Table 1: ACFI at a glance Note: the resident’s ACCR must be included in the ACFI Appraisal Pack ACFI Question ACFI appraisal evidence - Mental and Behavioural Diagnosis Medical Diagnosis Disorders/ diagnosis checklists Source materials checklists Copies of source materials e.g. ACCR, GP comprehensive medical assessment, other medical practitioner assessments or notes 1 Nutrition Care need: readiness to eat / eating Assistance level = independent OR supervision OR physical assistance Assessment Nutrition Checklist 2 Mobility Care need: transfers / locomotion Assistance level = independent OR supervision OR physical assistance OR mechanical lifting equipment Assessment Mobility Checklist 3 Personal Hygiene Care need: dressing / washing / grooming Assistance level = independent OR supervision OR physical assistance Assessment Personal Hygiene Checklist 4 Toileting Care need: use of toilet / toilet completion Assistance level = independent OR supervision OR physical assistance Assessment Toileting Checklist 5 Continence Urinary continence and faecal continence Measurement = frequency Continence Assessment Summary Continence Record Continence Checklist Documentary evidence of incontinence prior to the implementation of a scheduled toileting program (Note: Other types of logs or diaries may be used to complete the continence record providing they contain all the required information.) 6 6 Cognitive Skills Care need: needs arising from cognitive impairment Measurement = none, mild, moderate, severe Cognitive Skills Assessment Summary PAS - CIS if appropriate Cognitive Checklist (Note: A clinical report may be attached to provide supporting evidence) 7 Wandering Care need: absconding or interfering whilst wandering Measurement = frequency Wandering/ verbal/ physical behaviour assessment summary Wandering/ verbal/ physical behaviour records Behaviour checklists (Note: Other types of logs or diaries may be used to complete the behaviour records providing they contain the same information as in the supplied record)
8 Verbal Care need: verbal behaviour Measurement = frequency Wandering/ verbal/ physical behaviour assessment summary Wandering/ verbal/ physical behaviour records Behaviour checklists (Note: Other types of logs or diaries may be used to complete the behaviour records providing they contain the same information as in the supplied record) 9 Physical Care need: physical behaviour Measurement = frequency Wandering/ verbal/ physical behaviour assessment summary Wandering/ verbal/ physical behaviour records Behaviour checklists (Note: Other types of logs or diaries may be used to complete the behaviour records providing they contain the same information as in the supplied record) 10 Depression Care need: depressive symptoms Measurement = none, mild, moderate, severe Depression Assessment Summary Cornell Scale for Depression Depression Checklist Diagnosis (Note: A clinical report may be attached to provide supporting evidence) 11 Medication Care need : assistance with medications Measurement = complexity, frequency and assistance time Source materials table Medication Checklist Medication chart 12 Complex Health Care Care need: complex health care procedures Measurement = complexity and frequency Complex Health Care Checklist Diagnoses, assessments and directives as specified If requested at validation–records of treatments Table 2: Assistance required Independent Requires no supervision with the stated activities or is not applicable Supervision Requires supervision with the stated activities Setting-up Supervision Requires supervision with the stated activities Standby in the stated activities Physical assistance Requires one-to-one physical assistance with the stated activities Physical ACFI 1 Nutrition Readiness to eat Place utensils in the resident’s hand Not applicable Cutting up food or vitamising food ACFI 1 Nutrition Eating Not applicable Stand by to provide assistance (verbal and/or physical) OR daily oral intake when ordered by a dietitian Placing or guiding food into mouth for most of the meal
for person with a PEG tube ACFI 2 Mobility Transfers Locking wheels to enable transfers AND adjusting/ removing foot plates or side arms Stand by to provide assistance (verbal and/ or physical) Physically assist moving to or from chairs, or wheelchairs, or beds OR use of mechanical lifting equipment ACFI 2 Mobility Locomotion Hand resident the mobility aid OR fitting of callipers, leg braces or lower limb prostheses Stand by to provide assistance (verbal and/or physical) Need for staff to push wheelchair OR assistance with walking on a basis ACFI 3 Personal Hygiene Dress/undress Choosing and laying out appropriate clothing OR undoing and doing up zips, buttons or other fasteners including velcro Stand by to provide assistance (verbal and/or physical) One-to-one physical assistance for dressing AND undressing i.e. putting on or taking off clothing AND footwear (i.e. underwear, shirts, skirts, pants, cardigan, socks, stockings) OR fitting and removing of hip protectors, slings, cuffs, splints, medical braces and prostheses other than for the lower limb ACFI 3 Personal Hygiene Wash/dry Set up toiletries within reach, organise taps Stand by to provide assistance (verbal and/or physical Washing and drying body ACFI 3 Personal Hygiene Groom Set up articles for grooming Stand by to provide assistance (verbal and/or physical) Dental care OR hair care OR shaving ACFI 4 Toileting Use of a toilet Setting-up toilet aids, hand person the bedpan/ urinal, place ostomy articles in reach Stand by to provide assistance (verbal and/or physical) Positioning resident for use of toilet or commode or bedpan or urinal ACFI 4 Toileting Toilet completion Emptying of drainage or stoma bags or bedpans Stand by to provide assistance (verbal and/or physical) Adjusting clothes AND wiping and cleaning of peri-anal area one
ACCR is the Aged Care Client Record. Where indicated, a Commonwealth review officer may request to see a record of treatment. Note: A record of the treatment should be kept as long as the treatment is being provided in accordance with its directive. Complete all complex health care procedures relevant to the resident Score Complex health care procedures Requirements Tick if yes 3 Blood pressure measurement for diagnosed hyper/ hypotension is a usual care need AND frequency at least daily 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 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 staff time in total Directive [registered nurse or medical practitioner or allied health professional]; AND 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 staff time in total. You can claim one item 4, either 4a or 4b Directive [registered nurse or medical practitioner or allied health professional]; AND 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 You can only claim one item 4–either 4a or 4b. Directive [medical practitioner or allied health professional]; AND Evidence based pain assessment; AND on request: record 4b 3 Complex skin integrity management for residents with compromised skin integrity who are confined to bed and/ or chair or cannot self ambulate. The management plan must include repositioning at least 4 Directive [registered nurse or medical practitioner or allied health professional]; AND Skin integrity assessment 5
times per day. 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. Diagnosis or ACCR; AND Directive (registered nurse or medical practitioner or allied health professional); AND 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.’ 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. Diagnosis or ACCR AND 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 Diagnosis or ACCR AND Directive [registered nurse or medical practitioner] 9 6 Management of chronic wounds, including varicose and pressure ulcers, and diabetic foot ulcers. Diagnosis or ACCR AND Directive [registered nurse or medical practitioner or allied health professional] AND Wound assessment AND on request: record 10 6 Management of ongoing administration of intravenous fluids, hypodermoclysis, syringe drivers and dialysis. Directive/ prescription [authorised nurse practitioner or medical practitioner] 11 3 Management of oedema, deep vein thrombosis or arthritic joints or chronic skin conditions by the fitting and removal of compression garments, compression bandages, tubular elasticised support bandages, dry dressings and/ or protective bandaging. Diagnosis or ACCR AND Directive [registered nurse or medical practitioner or allied health professional] 12 3 Oxygen therapy not self managed. Diagnosis or ACCR AND 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 Directive by 3CNC/ CNS in pain or palliative care or medical practitioner AND Pain assessment 14