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Tip of the week: Incorporate ADL tracking tools in your everyday care planning

Contemporary Long-Term Care Weekly, October 9, 2008

Editor’s note: The following article and tools are excerpted from The Big Book of Care Plans: Best Practices for Interdisciplinary Assessments and Care Planning by Debbie Ohl, RN, NHA. For more information or to order a copy, call 800/650-6787 or go towww.hcmarketplace.com and type the title in the search box.

Decline in ADL is a common issue for nursing home residents and needs to be documented appropriately. When used as designed, the following ADL tools will help you to enhance resident outcomes and meet the test of regulatory scrutiny, says author Debbie Ohl, RN, NHA, long-term care consultant and educator with Ohl and Associates in Cincinnati.

RAP evaluations. Comprehensive professional assessments support MDS coding and provide a clear rationale for decision-making when you complete the documents in their entirety. These assessments keep you from having to double back to complete RAPs triggered by the MDS. That’s because the related RAP guidelines have been incorporated into the assessments, Ohl stresses. The “RAP evaluation for activities of daily living” chart on p. 3 of the PDF of this issue covers all of the points that you need for care planning. The ADL RAP will always be triggered unless the resident is independent in all areas, which is rare. Consequently, it’s not necessary to wait until the MDS has been completed to fill out the RAP and complete the RAP evaluation.

Tracking tools. Tools such as the “Seven-day core ADL tracking tool” chart on p. 4 of the PDF of this issue are for the direct-care staff and unit nurses and are laid out in a user-friendly format. Use this form to further enhance accurate MDS coding and aid communication among and between disciplines.

Use of the ADL trackers will ensure up-to-the-minute snapshot status for the MDS assessment reference date (ARD). These trackers should be initiated six days prior to the ARD and completed through the ARD, Ohl recommends.

Trackers for different areas of care allow the social services, dietary, and activities disciplines to complete their assessments in a more flexible time frame. That’s because the trackers ensure that data are collected through the ARD, Ohl says.

Any variance in information on the trackers from the professional assessments alerts the disciplines to any changes in the resident (e.g., differences or shifts in perception, performance, or behavior). The trackers will always facilitate interdisciplinary communication.

As long as the ADL trackers are used in the MDS ARD window, it’s unnecessary for each discipline to use the same date on their assessments, thereby allowing a more comprehensive evaluation for the quarter. If the trackers are in conflict, communication must be established, and it only requires an additional short note from the affected discipline to ensure that everyone is in concert.

These conflicts are easily resolved if each discipline reviews the MDS prior to locking and sending it, Ohl advises. And, of course, the MDS coordinator is the double assurance validator, alerting others to possible conflicts as he or she correlates information. Every effort must be made to ensure that information is as accurate and up-to-date as possible. But when you use these tools, make sure that you keep abreast of any ongoing changes and clarifications that might affect the way that you use them, Ohl cautions.

Regardless of the type of documentation format that you use, the individual reviewer’s expertise is vital in completing and analyzing the information. Forms that are well constructed can go a long way toward assisting in an effective review, Ohl adds.

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