Table 1 Example ACE tool domains and questions

Domain 1: Demographics

 ● Date of birth

 ● Date of death

 ● Gender

 ● Length of NH stay (in months)

Domain 2: Situation around death

 ● Indication on health record that death was expected? (YES/NO)

 ● Place of death (NH/Chronic Care/Acute Care/Palliative Care Unit)

 ● Was the resident transfered to acute care in their last month of life? (YES/NO)

Domain 3: Clear decision making

 ● Was there an Advance Care Plan? (YES/NO)

 ● Any changes to the Advance Care Plan made at last review? (YES/NO)

 ● Was there a Health Care Directive (YES/NO)

Domain 4: Preparation for death

 ● Is there evidence in the progress notes that staff recognized changes in the resident's condition that acknowledged that end of life was near? (YES/NO)

 ● Were there changes or adjustments made to the resident's physician/NP orders in the last month of life? (YES/NO)

 ● Were there any medication changes made in the last week of life? (YES/NO)

 ● Is there evidence in the progress notes that psychosocial support was provided to family members or friends during the dying experience? (YES/NO)

 ● Is there evidence in the progress notes of communication with family or friends about end-oflife care? (YES/NO)

Domain 5: Spiritual health and cultural aspects of care

 ● Evidence of resident’s or family wishes regarding rites and rituals, or spiritual considerations acted upon (e.g., minister/pastor called, last rites administered)? (YES/NO)

 ● Resident's spiritual health preferences documented? (YES/NO)

Domain 6: Symptoms and symptom management through the death

 ● Is there evidence that Pain was assessed?(YES/NO)

 ● If a symptom (physical or psychological) is present, describe the managment.

 ● Personal Care/Comfort Provided in last week of life (e.g.: bathing, mouth care, positioning; incontinence care)?(YES/NO)

 ● Were consults made for other resources (e.g. Social Work, Volunteers, Clinical Nurse Specialists, Speech Language Pathologist)? (YES/NO)