    17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                   RESTRICTED MANAGEMENT


Content Name                                                  Content Purpose – used to assess or record:         Content Setting - used            Available format of
                                                                                                                  predominantly in / by:            Clinical Content
Abbreviated Mental Test                                       Dementia Screening                                  Older People                      PDF
ABCD2 TIA Risk Assessment Tool                                Risk of early disabling stroke                      Primary Care/Acute Care           PDF
Addenbrookes Cognitive Examination (ACE-R)                    Cognitive function over time of people with         Mental Health                     PDF
                                                              suspected dementia or other cognitive disorders.
Alcohol Use Disorders Identification Test - AUDIT             Alcohol use                                         Mental Health                     Paper
Alcohol Withdrawal Scale (AWS)                                Alcohol withdrawal                                  Acute                             Paper
Amsterdam Criteria                                            Criteria for Hereditary Non-Polyposis Colorectal    Acute and Community               PDF
                                                              Cancer
ASA Physical Status Classification                            Fitness to undergo anaesthetic                      Anaesthetics                      Paper
Assessment of Communication and Interaction Skills – ACIS     Communication and Interaction Skills                Adults with communication         Paper
                                                                                                                  difficulties
Auditory Brainstem Response                                   Hearing                                             Audiology                         Paper
Automated Peritoneal Dialysis Prescription                    Renal - Recording of the treatment                  Acute and Patient's Home          Electronic
Automated Peritoneal Dialysis Record of Care                  Renal - Recording of the actual delivery of CAPD    Acute                             Electronic
AVPU (Alert, Voice, Pain, Un-responsive)                      Level of consciousness                              Acute                             Paper
Barthel Index, Modified version                               Functional ability                                  Acute and Community               Paper
Barthel Index, Original version                               Functional ability                                  Acute and Community               Paper
Barthel Index, UK version                                     Functional ability                                  Acute and Community               Paper
Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)   Ankylosing Spondylitis                              Rheumatology                      Paper

Bath Ankylosing Spondylitis Functional Index – BASFI          Ankylosing Spondylitis                              Rheumatology                      Paper
Bath Ankylosing Spondylitis Patient Global Score (BAS-G)      Ankylosing Spondylitis                              Rheumatology                      Paper
Bath AS Metrology Index - BASMI                               Ankylosing Spondylitis                              Rheumatology                      Paper
Bay area functional assessment (BaFPE)                        Functional performance                                                                Paper
                                                                                                                  Mental Health, Brain Injury,
                                                                                                                  older people, and
                                                                                                                  developmentally disabled adults
Berg Balance Scale                                            Falls risk                                          Acute and Community               Paper
Borderline Personality Disorder Index                         Personality disorder                                Mental Health                     Paper
Braden Scale                                                  Pressure sore risk                                  Acute and Community               Paper
Brief Pain Inventory                                          Cancer Care                                         Cancer Care                       PDF
Brighton Paediatric Early Warning Score (BPEWS)               Early Warning Score                                 Paediatrics                       Paper
Bristol Stool Form Scale, Description                         Gut function                                        Acute and Community               Paper
Bristol Stool Form Scale, Graphic                             Gut function                                        Acute and Community               Paper
Canadian Cardiovascular Society (CCS) Classification for      The extent of angina (using a scale from I to IV)   pre-operative/pre-anaesthetic     PDF
Angina                                                                                                            assessment
Cardiff Acne Diability Index (CADI)                           Impact of dermatological conditions                 Dermatology                       Word
Carers and Users Expectations of Service Questionnaire        Service Users experience of mental illness          Mental Health                     Paper
(CUES)
Carers of Older People in Europe (COPE) Questionnaire         Need for support in carers of older people          Community                         PDF




                                                                               Page 3 of 13
                                                      17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                     RESTRICTED MANAGEMENT


Content Name                                                  Content Purpose – used to assess or record:               Content Setting - used     Available format of
                                                                                                                        predominantly in / by:     Clinical Content
Center for Epidemiologic Studies Depression (CES-D) Scale     Depression                                                Mental Health              Paper

Child Occupational Self Assessment - COSA                     Occupational performance and participation                Children 8 - 13            Paper
Children's Dermatology Life Quality Index (CDLQI)             Impact of dermatological conditions                       Dermatology                Word / PDF (Cartoon)
Children's Global Assessment Scale 4-16 years (CGAS)          Child Behaviour                                           Paediatrics                PDF
Chronic Fatigue Syndrome Questionnaire                        Chronic Fatigue                                           Acute and Community        Paper
Clinical Impairment Assessment - CIA                          Eating disorders                                          Mental Health              Paper
Clinical Institute Withdrawal Assessment for Alcohol scale    Alcohol withdrawal                                        Acute                      Paper
(revised) - CIWA-Ar
Community Dependency Index (CDI)                              Functional ability                                        Community                  Paper
Comprehensive Assessment of At Risk Mental States –           Psychotic illness                                         Mental Health              Paper
CAARMS
Confusion Assessment Method - CAM-ICU                         Level of confusion / agitation / sedation                 Intensive Care             Paper

Consent to Post-Mortem                                        Consent                                                   Any                        Paper
Continuous Ambulatory Peritoneal Dialysis Prescription        Renal - Recording of the treatment                        Acute and Patient's Home   Electronic
Continuous Ambulatory Peritoneal Dialysis Record of Care      Renal - Recording of the actual delivery of CAPD          Acute                      Electronic
COPD Assessment Test (CAT)                                    Effects of Chronic Obstructive Pulmonary Disease          Acute and Community        PDF
                                                              (COPD)
CWILTED: Paediatric Emergency Department Assessment           standardised paediatric assessment tool designed to       Acute                      PDF
                                                              be used with the Manchester Triage system.
DAS Score                                                     Rheumatoid arthritis                                      Rheumatology               Paper
DAS28 Score                                                   Rheumatoid arthritis                                      Rheumatology               Paper
DAS-CRP Score                                                 Rheumatoid arthritis                                      Rheumatology               Paper
Dermatitis Family Impact Questionnaire (DFI)                  Impact of dermatological conditions                       Dermatology                Word
Dermatology Life Quality Index (DLQI)                         Impact of dermatological conditions                       Dermatology                PDF / Word
Diagnostic request templates:Diagnostic :Endoscopy            Endoscopy                                                 Any                        Electronic
Diagnostic request templates:Diagnostic Imaging               Imaging                                                   Any                        Electronic
Diagnostic request templates:Physiological Measurement        Audiology                                                 Any                        Electronic
Diagnostic request templates:Physiological Measurement        Cardiac Physiology                                        Any                        Electronic
Diagnostic request templates:Physiological Measurement        Neurophysiology                                           Any                        Electronic
Diagnostic request templates:Physiological Measurement        Urodynamics                                               Any                        Electronic
Diagnostic request templates:Physiological Measurement        Vascular                                                  Any                        Electronic
Diagnostic request templates:Physiological Measurement        Gastrointestinal                                          Any                        Electronic

Diagnostic request templates:Physiological Measurement        Respiratory                                               Any                        Electronic
Dialysis Adequacy                                             Renal - Calculations for different dialysis modalities,   Acute                      Electronic
                                                              and associated calculations;
Disabilities of the Arm, Shoulder and Hand – DASH             Functional ability                                        Acute and Community        Paper
DNAR orders                                                   Advance Directives                                        Any                        Paper



                                                                                   Page 4 of 13
                                                       17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                      RESTRICTED MANAGEMENT


Content Name                                                   Content Purpose – used to assess or record:        Content Setting - used           Available format of
                                                                                                                  predominantly in / by:           Clinical Content
Duke OARS (Older Americans Resources and Services)             Functional ability                                 Older People                     Paper
Multidimensional Functional Assessment Questionnaire
Dynamic Gait Index                                             Gait                                               Acute and Community              Paper
Early Warning Scoring System (EWSS)                            Critical care                                      Acute                            Paper
Eating Disorder Questionnaire – EDE-Q                          Eating disorders                                   Mental Health                    Paper
Edinburgh Post Natal Depression Scale                          Post natal depression                              Maternity                        Paper
Emergency Admission Risk Likelihood Index (EARLI)              Readmission risk                                   Community                        Paper
(sometimes referred to as the Castlefield Predictive Tool)
EU Scale for Peak Expiratory Flow Rate for Adults              Respiratory status                                 Acute and Community              Paper
EU Scale for Peak Expiratory Flow Rate for Children            Respiratory status                                 Acute and Community              Paper
Experience of Service Questionnaire (ESQ)                      Experience of service                              CAMHS                            Paper
Falls Efficacy Scale (Modified)                                Fall Efficacy                                      Acute and Community              PDF
Falls Risk Assessment Score for the Elderly - Community        Falls risk                                         Acute and Community              Paper
(Community FRASE)
Falls Risk Assessment Score for the Elderly (FRASE)            Falls risk                                         Acute and Community              Paper
Falls Risk Assessment Tool - FRAT                              Falls risk                                         Acute and Community              Paper
Family Dermatology Life Quality Index (FDLQI)                  Impact of dermatological conditions                Dermatology                      Word
FAST Assessment of Stroke Symptoms                             Stroke symptoms                                    Neurology                        PDF
Fear Questionnaire                                             Anxiety                                            Mental Health                    Paper
Finnegan Neonatal Abstinence Score (NAS)                       The effects of withdrawal on opiate-exposed        Neonatal nursing                 PDF
                                                               newborn babies
Foot Drawings                                                  Anatomical drawings                                Podiatry                         tif / jpg
Fukuda's Stepping test                                         Balance                                            Acute and Community              Paper
Functional Assessments - Later Life Training                   Functional ability                                 Older People                     PDF

Functional Reach Score                                         Balance                                            Acute and Community              Paper
Generalised Anxiety Disorder - GAD7                            Anxiety                                            Mental Health                    Paper
Geriatric Depression Scale – Long Form English Scoring         Depression                                         Mental Health and Acute          Paper
Geriatric Depression Scale – Short Form English                Depression                                         Mental Health and Acute          Paper
Geriatric Depression Scale – Short Form English Scoring        Depression                                         Mental Health and Acute          Paper
Glasgow Coma Scale for Adults, Modified Version                Level of consciousness                             Acute                            Paper
Glasgow Coma Scale for Adults, Original Version                Level of consciousness                             Acute                            Paper
Gold Standard Framework                                        Framework for End of Life Care                     Acute and Community              Paper
Good European Health Record (GEHR) / Centre for Health         Anatomical drawings                                Acute and Community              Paper
Informatics and Multi-professional Education (CHIME) /
University College London (UCL) Anatomical Drawings
Gordon’s Functional Health Patterns                            Nursing process                                    Nursing                           Paper
Haemodialysis                                                  Renal - Prescribing of haemodialysis treatments    Acute and planned in all settings Electronic




                                                                                    Page 5 of 13
                                                  17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                 RESTRICTED MANAGEMENT


Content Name                                              Content Purpose – used to assess or record:           Content Setting - used            Available format of
                                                                                                                predominantly in / by:            Clinical Content
Haemodialysis Catheter Insertion and Removal Record       Renal - The recording of insertion, removal and       Procedures outside of Theatres-   Electronic
                                                          replacement of haemodialysis catheters procedures. Monor ops rooms-see note
                                                                                                                Paediatrics
Harris Hip Score                                          Hip function                                          Acute                             PDF
Harris Hip Score (Abridged)                               Hip Function                                          Acute                             PDF
HCR-20                                                    Risk of violence associated with MH disorder          Mental Health                     Paper
Head Impulse / Head Thrust Test                           Balance                                               Acute and Community               Paper
Health Anxiety Index (HAI)                                Anxiety                                               Mental Health                     Paper
Health Assessment Questionnaire - HAQ                     Functional ability                                    Dermatology / Rheumatology        Paper
HOME FAST Screening Tool                                  Falls Risk                                            All patients and older people     PDF
Home Haemodialysis Assessment                             Renal - The recording of information needed as part Patient's Home.                     Electronic
                                                          of the ongoing care of patients on home
                                                          haemodialysis;
Home Haemodialysis Initial Patient Assessment             Renal - Recording of the initial assessment of the    Patient's Home.                   Electronic
                                                          patient’s and their home’s suitability for home
                                                          haemodialysis.
Home Haemodialysis Patient Training Record                Renal - Provides the Renal Unit with an electronic    Patient's Home.                   Electronic
                                                          record that the patient has achieved all the required
                                                          competencies in order to dialyse safely at home.

HoNOS (Working Age Adults)                                MH outcomes                                          Mental Health                      Paper
HoNOS ABI                                                 MH outcomes                                          Mental Health                      Paper
HoNOS LD                                                  MH outcomes                                          Mental Health                      Paper
HoNOS Secure                                              MH outcomes                                          Mental Health                      Paper
HoNOS65+                                                  MH outcomes                                          Mental Health                      Paper
HoNOSCA                                                   MH outcomes                                          Mental Health                      Paper
Human ear drawing                                         Anatomical drawings                                  Acute and Community                Paper
Impact of Events Scale                                    Post Traumatic Stress Disorder                       Mental Health                      Paper
Infant's Dermatitis Quality of Life Index (IDQoL)         Impact of dermatological conditions                  Dermatology                        Word
Interest checklist                                        Occupational performance and participation           Adults and adolescents             Paper
Internal State Scale                                      Bi Polar Disorder                                    Mental Health                      Paper
International Prostate Symptom Score (IPSS)               Symptoms of prostate disorder                        General Medicine                   Paper
Krawiecka, Goldberg and Vaughn Modified Symptom Scale -   Psychotic illness                                    Mental Health                      Paper
KGV-M
Kunkler Neuro-Vascular Assessment                         Monitoring and recording of neurovascular            Orthopaedic nursing                Paper
                                                          observations
Kurtzke Expanded Disability Status Scale (EDSS)           Disability in Multiple Sclerosis                     Neurology                          PDF
London Chest Activities of Daily Living Scale             Chronic Obstructive Pulmonary Disease                Acute                              PDF
Makaton                                                   Means of communication                               Speech and Language Therapy        Paper
Mallampati Scale                                          Intubation for anaesthesia                           Surgery                            PDF
Malnutrition Universal screening Tool (MUST)              Nutritional status                                   Acute and Community                Paper



                                                                          Page 6 of 13
                                                       17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                      RESTRICTED MANAGEMENT


Content Name                                                   Content Purpose – used to assess or record:                 Content Setting - used               Available format of
                                                                                                                           predominantly in / by:               Clinical Content
Maudsley Addiction Profile (MAP)                               Substance Addiction                                         Mental Health                        Paper
Mayers’ Lifestyle Questionnaire 1                              Quality of Life priorities                                  People with physical disability      Paper
Mayers’ Lifestyle Questionnaire 2                              Quality of Life priorities                                  People with enduring mental
                                                                                                                           health problems
McCormick Toy Discrimination Test                              Hearing                                                     Audiology                            Paper
Medscape diagrams (Adult - Anterior and Posterior Views ,      Anotomical drawings                                         Acute and Community                  PDF
Tonsils and Adenoids, Child - Anterior and Posterior Views,
Heart)
Model of Human Occupation Screening Tool – MOHOST              Occupational functioning                                    Mental Health                        Paper
Modified Clinical test of Sensory Interaction of Balance       Balance                                                     Acute and Community                  Paper
(CTSIB)
Modified Rankin Scale                                          Disability or dependance in stroke patients                 Stroke Care                          PDF
Montgomery Asburg Depression Rating Scale - MADRS              Depression                                                  Mental Health                        Paper
Morse Fall Scale                                               Falls risk                                                  Acute and Community                  PDF
MRC Dyspnoea Scale                                             Breathlessness                                              Acute and Community                  Paper
MRC Muscle Grade Scale                                         Muscle power in examination of peripheral nervous           Acute and Community                  Paper
                                                               system
National Institute for Health Stroke Scale (NIHSS)             Impairment caused by a stroke.                              Primary Care/Acute Care              PDF
NCEPOD Classification of Interventions                         Clinicial priority for an intervention such as a surgical   Acute                                PDF
                                                               procedure
Neonatal Infant Pain Assessment (NIPS)                         Pain                                                        Neonatal                             Paper
NHS Supplies Catalogue                                         Supplies                                                    Any                                  Paper
Norton Scale                                                   Pressure sore risk                                          Acute and Community                  Paper
Nottingham Extended Activities of Daily Living Scale           Functional ability                                          Acute and Community                  Paper
Obsessive Compulsive Inventory                                 Obsessive Compulsive Disorder                               Mental Health                        PDF
Occupational case analysis interview and rating scale –        Occupational adaptation                                                                          Paper
OCAIRS                                                                                                                     Adults and adolescents.Adults
                                                                                                                           and adolescents.
                                                                                                                           Mental Health, Forensic Mental
                                                                                                                           Health, and Physical Disabilities.

Occupational Performance History Interview – OPHI-II           Life history, impact of disability and life goals           Adults and children over 12          Paper
                                                                                                                           years
Occupational Questionnaire - OQ                                Occupational performance, participation and use of                                               Paper
                                                               time                                                        Adults and adolescents
Occupational Self Assessment - OSA                             Occupational functioning and adaptation                     Adults and children over 12          Paper
                                                                                                                           years
Occupational Therapy Psychosocial Assessment of Learning - Occupational performance at school                                                                   Paper
OTPAL                                                                                                                      Children 6 – 12 years
Osteoporosis Risk Factor Assessment Tool                   Osteoporosis risk                                               Acute and Community                  Paper
Otoaccoustic Emissions                                     Hearing                                                         Audiology                            Paper



                                                                                  Page 7 of 13
                                                        17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                       RESTRICTED MANAGEMENT


Content Name                                                    Content Purpose – used to assess or record:            Content Setting - used        Available format of
                                                                                                                       predominantly in / by:        Clinical Content
Oxford Hip Score                                                Joint specific outcome measure tool                    Acute and Community           PDF
Oxford Knee Score                                               Joint specific outcome measure tool                    Acute and Community           PDF
Paediatric Glasgow Coma Scale                                   Level of consciousness                                 Acute                         Paper
Paediatric Volitional Questionnaire - PVQ                       Motivation, environment and participation              Children 2 - 7 years          Paper
Parkinson’s Disease Assessment                                  Comprehensive assessment by Nurse Specialists          Primary Care/Acute Care       Electronic
Patient Experience Questionnaire                                Service Users experience of MH treatment               Mental Health                 Paper
Patient Health Questionnaire - PHQ9                             Depression                                             Mental Health                 Paper
Patients At Risk of Re-hospitalisation (PARR)                   Readmission risk                                       Acute                         Paper
PCC Diagram (Heart Structure)                                   Anatomical drawings                                    Acute and Community           PDF
Penn State Worry Questionnaire (PSWQ)                           Anxiety                                                Mental Health                 Paper
Peritoneal Dialysis Assessment                                  Renal - Recording of information needed as part of     Patient's Home.               Electronic
                                                                the ongoing care of patients at home on peritoneal
                                                                dialysis (both CAPD and APD);
Peritoneal Dialysis Catheter Exit Site Scoring System           Continuous Ambulatory Peritoneal Dialysis (CAPD)       Renal Practices               Paper
                                                                record of care and Automated Peritoneal dialysis.

Peritoneal Dialysis Initial Assessment                          Renal - Assessment of a patient’s suitability for      Patient's Home.               Electronic
                                                                peritoneal dialysis
Peritoneal Dialysis Patient Training Record                     Renal - Training of patients for home haemodialysis    Patient's Home/Acute          Electronic

Physiological Observation Track and Trigger System (POTTS)      Physiological Score                                    Acute                         PDF
Chart
Positive and Negative Syndrome Scale (PANSS)                    Mental Health - symptoms of psychotic illness          Mental Health                 PDF
Post Anesthesia Discharge Scoring System (PADS)                 Criteria for discharge following anaesthesia           Surgery                       PDF
Preferred Priorities for Care                                   End of Life Care                                       Acute and Community           PDF
Psoriasis Diability Index (PDI)                                 Impact of dermatological conditions                    Dermatology                   Word
Psychotic Symptom Rating Scales (PSYRATS)                       Assessment and classification of psychotic             Mental Health                 Paper
                                                                symptoms (hallucinations and delusions)
Pure Tone Audiometry                                            Hearing                                                Audiology                     Paper
QuickDASH                                                       Functional ability                                     Acute and Community           Paper
Renal Dietetic Record                                           Renal - The ongoing nutritional review of renal        Adult only Dietectics         Electronic
                                                                patients by the renal dieticians.
Renal Dietetic Record Paediatric                                Renal - The ongoing nutritional review of paediatric   Paediatric Diatectics         Electronic
                                                                renal patients by the renal dieticians.
Renal Information Record                                        Record of discussions, treatment options and choice.   Acute                         Electronic

Renal Preparation Record Paediatric                             Renal - A record of information and preparation (e.g. Paediatric Multidisciplinary   Electronic
                                                                information, preparation via play) received by the
                                                                patient
Renal Pre-Transplant Live Donor Assessment                      Renal - Record of Information regarding live donor    Acute                          Electronic
Renal Pre-Transplant Live Donor Information Record              Renal - Record of Information regarding live donor    Acute                          Electronic



                                                                                 Page 8 of 13
                                                         17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                        RESTRICTED MANAGEMENT


Content Name                                                      Content Purpose – used to assess or record:                   Content Setting - used          Available format of
                                                                                                                                predominantly in / by:          Clinical Content
Renal Summary Record                                              Renal - The Renal Summary Record is intended to               Acute                           Electronic
                                                                  ‘supply’ the content of the Renal Summary View and
                                                                  Timeline
Renal Summary View                                                Renal - Key administrative and clinical data items            Acute                           Electronic
                                                                  relating to a patient’s renal care
Renal Supportive Care Record                                      Renal - A record of discussions, treatment options,           Renal Supportive                Electronic
                                                                  patient preference and choice between clinician,              Management/Care
                                                                  patient, their family and/or carers;
Renal Transplant Information Record                               Renal - Record of Information given to transplant             Acute                           Electronic
                                                                  Recipient
Renal Transplant Preparation Record Paediatric                    Renal - Record of Information given to transplant             Acute and Patient's Home        Electronic
                                                                  Recipient
Richmond Agitation Sedation Scale - RASS                          Level of confusion / agitation / sedation                     Intensive Care                   Paper
Riker Sedation-Agitation Scale                                    Level of confusion / agitation / sedation                     Intensive Care                   Paper
Rinnes Test                                                       Hearing                                                       Audiology                        Paper
Rivermead Activities of Daily Living Scale                        Activities of Daily Living                                    Neurology: stroke and head injuryPDF
Rivermead Extended Activities of Daily Living Scale               Activities of Daily Living                                    Neurology                        PDF
Rivermead Life Goals Questionnaire                                Patient reported handicap                                     Adults                           PDF
Rivermead Mobility Index                                          Mobility tasks essential to activities of daily living        Stroke and head injuries         PDF
Rivermead Motor Assessment                                        Self care and domestic activities of daily living             Stroke and head injuries         PDF
Rockall Risk Score                                                Risk of death or rebleed after acute upper                    Acute                            PDF
                                                                  gastrointestinal haemorrhage
ROSIER Stroke Assessment Tool                                     Stroke and stroke mimics                                      Primary Care/Acute Care         PDF
School Setting Interview (SSI)                                    Occupational performance and school environment               Students with disabilities      Paper
Severity Of Alcohol Dependence Questionnaire (SADQ)               Alcohol use                                                   Mental Health                   Paper
Severity Of Alcohol Dependence Questionnaire (SADQ-C)             Alcohol use                                                   Mental Health                   Paper
Short Child Occupational Profile - SCOPE                          Occupational participation                                    Children up to 21 years         Paper
Short Falls Efficacy Scale - International (FES-I)                Falls Risk                                                    Acute and Community             Paper
Six Item Cognitive Impairment Test (6CIT)                         Dementia Screening                                            Older People                    PDF
Smart Imagebase diagrams (Teeth, Ear)                             Anatomical drawings                                           Ear Nose and Throat             Paper
Social Phobia Inventory (SPIN) scale                              Measurement for the screening of, and treatment               Mental Health                   Paper
                                                                  response to, social phobia
Stanford Health Assessment Questionnaire (HAQ)                    Anxiety                                                       Mental Health                   PDF
Strengths and Difficulties Questionnaires (SDQ)                   Behavioural screening of 3-16 year olds                       Mental Health                   PDF
Structured observation test of function – SOTOF                   Functioning and neurological deficits                         Adults                          Paper
Survey of activities and fear of falling in the elderly (SAFFE)   Activity level, fear of falling and restriction of activity   Acute and Community             PDF
                                                                  in older people.
The Finnegan Neonatal Abstinence Score (NAS)                      Neonatal Abstinence                                           Neonatal                        PDF
Threshold Assessment Grid (TAG)                                   To identify people with mental health needs of the            Mental Health                   Paper
                                                                  severity to require access to secondary mental
                                                                  health services



                                                                                     Page 9 of 13
                                                       17f86d3d-8250-4fdb-be99-c916857d4340.xls Clinical Content List
                                                                      RESTRICTED MANAGEMENT


Content Name                                                   Content Purpose – used to assess or record:        Content Setting - used             Available format of
                                                                                                                  predominantly in / by:             Clinical Content
Timed Up and Go (TUG or TUAG)                                  Falls Risk                                         Acute and Community                Paper
Tinetti Falls Efficacy Scale                                   Falls risk                                         Acute and Community                Paper
Tinetti Performance-Oriented Mobility Assessment I (aka        Falls risk                                         Acute and Community                Paper
Tinetti Balance and Gait Scale)
Tympanometry                                                   Hearing                                            Audiology                          Paper
UK FIM+FAM (Functional Independence Measure and                Functional Capability                                                                 Paper
Functional Assessment Measure)
UK-90 Centile Chart Data Set                                   Child growth                                       Child Health                       Paper
[Supersedes WHO Centile Chart Data Set]
Venous Thromboembolism Risk Assessment                         Risk of thrombosis                                 Admissions                         PDF
Vestibular disorders Activities of Daily Living (VADL) Scale   Balance                                            Acute and Community                Paper
Visual Infusion Phlebitis (VIP) Score                          Infusion Phlebitis                                 Acute                              Paper
Visual Reinforced Audiometry                                   Hearing                                            Audiology                          Paper
Volitional Questionnaire - VQ                                  Motivation, environment and participation          Adults and adolescents             Paper
Walsall Community Pressure Sore Risk Assessment                Pressure sore risk                                 Community                          Paper
Waterlow Pressure Ulcer Risk Assessment and Prevention         Pressure sore risk                                 Acute and Community                Paper
Score
Webbers Test                                                   Hearing                                            Audiology                        Paper
Wells Scores                                                   Prediction of DVT or Pulomonary Embolism (PE)      Acute                            Paper
Westcotes Individualised Outcome Measure                       Patient goals and outcome                          All patients                     Paper
WHO Fracture Risk Assessment Tool (FRAX)                       Fracture Risk                                      Acute and Community              Paper
Work and Social Adjustment Scale (WAS)                         Work and social adjustment                         Adults with anxiety or           Paper
                                                                                                                  depression
Work Environment Impact Scale - WEIS                           Occupational performance in work environments      Adults with physical or psychosocial disabilities
                                                                                                                                                   Paper
Worker Role Interview - WRI                                    Psychosocial and environmental factors impacting                                    Paper
                                                               on return to work                                  Vocational rehabilitation
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)                 Personality disorder                               Mental Health                    PDF




                                                                               Page 10 of 13
Amendment History:
 Version     A&S Ver      Date     Amendment History
       0.1         7.1   2/17/2009 First draft for discussion
       1.0                         Approved & Issued
       1.1         7.2   4/29/2009 Additions:
                                   Venous Thromboembolism Risk Assessment
                                   UK-90 Centile Chart Data Set
                                   Removals:
                                   World Health Organisation Centile Chart Data Set
       1.2         n/a   4/30/2009 Additions: Renal Assessments
       2.1         7.3   5/22/2009 Additions:
                                   Dermatology Life Quality Index (DLQI)
                                   Children's Dermatology Life Quality Index (CDLQI)
                                   Family Dermatology Life Quality Index (FDLQI)
                                   Psoriasis Diability Index (PDI)
                                   Cardiff Acne Diability Index (CADI)
                                   Dermatitis Family Impact Questionnaire (DFI)
                                   Infant's Dermatitis Quality of Life Index (IDQoL)
                                   Foot Drawings
                                   Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
                                   Carers of Older People in Europe (COPE) Questionnare
                                   Children's Global Assessment Scale 4-16 years (CGAS)
                                   ASA Physical Status Classification
       3.1         8.1   6/26/2009 Additions:
                                   Falls Risk Assessment Score for the Elderly - Community (Community
                                   FRASE)
                                   Obsessive Compulsive Inventory
                                   MRC Muscle Grade Scale
                                   Kunkler Neuro-Vascular Assessment
                                   Finnegan Neonatal Abstinence Score (NAS)
                                   Social Phobia Inventory (SPIN) scale
                                   Psychotic Symptom Rating Scales (PSYRATS)
                                   Strengths and Difficulties Questionnaires (SDQ)
                                   Threshold Assessment Grid (TAG)
       4.1         8.2   7/29/2009 Alterations to Readme page

       4.3         9.1   8/25/2009 Additions:
                                   Addenbrooke's Cognitive Examination (ACE-R)
                                   Functional Assessments - Later Life Training
                                   Stanford Health Assessment Questionnaire (HAQ)
                                   Positive and Negative Syndrome Scale (PANSS)
                                   Brief Pain Inventory
                                   Preferred Priorities for Care
                                   Edinburgh Post Natal Depression Scale
                                   International Prostate Symptom Score (IPSS)
                                   Morse Fall Scale
       4.4        10.1   9/16/2009 Additions:
                                   Duke OARS (Older Americans Resources and Services) Multidimensional
                                   Functional Assessment Questionnaire
                                   Patients At Risk of Re-hospitalisation (PARR)
                                   Rockall Risk Score
                                   Harris Hip Score
                       Kurtzke Expanded Disability Status Scale (EDSS)
                       Modified Rankin Scale
                       London Chest Activities of Daily Living Scale
                       PCC Diagram (Heart Structure)
                       Medscape diagrams (Adult - Anterior and Posterior Views , Tonsils and
                       Adenoids, Child - Anterior and Posterior Views, Heart)
                       The Finnegan Neonatal Abstinence Score (NAS)
 4.5   11.1 23.10.09   Additions:
                       Harris Hip Score (Abridged)
                       Rivermead Activities of Daily Living Scale
                       Rivermead Extended Activities of Daily Living Scale
                       Rivermead Life Goals Questionnaire
                       Rivermead Mobility Index
                       Rivermead Motor Assessment
                       Six Item Cognitive Impairment Test (6CIT)
                       Amsterdam Criteria
 4.6   12.1 24.11.09   Additions:
                       Abbreviated Mental Test
                       Wells Scores
                       Mobility Inventory for Agoraphobia (MIA)
                       Physiological Observation Track and Trigger System (POTTS) Chart

 4.7   13.1 23.12.09   Additions:
                       ABCD2 TIA Risk Assessment Tool
                       Falls Efficacy Scale (Modified)
                       FAST Assessment of Stroke Symptoms
                       Mallampati Scale
                       National Institute for Health Stroke Scale (NIHSS)
                       ROSIER Stroke Assessment Tool
 4.8   14.1 28.01.10   Additions:
                       Post Anesthesia Discharge Scoring System (PADS)
                       Gold Standards Framework
                       COPD Assessment Test (CAT)
                       Oxford Hip Score
                       Oxford Knee Score
 4.9   15.1 25.02.10   Smart Imagebase diagrams (Teeth, Ear)
                       NCEPOD Classification of Interventions
4.10   16.1 25.03.10   Additions:
                       CWILTED: Paediatric Emergency Department Assessment
                       Canadian Cardiovascular Society (CCS) Classification for Angina
                       Peritoneal Dialysis Catheter Exit Site Scoring System
                       Survey of activities and fear of falling in the elderly (SAFFE)

                       Amendments to Content Purpose and Content Setting for:
                       Assessment of Communication and Interaction Skills – ACIS
                       Bay area functional assessment (BaFPE)
                       Child Occupational Self Assessment - COSA
                       Interest checklist
                       Mayers’ Lifestyle Questionnaire 1
                       Mayers’ Lifestyle Questionnaire 2
                       Model of Human Occupation Screening Tool – MOHOST
                       Occupational circumstances assessment interview and rating scale –
                       OCAIRS
                       Occupational Performance History Interview – OPHI-II
                       Occupational Questionnaire - OQ
                       Occupational Self Assessment - OSA
                       Occupational Therapy Psychosocial Assessment of Learning - OTPAL
                       Paediatric Volitional Questionnaire - PVQ
                       School Setting Interview (SSI)
                       Short Child Occupational Profile - SCOPE
                       Structured observational test of function – SOTOF
                       Volitional Questionnaire - VQ
                       Westcotes Individualised Outcome Measure
                       Work and Social Adjustment Scale (WAS)
                       Work Environment Impact Scale - WEIS
                       Worker Role Interview - WRI
                       Rivermead Activities of Daily Living Scale
                       Rivermead Extended Activities of Daily Living Scale
                       Rivermead Life Goals Questionnaire
                       Rivermead Mobility Index
                       Rivermead Motor Assessment
4.11   17.1 27.04.10   Additions:
                       UK FIM+FAM (Functional Independence Measure and Functional
                       Assessment Measure)
                       WHO Fracture Risk Assessment Tool (FRAX)
                       HOME FAST Screening Tool
                       Parkinson’s Disease Assessment

				
DOCUMENT INFO
Description: Paediatric Templates document sample