Table 2 Percentage agreements between auditors on the ACE items

6

18

100

Indication on health record death was expected

9

18

100

Place of death

10

18

100

Was the resident transferred to acute care (ED) in the last month of life?

11

18

100

Was there a Health Care Directive?

12

18

100

Was there an Advance Care Plan (ACP)?

12a

17

94

Goals of care chosen

14

15

83

Any changes made to the last ACP?

15

18

100

Is there evidence that EOL was near?

16

16

88

Were there changes to resident’s orders in the last month?

17

18

100

Were there medication changes in the last week?

18

15

83

Is there evidence of communication with family?

19

17

94

Is there evidence that psychosocial support was provided to the family?

20

16

88

Resident’s spiritual health preferences documented?

21

15

83

Evidence of resident’s or family wishes regarding rites and rituals, spiritual considerations acted upon?

22

17

94

Is there evidence that pain was assessed?

24a

13

71

Pain present?

24b

18

100

Nausea present?

24c

16

88

Vomiting present?

24d

18

100

Constipation present?

24e

15

83

Diarrhea present?

24f

17

94

Dysphagia present?

24 g

15

83

Dyspnea present?

24 h

15

83

Respiratory congestion?

24i

14

77

Cough present?

24j

13

72

Dry mouth present?

24 k

11

61

Fever present?

24 l

13

72

Skin breakdown present?

24 m

17

94

UTI?

24n

17

94

Edema present?

24o

18

100

Seizures present

24p

13

72

Other symptom issues?

24q

17

94

Depression present?

24r

16

88

Anxiety present

24 s

18

100

Agitation present?

24 t

14

77

Delirium present?

24u

13

72

Other psychosocial symptoms present?

25a

16

88

Was mouth care provided in the last week of life?

25b

14

77

Was bathing provided in the last week of life?

25c

16

88

Was incontinence care provided in the last week of life?

25d

17

94

Was positioning provided in the last week of life?

26

17

94

Was the Regional Health End-of-Life Toolkit used?

27a

18

100

Was a consult made for the Regional Palliative care program?

27b

18

100

Was a consult made for other MD or NP services?

27c

18

100

Was a consult made to the site CNS?

27d

18

100

Was a consult made to the Hospice Palliative care volunteer program?

27e

18

100

Was a consult made to the Facility Volunteers?

27f

17

94

Was a consult made to the Speech Language Pathologist?

27 g

17

94

Was a consult made to the Spiritual Health Practitioner?

27 h

16

88

Was a consult made to the Registered Dietitian?

27i

18

100

Was a consult made to the Regional NH CNS?

27j

14

77

Was a consult made to the Therapeutic Recreation?

27 k

18

100

Was a consult made to the Respiratory Therapist?

27 l

18

100

Was a consult made to the Pharmacist?

27 m

16

88

Was a consult made to Social Work?

27n

12

66

Was a consult made to the OT/PT/Rehab services?

27o

18

100

Was a consult made to the manager of food services?

27p

14

77

Were other consults made?

27q

18

100

Was a consult made to the Regional ethics committee?