ADL General Collection Information

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 should be determined on admission to the ward (not the first Service tmp entry with the exception of EMIP)

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. 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 have emailed DR. Ttenbergen 12:40, 24 June 2025 (CDT)

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• 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).
• If the patient is an EMIP use first Service tmp entry instead of the admission to the ward

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. Ttenbergen 09:54, 24 June 2025 (CDT)

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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

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.

• ADL Bathing
• ADL Dressing
• ADL Toiletting
• ADL Transfering
• ADL Continence
• ADL Feeding

Data Use

• ADL Score
• ALERT Scale

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.