Hospice and palliative care patients often have multiple symptoms that can make creating and following a plan of care difficult. The Edmonton Symptom Assessment Scale (ESAS) is a validated symptom rating tool that has been used extensively worldwide for nearly 30 years. It is designed to assist with the assessment of multiple symptoms. The tool uses the objective rating of the patient or caregiver to assess their opinions on the amount of distress they are experiencing. These ratings should be entered into a hospice software to easily monitor pain and symptom management.
Using the ESAS for Hospice Patients
The symptoms included on the ESAS that can be tracked on nursing documents in Axxess Hospice are:
- Anxiety
- Constipation
- Dizziness
- Nausea
- Vomiting
- Appetite
- Depression
- Dyspnea
- Sleep Pattern
- Weakness
Pain is also evaluated on each visit in Axxess Hospice using the Pain Assessment. Each symptom is rated on a scale of zero to ten, with zero being no distress from the symptom and ten being the most distress possible from the symptom.
How Does the Scoring Work?
When possible, the scoring should be done by the patient. When the patient is cognitively impaired and cannot complete the scoring themselves, the caregiver should complete the ESAS based on what they observe from the patient’s behavior. For example, a caregiver can notice pain behavior, vomiting or respiratory distress, or the appearance of fatigue or increased sleeping. However, the caregiver cannot score the patient’s dizziness, anxiety or depression, as these symptoms can only truly only be evaluated by the patient.
Why Using the ESAS Is Necessary
The State Operations Manual Guidance to Surveyors: Hospice states that part of the assessment for hospice certification and the comprehensive assessment includes objective data to determine eligibility and progress toward goals for symptom management. Surveyors investigate how interventions to alleviate symptoms are selected and how the effectiveness of these interventions is evaluated. It is also a requirement in §418.56(c)(3) of the Conditions of Participation to have measurable outcomes for the plan of care, and use of the ESAS in Axxess Hospice fulfills this requirement seamlessly.
The State Operations Manual instructs surveyors to review how the hospice uses objective data as part of the plan of care to determine whether they are meeting the goals of care. Using the ESAS scores to evaluate progress toward goals assists organizations with the survey process by showing clear objective data on the effectiveness of interventions, as well as assisting clinicians in identifying when they need to change the interventions on the plan of care to improve the patient’s symptom burden.
The use of the ESAS tool is a proven and effective method to obtain objective data regarding the subjective experience of the patient with uncomfortable symptoms. Documenting regularly in an intuitive hospice software will drive updates to the plan of care interventions and enable organizations to record measurable outcomes for the plan of care that the survey process requires.