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Careplan

IRF, BADL Impairment, Adult

Feb.28.2019

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 care

A. The patient will achieve the following goals:
  • Optimal Safe BADL Performance

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • 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 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

  • 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, a division of UB Foundation Activities, Inc. and its successor in interest, UDSMR, LLC.

    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 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

References

  • Agency for Healthcare Research and Quality (AHRQ). (2016). NQF 2635. Inpatient rehabilitation facility (IRF) functional outcome measure: Discharge self-care score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2286. Functional change: Change in self care score. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2287. Functional Change: Change in motor score. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2633. Inpatient rehabilitation facility (IRF) functional outcome measure: Change in self-care score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
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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.