Don't wait until you have time to make your own screening tool. Try this one. ASSESSMENT OF RISK FACTORS FOR HOSPITALIZATION AND EMERGENT CARE Prior Pattern - Check all that apply Chronic conditions - Check all that apply (M0230/M0240) Risk Factors - Check all that apply (6 or more boxes checked indicates high risk for emergent care) Disciplines presently involved in patient's care: Source: Designed by Georgia Medical Care Foundation and available at www.medqic.org ...quot; select "Home Health," then select "Tools."
Hospitalizations or ER visits in the past 12 months
History of falls
History of noncompliance
CHF
Diabetes
HIV/AIDS
Chronic skin ulcers
Neoplasm as primary diagnosis
COPD
"New" diagnosis/problem
Discharged from hospital or skilled nursing facility (M0175)
More than two secondary diagnoses (M0240)
Low socioeconomic status or financial concerns
Lives alone (M0340)
Help with managing medications needed (M0780)
Confusion (M0570)
Short life expectancy (M0280)
Poor prognosis (M0260)
Dyspnea (M0490)
Urinary catheter (M0520)
Open wound (M0440)
Total of checked boxes_____________
q SN q PT q OT q ST q HHA q MSW
Patient name:__________________________________________________ Date:_______________
Staff signature:______________________________________________________________________