ADL General Collection Information: Difference between revisions

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'''Activities of Daily Living''' (ADL) refers to daily self-care activities within an individual's place of residence, in outdoor environments, or both. The evaluation tool used by Medicine is the Katz ADL and is used for all Medicine patients.
The '''Activities of Daily Living''' (ADL) assesses a patient's capability to perform six daily self-care activities.  


Specifically, the Katz ADL tool is used to:
== Collection Instructions ==
* Assess a patient's functional status as a measurement of their ability to perform activities of daily living independently.
* 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.
* Rank adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding.
* 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]]


== Activities ==
=== 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


{| class="wikitable"
=== Low functioning ADL due to condition that is expected to be temporary ===
! Activity || Description || Unassisted || Minor Assistance || Major Assistance
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.  
|-
{{Ex|
|  Bathing
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.
|| Either sponge bath, tub bath, or shower
}}
|| Receives no assistance (gets in and out of tub if tub is the usual means of bathing)
|| Receives assistance in bathing only one part of the body (such as the back or leg)
|| Receives assistance in bathing more than one part of the body (or not bathed)
|-
|  Dressing
|| Gets clothes from closets and drawers including underclothes, outer garments, and using fasteners, e.g., for braces
|| Gets clothes and gets completely dressed without assistance
|| Gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items
|| Receives assistance in getting clothes or in getting dressed or stays partly or completely undressed
|-
|  Toileting
|| Going to the "toilet room" for bowel movement and urine elimination; cleaning self after elimination, and arranging clothes
|| Goes to "toilet room", cleans self, and arranges clothes without assistance; may use object for support such as cane, walker, or wheelchair and may manage night bedpan or commode, emptying same in the morning
|| Receives assistance in going to "toilet room" or in cleansing self or in arranging clothes after elimination or in use of night bedpan or commode
|| Doesn't go to "toilet room" for elimination process
|-
|  Transferring
|| Moving from one place to another while performing activities
|| Moves in and out of bed as well as in and out of chair without assistance; may use object for support such as cane or walker
|| Moves in and out of bed or chair with assistance
|| Doesn't get out of bed
|-
|  Continence
|| Control of urination and bowel movements
|| Controls urination and bowel movement completely by self, including patients with chronic renal failure; manages Foley at home on own (Foley is inserted solely to keep track of fluid output)
|| Has occasional "accidents"
|| Supervision helps keep urine or bowel control; catheter is used, or patient is incontinent; Foley is used because patient is unable to control bladder function (if it cannot be determined if the patient would be continent without a foley and the patient has a Foley, then score as major)
|-
|  Feeding
|| Preparing and eating food
|| Feeds self without assistance; NPO due to pre-OP, tests or procedures or GI bleeding
|| Feeds self except for getting assistance in cutting meat or buttering bread
|| Receives assistance in feeding of is fed partly or completely by using tubes or intravenous fluids; dysphagia
|}


== Assessment guidelines ==
=== Directed Restrictions ===
An ADL assessment is usually done within 24 hours of admission (done by allied health or nurses). The ADL assesses a patient's capability to perform a certain activity.  Restrictions on a patient's activities should not be assessed as requiring assistance. For example, if a pt is on bedrest 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. The ADL assessment we utilize is the patient's state of activity on admission (not at home prior to admission). It takes into consideration acute medical issues that resulted in admission to the hospital.  --[[User:LKolesar|LKolesar]] 15:10, 2013 May 30 (EDT)
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|
== Where to get data ==
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:
Data to evaluate ADL can be obtained from the following sources:
* OT/PT initial assessment
* OT/PT initial assessment
Line 59: Line 30:
* Risk assessment for falls form (if used)
* Risk assessment for falls form (if used)


== Scoring ==
== Data Entry Instructions ==
Performance of each of the activities is evaluated as unassisted (0 points), minor assistance (3 points), or major assistance (6 points).
For every Medicine profile, enter the status into the ADL dropdown boxes in the [[Patient Viewer Tab ADL]] in [[CCMDB.accdb]].
 
'''Total ADL Score''' is the sum of points of all the six activities.
 
ADL is also part of the [[MOST]] score.


As per email from Julie 2013-12-17:
=== Specific Activities collected ===
Ed’s database assigns the points 1, 3, 6 to unassisted, minor and major respectively.
See the following for specific coding instructions for the different activities.
* [[ADL Bathing]]
* [[ADL Dressing]]
* [[ADL Toiletting]]
* [[ADL Transfering]]
* [[ADL Continence]]
* [[ADL Feeding]]


But in calculating the MOST Score, the point for unassisted  has zero point instead of one.
== Data Use ==
 
* [[ADL Score]]
So maybe you have to change the S_ADL options from 2,4,6  not to 1,3,6  but 0,3,6.
* [[ALERT Scale]]
 
 
== References ==


== 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 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.
* S Katz, SD Downs, HR Cash, RC Grotz. Index of daily living. ''The Gerontologist'' 1:20-301.


[[Category:ADL|*]]
== Related articles ==
[[Category:Medicine Elements]]
{{Related Articles}}
[[Category:MOST Score Elements]]
 
[[Category:ADL| *]]
[[Category:Data Collection Guide]]
[[Category:ALERT Scale Elements]]

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.

Related articles

Related articles:
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