ADL Facility Assessment Checklists - Kansas Foundation for ...

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Checklist: Monitoring and Reassessing ADL FunctionDoes your facility have a process to monitor and regularly reassess ADL function/abilities ofresidents currently in an ADL or restorative nursing program?______ No. If no, this is an area for improvement. Use this checklist and the Quality ImprovementWorksheets to guide your team in implementing a process to monitor and reassess ADL functionthat includes the key components outlined below.______This is an area we are working on. Our target date for revising ADL monitoring andreassessment process is __________. If needed, use the Quality Improvement Worksheets toguide your improvement process.______Yes. Please continue to the questions below.Does your facility’s monitoring and reassessment process include the following components?1. Does your documentation system allow you torecord:YesNoPersonResponsible:Comments:a. Current health condition, comorbidities thatmay influence functionYNb. Response to current interventionsYNc. Type of interventions, treatments providedYNd. Type of ADL performed (eating, transfers)YNe. Level of self-performanceYNf. Amount of assistance given by caregiverYNg. Devices/equip requiredYNh. Frequency ADLs performed (daily, 3x/wk)YNi. Duration of activity (30 mins, etc.)YNj. Progress toward established goalsYNk. Cancellation, refusal of treatment and reasonYNl. Resident’s attitude toward ADL programYNm. Change in statusYNn. Need for reassessmentYNo. Need for referral to other health professionalto mange condition(s) outside yourprofessional scope of practiceYN2. Does your facility have a policy and procedure forreassessing residents at regular intervals afterthey have started a restorative program?YN
Checklist: Monitoring and Reassessing ADL Function (Cont.)3. Does your facility have a process for therestorative nurse aide or certified nurse aide tonotify an RN and rehab designee of a change inresident’s response to ADLs &/ or restorativeprogram?4. Does your facility discuss residents’ ADL statusand related issues at the interdisciplinary careplanning meeting?5. Does your facility reassess the resident when theresident or family expresses a concern regardinga change or decline in ADL abilities?YesYYYNoNNNPersonResponsible:Comments:If any of the above elements in your process are missing:• Choose one element to focus your quality improvement effort on first.• Start with the Quality Improvement Worksheet A: Identifying Areas for 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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ADL Facility Assessment Checklists - Kansas Foundation for ...

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