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== General Considerations ==
The '''Activities of Daily Living''' (ADL) assesses a patient's capability to perform six daily self-care activities.  
* [[:Category:ADL | ADL]] - assess functional status during the '''first 24 hours''' after the patient has been "accepted" to medicine service by a medicine service attending physician. 
* If dependancy of an ADL is induced solely by medical intervention, estimate the ADL without intervention.
* ADL assesses a patient ''"capability"'' to perform a certain activity if allowed. Patients who are ordered not to do a certain activity should '''not''' be assessed as requiring assistance. If patient ''would be able'' to perform the activity if allowed then they are to be assessed as '''"unassisted"'''
* If the patient is''' surgical''' take the ADL prior to surgery. This information is from Fran Lindell who gets the renal transplants.


{{Discussion}}
== 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]]


== Discussion ==
=== Timeframe ===
=== where to get the data===
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
This information can be obtained from a variety of sources '''in the first 24 hours''' depending on the timing and details documented.For example:
*OT/PT intial assessment
*nursing activity flow sheets if used
*Nursing data base or Primary patient care record
*Integrated progress notes
*risk assessment for falls form if used


=== which of several values to use ===
=== Low functioning ADL due to condition that is expected to be temporary ===
*We have addressed that status during first 24 hrs is what should be collected. Should it really be '''worst''' status during the first 24 hrs?{{Discussion}}
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.  
** most likely accurate in other location
{{Ex|
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.
}}


===specific guidelines===
=== 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.
{{Ex|
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)


== Reference ==
== Data Entry Instructions ==
*Studies of Illness in the Aged: The Index of ADL; a standardized measure of ...ological and Psychological functioning. by Katz S, et al.. Copyright 1963 by the American Medical Association. Reprinted with permission of AMA via the Copyright Clearance Center.  
For every Medicine profile, enter the status into the ADL dropdown boxes in the [[Patient Viewer Tab ADL]] in [[CCMDB.accdb]].


* S Katz, TD Downs, HR Cash, RC Grotz, (1970). Index of Activities of Daily Living, ''The Gerontologist'', 1:20-301.
=== Specific Activities collected ===
See the following for specific coding instructions for the different activities.
* [[ADL Bathing]]
* [[ADL Dressing]]
* [[ADL Toiletting]]
* [[ADL Transfering]]
* [[ADL Continence]]
* [[ADL Feeding]]


==Discussion==
== Data Use ==
[[Category: ADL|*]]
* [[ADL Score]]
[[Category: Questions_ADL]]
* [[ALERT Scale]]
ADL Unassisted Minor Major
 
ADL Bathing Receives no assistance Needs assistance with only one part of body (such as back or leg). Needs assistance with more than one part of the body.
== References/Background ==
ADL Continence Controls urination and BM’s completely by self. If has foley used solely for fluid output issues.  Home foley:  manages on his own.  Has occasional incontinence Needs supervision to maintain urine or bowel control or is incontinent. Foley if used for incontinence.
The evaluation tool used for all Medicine patients is the Katz ADL.
ADL Feeding Feeds self without assistance. Feeds self except for assistance with ie cutting meat, buttering bread. Pt requires feeding partly or completely.  Also for tube feeds, TPN and dysphagic pts.
* S Katz et al. Studies of illness in the aged: the index of ADL. American Medical Association, 1963.
ADL Toileting Independent in going to toilet room.  Able to clean self, etc. May need aids like cane or wheelchair. Needs some assistance like help with cleaning self or with arranging clothing after elimination, but can go to the toilet room Does not go to the washroom for elimination. Needs commode or bed pan. 
* S Katz, SD Downs, HR Cash, RC Grotz. Index of daily living. ''The Gerontologist'' 1:20-301.
ADL Transferring Can move in and out of bed and in and out of chair without assistance.  May use cane or walker. Needs some assistance to get in and out of bed and in and out of chair. Does not get out of bed.
 
== Related articles ==
{{Related Articles}}
 
[[Category:ADL| *]]
[[Category:Data Collection Guide]]
[[Category:ALERT Scale Elements]]
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