six days in a week Problem wandering occurs twice a day or more, at least six days in a week 4 ACFI 7 Rating key Rating: RATING A = yes to item 1 RATING B = yes to item 2: you must complete and enclose the behaviour record RATING C = yes to item 3: you must complete and enclose the behaviour record RATING D = yes to item 4: you must complete and enclose the behaviour record. ACFI 8 Verbal Behaviour Verbal Behaviour Assessment Summary Tick if yes No behaviours recorded 8.1 Verbal refusal of care 8.2 Verbal disruption to others 8.3 Paranoid ideation that disturbs others 8.4 Verbal sexually inappropriate advances 8.5 Evidence requirement: Assessment summary must be completed Checklist must be completed For a rating of B, C or D you must complete and enclose the Verbal Behaviour Record. Verbal Behaviour Checklist Tick if yes Verbal behaviour does not occur or occurs less than two days per week 1 Verbal behaviour occurs at least two days per week 2 Verbal behaviour occurs at least six days in a week 3 Verbal behaviour occurs twice a day or more, at least six days in a week 4 ACFI 8 Rating key Rating: RATING A = yes to item 1 RATING B = yes to item 2: you must complete and enclose the behaviour record RATING C = yes to item 3: you must complete and enclose the behaviour record RATING D = yes to item 4: you must complete and enclose the behaviour record ACFI 9 Physical Behaviour Physical Behaviour Assessment Summary Tick if yes No behaviours recorded 9.1 Physically threatening or doing harm to self, others or property 9.2 Socially inappropriate behaviour impacts on other residents 9.3 Constantly physically agitated 9.4 Evidence requirement: Assessment summary must be completed Checklist must be completed For a rating of B, C or D you must complete and enclose the Physical Behaviour Record. Physical Behaviour Checklist Tick if yes Physical behaviour does not occur or occurs less than two days per week 1
RATING D = score of 10 or more: enclose evidence for procedures as described in the requirements column Evidence requirement: For a rating of B, C or D enclose evidence for procedures as described in the ‘Evidence Requirements’ column on the next page. Complete all complex health care procedures relevant to the resident Score Complex health care procedures Evidence Requirements Tick if yes 1 Blood pressure measurement for diagnosed hyper/ hypotension is a usual care need AND frequency at least daily 1. Medical practitioner directive AND on request: record 1 3 Blood glucose measurement for the monitoring of a diagnosed medical condition e.g. diabetes, is a usual care need AND frequency at least daily 1. Medical practitioner directive AND on request: record 2 1 Pain management involving therapeutic massage or application of heat packs AND Frequency at least weekly AND Involving at least 20 minutes of one on one staff time in total 1. Directive [registered nurse or medical practitioner or allied health professional] AND 2. Evidence based pain assessment AND on request: record 3 3 Complex pain management and practice undertaken by an allied health professional or registered nurse. This will involve therapeutic massage and/ or pain management involving technical equipment specifically designed for pain management AND Frequency at least weekly AND Involving at least 20 minutes of one on one staff time in total. You can only claim one item 4–either 4a or 4b 1. Directive [registered nurse or medical practitioner or allied health professional] AND 2. Evidence based pain assessment AND on request: record 4a 6 Complex pain management and practice undertaken by an allied health professional. This will involve therapeutic massage and/ or pain management involving technical equipment specifically designed for pain management AND Ongoing treatment as required by the resident, at least 4 days per week, AND Involving at least 80 minutes of one on one staff time in total. You can only claim one item 4–either 4a or 4b 1. Directive [medical practitioner or allied health professional] AND 2. Evidence based pain assessment AND on request: record 4b
3 Complex skin integrity management for residents with compromised skin integrity who are usually confined to bed and/ or chair and cannot self-ambulate. The management plan must include repositioning at least 4 times per day. 1. Directive [registered nurse or medical practitioner or allied health professional] AND 2. Skin integrity assessment 5 Score Complex health care procedures Evidence Requirements Tick if yes 3 Management of special feeding undertaken by an RN, on a one-to-one basis, for people with severe dysphagia, excluding tube feeding. Frequency at least daily. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner or allied health professional] AND 3. Swallowing assessment 6 1 Administration of suppositories or enemas for bowel management is a usual care need. The minimum required frequency is ‘at least weekly.’ 1. Directive [registered nurse or medical practitioner] AND on request: record 7 3 Catheter care program (ongoing); excludes temporary catheters e.g. short term post-surgery catheters. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner] 8 6 Management of chronic infectious conditions Antibiotic resistant bacterial infections Tuberculosis AIDS and other immune-deficiency conditions Infectious hepatitis 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner] 9 6 Management of chronic wounds, including varicose and pressure ulcers, and diabetic foot ulcers. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner or allied health professional] AND 3. Wound assessment AND on request: record 10 6 Management of ongoing administration of intravenous fluids, hypodermoclysis, syringe drivers and dialysis. 1. Directive/ prescription [authorised nurse practitioner or medical practitioner] 11 1 Management of arthritic joints and oedema related to arthritis by the application of tubular and/or other elasticised support bandages. Note: The maximum score for claiming both items 12.12a and 12.12b is 3 points. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner or allied health professional] 12a
3 Management of; non-arthritic oedema OR deep vein thrombosis by the fitting and removal of compression garments and/or compression bandages, OR chronic skin conditions by the application and removal of dry dressings and/or protective bandaging. Note: The maximum score for claiming both items 12.12a and 12.12b is 3 points. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner or allied health professional] 12b Score Complex health care procedures Evidence Requirements Tick if yes 3 Oxygen therapy not self-managed. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner] 13 10 Palliative care program involving End of Life care where ongoing care will involve very intensive clinical nursing and/ or complex pain management in the residential care setting. 1. Directive by CNC/ CNS in pain or palliative care or medical practitioner AND 2. Pain assessment 14 1 Management of ongoing stoma care. Excludes temporary stomas e.g. post-surgery. Excludes supra pubic catheters (SPCs) Diagnosis AND 2. Directive [registered nurse or medical practitioner] 15 6 Suctioning airways, tracheostomy care. 1. Diagnosis AND 2. Directive [registered nurse or medical practitioner] 16 6 Management of ongoing tube feeding. Diagnosis AND 2. Directive [registered nurse or medical practitioner or allied health professional] 17 3 Technical equipment for continuous monitoring of vital signs including Continuous Positive Airway Pressure (CPAP) machine. 1. Directive [registered nurse or medical practitioner] AND on request: record 18 ACFI 12 rating key RATING A = score of 0 (no procedures) RATING B = score of 1–4 RATING C = score of 5–9 RATING D = score of 10 or more