ADL General Collection Information: Difference between revisions

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== Collection Instructions ==
== Collection Instructions ==
*For every Medicine profile, enter the status into the ADL dropdown boxes in the [[Patient Viewer Tab ADL]] in [[CCMDB.accdb]].
* The ADL assessment should reflect the amount of assistance a patient requires to perform the six activities. It takes into consideration acute medical issues that resulted in admission to the hospital.
*The ADL assessment should reflect the amount of assistance a patient requires to perform the six activities. It takes into consideration acute medical issues that resulted in admission to the hospital.
* Using your best judgment based on age, diagnosis, pre hospital admission ADL, and [[#Where to get data]] below, select the option that best reflects their ADL status  
* using your best judgment based on age, diagnosis, pre hospital admission ADL, and 'where to get data' below, and select the option that best reflects their ADL status on admission to the ward
* For ostomy care see [[ADL Toiletting]] and [[ADL Continence]]
* for ostomy care see [[ADL Toiletting]] and [[ADL Continence]]
* For use of mechanical aids see [[ADL Transfering]]
* for use of mechanical aids see [[ADL Transfering]]


=== Timeframe ===
=== Timeframe ===
* The ADL assessment should be determined on admission to the ward (not the first [[Service tmp entry]] with the exception of EMIP)
The ADL assessment (done by allied health or nurses) we utilize is the patient's state of activity on first [[Service tmp entry]]. When possible, use an ADL assessment done within 24 hours after the admission to the ward
{{DL |
* ADLs are mandatory right now. If we want to not fill them for EMIP we would need to update the cross check for this. It is so old that it's not even on wiki. So, we would need to decide exactly how we want to do this. Do we enter "unassisted" for these, or allow leaving them blank? If we want to leave them blank we also need to define what we will do with them for things like [[ALERT Scale]]. [[User:Ttenbergen|Ttenbergen]] 14:39, 16 June 2025 (CDT)
** This also raises the issue that the [[ALERT Scale]] values would likely change in reports, in the same way as the [[ADL Score]]. Do we really want to change this? I will email DR. [[User:Ttenbergen|Ttenbergen]] 09:54, 24 June 2025 (CDT)


<!--[[Function ADL_Yellower]]
=== Low functioning ADL due to condition that is expected to be temporary ===
[[Function Validate_ADL_Bathing]]
If a patient is admitted with a diagnosis that is expected to improve to the point of higher functioning ADLs (and they possibly have improved already by the time collection happens), code the ADLs that are expected to be the long-term state.
[[Function Validate_ADL_Dressing]]
{{Ex|
[[Function Validate_ADL_Toileting]]
A patient is admitted with [[Diabetic ketoacidosis (DKA)]] and is expected to improve with treatment to the point where they can manage their activities of daily living (ADLs) independently. Code the ADLs based on their anticipated long-term state of independent functioning, even if they are still experiencing limitations at the time of data collection.
[[Function Validate_ADL_Transfering]]
[[Function Validate_ADL_Continence]]
[[Function Validate_ADL_Feeding]]-->
}}
}}


*The ADL assessment (done by allied health or nurses) we utilize is the patient's state of activity '''on admission to the ward''' (not at home prior to admission).  
=== Directed Restrictions ===
* If the patient is an EMIP use first [[Service tmp entry]] instead of the admission to the ward
Directed restrictions on a patient's activities should not be assessed as requiring assistance. Code these based on what the patient would actually be capable of doing if they were permitted.
 
{{Ex|
{{Discuss | * using an ER based entry for EMIPs and a unit based entry for other patients would compare apples and oranges. It's a problematic idea, and the reason why we basically unified rules around collecting based on service start. If we want to create an exception for ADL (which will trickle into ALERT and possibly more) then we need to be very deliberate about this. [[User:Ttenbergen|Ttenbergen]] 09:54, 24 June 2025 (CDT)
A patient comes in with a stroke. They can mobilize independently and go to the washroom. The patient is then ordered to be on bedrest after a procedure. If the patient would be able to perform the activity if allowed then they are to be assessed accordingly. So in this case they would would be coded as '''unassisted'''.
 
}}
}}
When possible, use an ADL assessment done within 24 hours after the admission to the ward
=== Directed Restrictions ===
Directed restrictions on a patient's activities should not be assessed as requiring assistance. For example, if a pt is on bed rest restrictions, it does not mean that they are unable physically to get out of bed. If the patient would be able to perform the activity if allowed then they are to be assessed accordingly.  for example, if a patient comes in with a stroke, but can mobilize independently and go to the washroom, but is ordered to be on bedrest after a procedure, this would be coded as '''unassisted'''.


=== Where to get data ===
=== Where to get data ===
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* Integrated progress notes
* Integrated progress notes
* Risk assessment for falls form (if used)
* Risk assessment for falls form (if used)
== Data Entry Instructions ==
For every Medicine profile, enter the status into the ADL dropdown boxes in the [[Patient Viewer Tab ADL]] in [[CCMDB.accdb]].


=== Specific Activities collected ===
=== Specific Activities collected ===

Latest revision as of 22:30, 29 June 2025

The Activities of Daily Living (ADL) assesses a patient's capability to perform six daily self-care activities.

Collection Instructions

  • The ADL assessment should reflect the amount of assistance a patient requires to perform the six activities. It takes into consideration acute medical issues that resulted in admission to the hospital.
  • Using your best judgment based on age, diagnosis, pre hospital admission ADL, and #Where to get data below, select the option that best reflects their ADL status
  • For ostomy care see ADL Toiletting and ADL Continence
  • For use of mechanical aids see ADL Transfering

Timeframe

The ADL assessment (done by allied health or nurses) we utilize is the patient's state of activity on first Service tmp entry. When possible, use an ADL assessment done within 24 hours after the admission to the ward

Low functioning ADL due to condition that is expected to be temporary

If a patient is admitted with a diagnosis that is expected to improve to the point of higher functioning ADLs (and they possibly have improved already by the time collection happens), code the ADLs that are expected to be the long-term state.

Example:   

A patient is admitted with Diabetic ketoacidosis (DKA) and is expected to improve with treatment to the point where they can manage their activities of daily living (ADLs) independently. Code the ADLs based on their anticipated long-term state of independent functioning, even if they are still experiencing limitations at the time of data collection.

Directed Restrictions

Directed restrictions on a patient's activities should not be assessed as requiring assistance. Code these based on what the patient would actually be capable of doing if they were permitted.

Example:   

A patient comes in with a stroke. They can mobilize independently and go to the washroom. The patient is then ordered to be on bedrest after a procedure. If the patient would be able to perform the activity if allowed then they are to be assessed accordingly. So in this case they would would be coded as unassisted.

Where to get data

Data to evaluate ADL can be obtained from the following sources:

  • OT/PT initial assessment
  • Nursing activity flow sheets (if used)
  • Nursing database or primary care patient record
  • Integrated progress notes
  • Risk assessment for falls form (if used)

Data Entry Instructions

For every Medicine profile, enter the status into the ADL dropdown boxes in the Patient Viewer Tab ADL in CCMDB.accdb.

Specific Activities collected

See the following for specific coding instructions for the different activities.

Data Use

References/Background

The evaluation tool used for all Medicine patients is the Katz ADL.

  • S Katz et al. Studies of illness in the aged: the index of ADL. American Medical Association, 1963.
  • S Katz, SD Downs, HR Cash, RC Grotz. Index of daily living. The Gerontologist 1:20-301.

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