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 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

(2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Amini, D. A.; Kannenberg, K.; Bodison, S.; Chang, P.; Colaianni, D.; Goodrich, B.; Lieberman, D. Occupational therapy practice framework: Domain & Process (3rd ed.). American Journal of Occupational Therapy. 2014;68, S1-S48. doi:10.5014/ajot.2014.682006 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Braddom, R. L.; Chan, L.; Harrast, M. A.; Kowalske, K. J.; Matthews, D. J.; Ragnarsson, K. T.; Stolp, K. A. (2011). Physical medicine and rehabilitation. Philadelphia: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Centers for Medicare & Medicaid Services. (2019). NQF 2633. Inpatient rehabilitation facility (IRF) functional outcome measure: Change in self-care score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
Centers for Medicare & Medicaid Services. (2019). NQF 2635. Inpatient rehabilitation facility (IRF) functional outcome measure: Discharge self-care score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
Chan, E. Y.; Samsudin, S. A.; Lim, Y. J. Older patients’ perception of engagement in functional self-care during hospitalization: A qualitative study. Geriatric Nursing. 2019;, 1-8. doi:10.1016/j.gerinurse.2019.11.009 Source[Expert/Committee Opinion]
Edemekong, P. F.; Bomgaars, D. L.; Levy, S. B.. (2020). Activities of daily living. Treasure Island, FL: StatPearls. doi:10.1016/j.apnr.2019.151189 Source[Expert/Committee Opinion]
Fan, B. J.; Wong, R. Y. Effect of cognitive training on daily function in older people without major neurocognitive disorder: A systematic review. Geriatrics. 2019;4(3), 44. doi: 10.3390/geriatrics4030044 Source[Systematic Review]
Freedman, V. A.; Kasper, J. D.; Spillman, B. C. Successful aging through successful accommodation with assistive devices. The Journals of Gerontology: Series B. 2017;72(2), 300-309. doi:10.1093/geronb/gbw102 Source[Review Articles]
Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Hoeman, S. P. (2008). Rehabilitation nursing prevention, intervention, and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Lehman, C. (2015). The specialty practice of rehabilitation nursing: A core curriculum. Chicago: Association of Rehabilitation Nurses. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Lim, Y. M.; Kim, H.; Cha, Y. J. Effects of environmental modification on activities of daily living, social participation and quality of life in the older adults: A meta-analysis of randomized controlled trials. Disability and Rehabilitation: Assistive Technology. 2020;15(2), 132-140. doi:10.1080/17483107.2018.1533595 [Meta-analysis]
Mauk, K. L. (2012). Rehabilitation nursing: A contemporary approach. Sudbury, MA: Jones & Bartlett Learning. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Registered Nurses' Association of Ontario. (2015). Person- and family-centred care. Source[Quality Measures,Clinical Practice Guidelines]
Roberts, C. E.; Phillips, L. H.; Cooper, C. L.; Gray, S.; Allan, J. L. Effect of different types of physical activity on activities of daily living in older adults: Systematic review and meta-analysis. Journal of Aging and Physical Activity. 2017;25(4), 653-670. doi:10.1123/japa.2016-0201 Source[Meta-analysis,Systematic Review]
Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc and its successor in interest, UDSMR, LLC. (2015). NQF 2287. Functional change: Change in motor score. Source[Quality Measures,Clinical Practice Guidelines]
Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc and its successor in interest, UDSMR, LLC. (2019). NQF 2286. Functional change: Change in self-care score. Source[Quality Measures,Clinical Practice Guidelines]
Vining Radomski, M.; Trombly Latham, C. A. (2014). Occupational therapy for physical dysfunction. Baltimore: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Wang, D. X.; Yao, J.; Zirek, Y.; Reijnierse, E. M.; Maier, A. B. Muscle mass, strength, and physical performance predicting activities of daily living: A meta‐analysis. Journal of Cachexia, Sarcopenia and Muscle. 2019;11(1), 3-25. doi:10.1002/jcsm.12502 Source[Meta-analysis]

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.

;

Cookies are used by this site. To decline or learn more, visit our cookie notice.