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The | The Katz Index of Independence in ''Activities of Daily Living'' commonly referred to as the Katz '''ADL''', is collected on all patients accepted to the Medicine service. | ||
* | *Katz ADL is used to assess functional status as a measurement of a patient's ability to perform activities of daily living independently. | ||
* | *Katz ADL ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence and feeding. | ||
*Adequacy of performance scoring: | *Adequacy of performance scoring: unassisted (independent) (0 points), minor assistance (3 points), major assistance (6 points). | ||
*The ADL is also being used as a component of the " | *The ADL is also being used as a component of the "[[MOST]]" Score | ||
== General Considerations == | == General Considerations == | ||
* ADL - assess functional status during the '''first 24 hours''' | * ADL - assess functional status during the '''first 24 hours''' after acceptance to medicine service. | ||
* Where a non-independent ADL is induced solely by medical intervention, estimate the ADL without intervention. | |||
* ADL assesses a patient "capability" to perform a certain activity if allowed. A patient who is | * ADL assesses a patient ''"capability"'' to perform a certain activity if allowed. A patient who is 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"'''. | ||
== '''Bathing''' == | == '''Bathing''' == | ||
| Line 27: | Line 27: | ||
* gets clothes and gets completely dressed without assistance | * gets clothes and gets completely dressed without assistance | ||
=== Minor === | === Minor === | ||
* gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items | * gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items | ||
=== Major === | === Major === | ||
* receives assistance in getting clothes or in getting dressed or stays partly or completely undressed | * 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 | Going to the "toilet room" for bowel movement and urine elimination; cleaning self after elimination, and arranging clothes | ||
=== Unassisted === | === Unassisted === | ||
* goes to "toilet room", cleans self, and arranges clothes without assistance (may use object for support such as cane, walker, or wheelchair and my manage night bedpan or commode, emptying same in the morning. | * goes to "toilet room", cleans self, and arranges clothes without assistance (may use object for support such as cane, walker, or wheelchair and my manage night bedpan or commode, emptying same in the morning. | ||
=== Minor === | === Minor === | ||
* 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. | * 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. | ||
===Major=== | ===Major=== | ||
* doesn't go to "toilet room" for elimination process | * doesn't go to "toilet room" for elimination process | ||
| Line 49: | Line 43: | ||
=== Unassisted === | === Unassisted === | ||
* moves in and out of bed as well as in and out of chair without assistance (may be using object for support such as cane or walker) | * moves in and out of bed as well as in and out of chair without assistance (may be using object for support such as cane or walker) | ||
=== Minor === | === Minor === | ||
* moves in and out of bed or chair with assistance | * moves in and out of bed or chair with assistance | ||
| Line 57: | Line 49: | ||
== '''Continence''' == | == '''Continence''' == | ||
Following discussion with [[Dr. Roberts]] and due to the way we use our data, our definition of "continence" differs somewhat from the Katz definition in our take on Foley catheters. In our definition a Foley catheter is to be scored as "unassisted" or as "major" depending on circumstances. | |||
=== Unassisted === | === Unassisted === | ||
* controls urination and bowel movement completely by self. | * controls urination and bowel movement completely by self. | ||
**Chronic Renal Failure (CRF) receiving regular dialysis- if patient can access and use a toilet by themselves and can control bowel function | **Chronic Renal Failure (CRF) receiving regular dialysis - if patient can access and use a toilet by themselves and can control bowel function | ||
**If patient manages | **If patient manages Foley at home on his own | ||
**If | **If Foley is inserted solely to keep track of fluid output | ||
=== Minor === | === Minor === | ||
* has occasional "accidents" | * has occasional "accidents" | ||
===Major=== | ===Major=== | ||
* supervision helps keep urine or bowel control; catheter is used, or is incontinent | * supervision helps keep urine or bowel control; catheter is used, or is incontinent | ||
*if | * if Foley inserted because patient is unable to control bladder function | ||
==Feeding == | ==Feeding == | ||
=== Unassisted === | === Unassisted === | ||
*feeds self without assistance | * feeds self without assistance | ||
* | * '''NPO due to pre-OP, tests or procedures or GI bleeding''' | ||
=== Minor === | === Minor === | ||
* feeds self except for getting assistance in cutting meat or buttering bread | * feeds self except for getting assistance in cutting meat or buttering bread | ||
===Major=== | ===Major=== | ||
* receives assistance in feeding of is fed partly | * receives assistance in feeding of is fed partly or completely by using tubes or intravenous fluids | ||
*E.G. Dysphagia[[User:TOstryzniuk|TOstryzniuk]] 17:59, 20 June 2008 (CDT) | * E.G. Dysphagia[[User:TOstryzniuk|TOstryzniuk]] 17:59, 20 June 2008 (CDT) | ||
===Discussion=== | ===Discussion=== | ||
* | * are there different degrees of disphagia, or would any lead to being scored as "major"?[[User:Ttenbergen|Ttenbergen]] 09:25, 22 July 2008 (CDT) | ||
{{Discussion}} | {{Discussion}} | ||
== Discussion == | == Discussion == | ||
* we | I am removing from the discussion what seems to be addressed above now[[User:Ttenbergen|Ttenbergen]] 09:25, 22 July 2008 (CDT) | ||
* Grace | * Where and how should this information be collected? There are differences in how the hospital work, but we should have a common starting direction at least. | ||
* Vic: go through ER, then as close as possible on Ward, OT/PT does good job usually within 24hr ( | |||
According to team meeting, | |||
* 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. | |||
* 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? | |||
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 | ** Worst in some locations | ||
** most likely accurate in other location | ** most likely accurate in other location | ||
** some use pre-admission ADL, some use | ** some use pre-admission ADL, some use only after WARD admission | ||
** "how they are normally" | ** "how they are normally" | ||
** some changed from "usual" pre-2007 to "worst" after | ** some changed from "usual" pre-2007 to "worst" after | ||
* | * "sedated patient is coded as if they were unassisted" - not true if the patient requires assistance when not sedated. Our definition above is clearer than this, so we should get rid of this. | ||
- | |||
* NPO due to pt aphasic = major (I suspect disphagic was intended here, or do we also have patients NPO because they can't talk? ) | |||
== Reference == | == Reference == | ||
Revision as of 08:25, 2008 July 22
The Katz Index of Independence in Activities of Daily Living commonly referred to as the Katz ADL, is collected on all patients accepted to the Medicine service.
- Katz ADL is used to assess functional status as a measurement of a patient's ability to perform activities of daily living independently.
- Katz ADL ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence and feeding.
- Adequacy of performance scoring: unassisted (independent) (0 points), minor assistance (3 points), major assistance (6 points).
- The ADL is also being used as a component of the "MOST" Score
General Considerations
- ADL - assess functional status during the first 24 hours after acceptance to medicine service.
- Where a non-independent ADL is induced solely by medical intervention, estimate the ADL without intervention.
- ADL assesses a patient "capability" to perform a certain activity if allowed. A patient who is 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".
Bathing
Either sponge bath, tub bath or shower.
Unassisted
- receives no assistance (gets in and out of tub if tub is the usual means of bathing)
Minor
- receives assistance in bathing only one part of the body (such as the back or leg)
Major
- 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 (including braces if worn)
Unassisted
- gets clothes and gets completely dressed without assistance
Minor
- gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items
Major
- 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
Unassisted
- goes to "toilet room", cleans self, and arranges clothes without assistance (may use object for support such as cane, walker, or wheelchair and my manage night bedpan or commode, emptying same in the morning.
Minor
- 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.
Major
- doesn't go to "toilet room" for elimination process
Transfer
Unassisted
- moves in and out of bed as well as in and out of chair without assistance (may be using object for support such as cane or walker)
Minor
- moves in and out of bed or chair with assistance
Major
- doesn't get out of bed
Continence
Following discussion with Dr. Roberts and due to the way we use our data, our definition of "continence" differs somewhat from the Katz definition in our take on Foley catheters. In our definition a Foley catheter is to be scored as "unassisted" or as "major" depending on circumstances.
Unassisted
- controls urination and bowel movement completely by self.
- Chronic Renal Failure (CRF) receiving regular dialysis - if patient can access and use a toilet by themselves and can control bowel function
- If patient manages Foley at home on his own
- If Foley is inserted solely to keep track of fluid output
Minor
- has occasional "accidents"
Major
- supervision helps keep urine or bowel control; catheter is used, or is incontinent
- if Foley inserted because patient is unable to control bladder function
Feeding
Unassisted
- feeds self without assistance
- NPO due to pre-OP, tests or procedures or GI bleeding
Minor
- feeds self except for getting assistance in cutting meat or buttering bread
Major
- receives assistance in feeding of is fed partly or completely by using tubes or intravenous fluids
- E.G. DysphagiaTOstryzniuk 17:59, 20 June 2008 (CDT)
Discussion
- are there different degrees of disphagia, or would any lead to being scored as "major"?Ttenbergen 09:25, 22 July 2008 (CDT)
Discussion
I am removing from the discussion what seems to be addressed above nowTtenbergen 09:25, 22 July 2008 (CDT)
- Where and how should this information be collected? There are differences in how the hospital work, but we should have a common starting direction at least.
According to team meeting,
- 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.
- 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?
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
- "sedated patient is coded as if they were unassisted" - not true if the patient requires assistance when not sedated. Our definition above is clearer than this, so we should get rid of this.
- NPO due to pt aphasic = major (I suspect disphagic was intended here, or do we also have patients NPO because they can't talk? )
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.