ADL General Collection Information

General Considerations

• 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".

Discussion

where to get the data

Different places use any of the following as sources for ADLs; are any of these inappropriate?

• physio discharge notes
  • are inappropriate etc. Yes, the instruction that data should be during the first 24hrs may already say that, but maybe not for patients discharged after less than a day

• Grace gets what they can off ER sheet, then use ward records; This may not be "within first 24 hrs of admission" - is it good enough?

• Vic: go through ER, then as close as possible on Ward, OT/PT does good job usually within 24hr (most patients are assessed). Lots of nursing home placements are why this is done - does OT/PT use the same criteria as us? If not, this likely is not appropriate.
  • The OT/PT notes include functional status prior to admission and a current functional status at the time of the assessment. These notes are very detailed. We have also been seeing more and more detailed home care reports on the patient's charts regarding functional status and services that are in place prior to admission.TAngell 09:53, 20 November 2008 (CST)

• StB: ER assessment for falls assessment / risk sheet / prevention program; sometimes filled by ward nurses, then you have physio and OT and home care, latter usually for elderly patients only. - as above, are those who fill out other ADLs using the same criteria as us?

• HSC Med Wards: Fall 2009-New tool introduced on some wards is Patient handling/transfer/falls assessment sheet. Should be completed at ward admission. Sometimes there is a physio assessment in ER but it is not always complete. When all else fails check with patient's nurse or unit assistant.--FLindell 13:11, 7 January 2010 (CST)

which of several values to use

• 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?
  • Worst in some locations
  • most likely accurate in other location
  • some use pre-admission ADL, some use only after WARD admission
  • "how they are normally"
  • some changed from "usual" pre-2007 to "worst" after

Reference

• 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.

• S Katz, TD Downs, HR Cash, RC Grotz, (1970). Index of Activities of Daily Living, The Gerontologist, 1:20-301.

Discussion

• the charting of the assessment of ADL is different between hospitals. Bedside nurses do not use the same criteria (ADL guidelines) to assess minor vs major therefore, are other collectors having to make assumptions because it is not clear on the charting?
• are other collectors able to clearly discern where the patient fits into each category for ADL or do they mostly have to make assumptions and use best guess?--Marie Laporte

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