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".

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?

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? )

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.