Careplan
IRF, BADL Impairment, Adult
BADL Impairment (Adult IRF)
Clinical Description
- Care of the patient experiencing impairment related to performance of BADLs (basic activities of daily living), such as bathing, dressing, self-feeding, toileting or grooming.
Key Information
- Achieving independence in BADLs (basic activities of daily living) significantly decreases the physical and time burdens on caregivers, while helping the individual to achieve a sense of dignity and privacy.
- The bathroom is a location where falls or injuries are more likely to occur. It is important to address bathroom safety issues, such as ability to safely negotiate small spaces, water temperature, lighting and electrical safety.
- Consider the patient’s cultural norms, priorities and preferences when promoting BADL (basic activity of daily living) performance.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Optimal Safe BADL Performance
- Education: Overview
- Education: Self Management/Training
- Education: When to Seek Medical Attention
Correlate Health Status
Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
BADL (Basic Activities of Daily Living) Impairment
Signs/Symptoms/Presentation
- activity intolerance
- bathing or showering ability limited
- dressing ability limited
- grooming ability limited
- limited endurance
- requires assistance with BADLs
- requires prompting to perform BADLs
- self-feeding ability limited
- toileting ability limited
Problem Intervention
Optimize Basic Activity of Daily Living Skills
- Assess BADL (basic activity of daily living) abilities; encourage participation at maximally safe independent level.
- Provide assistance and supervision needed to maintain safety; involve caregiver in BADL (basic activity of daily living) training.
- Ensure effective use of equipment or devices, such as a long-handled reacher, shower seat or orthosis.
- Ensure proper body mechanics and positioning for optimal task performance.
- Provide set-up of items if patient is unable to retrieve; store personal care items in accessible location.
- Schedule BADL (basic activity of daily living) activities when pain and fatigue are at a minimum; pace activity to conserve energy.
- Identify and address impairments or safety issues affecting performance, such as balance, strength or cognition.
- Provide BADL (basic activity of daily living) re-training with therapeutic interventions.
Associated Documentation
- Self-Care (BADL) Promotion
Education
CPG-Specific Education Topics
Overview
risk factors
signs/symptoms
Self Management/Training
energy conservation
equipment/methods
safety techniques
When to Seek Medical Attention
new or worsening symptoms
General Education Topics
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
Quality Measures
- NQF 2286. Functional Change: Change in Self Care Score
Change in rasch derived values of self-care function from admission to discharge among adults receiving inpatient medical rehabilitation and discharged alive. The timeframe for the measure is 12 months. The measure includes the following 8 items: Feeding, Grooming, Dressing Upper Body, Dressing Lower Body, Toileting, Bowel, Expression, and Memory.
Steward: Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. and its successor in interest, UDSMR, LLC.
Care Setting: Inpatient/Hospital, Post-Acute Care
National Quality Forum-endorsed measure.
Last Edited: 10/25/2019
- NQF 2287. Functional Change: Change in Motor Score
Change in rasch derived values of motor function from admission to discharge among adult inpatient rehabilitation facility patients aged 18 years and older who were discharged alive. The timeframe for the measure is 12 months. The measure includes the following 12 FIM® items: Feeding, Grooming, Dressing Upper Body, Dressing Lower Body, Toileting, Bowel, Expression, Memory, Transfer Bed/Chair/Wheelchair, Transfer Toilet, Locomotion and Stairs.
Steward: Uniform Data System for Medical Rehabilitation
Care Setting: Home Care, Inpatient/Hospital, Post-Acute Care
National Quality Forum-endorsed measure.
Last Edited: 07/23/2015
- NQF 2633. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
This measure estimates the risk-adjusted mean change in self-care score between admission and discharge for Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients.
Steward: Centers for Medicare and Medicaid Services
Care Setting: Post-Acute Care
National Quality Forum-endorsed measure.
Last Edited: 10/25/2019
- NQF 2635. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients
This measure estimates the percentage of IRF patients who meet or exceed an expected discharge self-care score
Steward: Centers for Medicare and Medicaid Services
Care Setting: Post-Acute Care
National Quality Forum-endorsed measure.
Last Edited: 10/25/2019
References
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Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.
