ADL Facility Assessment Checklists - Kansas Foundation for ...
ADL Facility Assessment Checklists - Kansas Foundation for ...
ADL Facility Assessment Checklists - Kansas Foundation for ...
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Checklist: <strong>ADL</strong> <strong>Assessment</strong> (Cont.)10. Environmental factors:a. FurnitureYesb. Building (configuration, size of room)Y Nc. OtherY N11. Family Support, caregiver involvement Y N12. Customs, religious beliefs that may affect healthcare Y N13. Ability to learn:YNoNPersonResponsible:Comments:a. Barriers to participation/learning (vision, hearing,language, comprehension, memory, depression,interest…)b. Preferred learning style14. Current treatment interventionsa. Frequency, duration, time of dayb. Response to treatments15. Need to refer resident to other health professional<strong>for</strong> management of health components outside yourprofessional scope of practice?16. Follow-up recommendations:a. Revise current <strong>ADL</strong> goals, plan of careb. Refer to therapy <strong>for</strong> comprehensive assessmentc. Recommend equip, environmental modifications,etc.d. Initiate <strong>ADL</strong>/restorative programe. Continue current restorative programf. Discharge from <strong>ADL</strong>/restorative programg. Other (describe)YYYYYYYYYYYYNNNNNNNNNNNNIf any of the above elements in your process are missing:• Choose one element to focus your quality improvement ef<strong>for</strong>t on first.• Start with the Quality Improvement Worksheet A: Identifying Areas <strong>for</strong> Improvement to collect datato investigate further.• Follow the Quality Improvement Worksheets to implement missing element(s) and monitor regularlyto determine whether implementation is successful.If none of the above elements are missing from your facility’s processes, please continue to the nextchecklist.
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