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

This information can be obtained from a variety of sources in the first 24 hours depending on the timing and details documented.For example:

• OT/PT assessment
• Activity flow sheets if used
• Nursing data base
• nurses note
• risk assessment for falls form if used

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