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.
• 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. 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

• Needs to include where this data is to be gathered from, and where not, i.e. 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. Ttenbergen 15:02, 21 August 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.
  • 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?

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? )

• • • I have a patient who came in with independent ADLs then went to the cath lab and had a coronary angio complicated by an embolic stroke.Now he is a complete in bathing and major in mobility .So I guess I can only change my adls if the stroke occurred within 24 hours .Is this correct?

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.

• http://classes.kumc.edu/som/amed900/ExposureSkills/Katz_Index_ADL.htm
  • This is a dead end link that doesn't provide any information, therefore should be taken out.

TOstryzniuk 13:06, 19 November 2008 (CST)

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

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