Table 1. Patient Communication Assessment Tool.

Baseline Communication Method/Special Needs Verbal Writing (Pen & Paper) Communication board Electronic communication device Speaking valve Gesturing Mouthing/lip reading Hearing aids Glasses Language interpreter needed Family facilitated Sign language/interpreter needed Other (document explanation)	Interventions At Point of Care Comfort measures Music Sitter Communication device (document explanation) Phone Speaking valve Calm spoken voice Give patient time to communicate Released restraints Glasses Hearing aid Call light Interpreter Other (document explanation)
Assessment	Re-Assessment
Patient's reported level of distress with communication [scale (0-5)]*	Patient's reported level of distress with communication [scale (0-5)]*
0) Not at all	0) Not at all
1) A little bit	1) A little bit
2) Somewhat	2) Somewhat
3) Quite a bit	3) Quite a bit
4) Very much	4) Very much
5) No response	5) No response
Current Barriers Hostility Withdrawn/depressed Delirium Agitation Confusion Impaired LOC Illiterate Orally intubated Tracheotomy Foreign language Sedated Restrained Surgery History of stroke Weakness Vision impairment Hearing impairment Visitation restrictions Other (document explanation) None	Evaluation/Effectiveness Patient reports being satisfied Family reports being satisfied Patient reports being unsatisfied Family reports being unsatisfied Patient responds appropriately with intervention Necessary information is obtained from and provided to the patient Patient demonstrates understanding Other (document explanation)
	Referral Yes (document explanation) No

^*Adapted from MSAS Short Form with permission (30).