ADLs: Plan of Care - Primaris

1 adls : plan of care Key Steps Key Elements Diagnosis and functional Identify clinical conditions impacting ADL decline ability identification Develop plan of care Develop plan of care Match interventions with specific conditions Coordinate plan and care with health care team, resident, family, caregivers Implement selected Implement Selected Interventions interventions Functional training in self- care adls Functional training in simulated environments Exercise Device and equipment use and training Task adaptation Barrier accommodation or modification Safety awareness training Injury prevention or reduction education Restorative nursing program Family, caregiver education, training Referrals to other health professionals as appropriate [Guide to Physical Therapist Practice.]

2 2nd ed. Phys Ther. 2001;81:9-744]. Manage general health Continue to monitor: throughout all stages of Comorbid conditions treatment Acute illness Nutrition, hydration Bowel, bladder function Prevent complications from developing: Deep vein thrombosis Dysphagia, aspiration Skin breakdown UTI. Falls Loss of ROM. Immobility Edema Adverse drug reaction Depression From Clinical Practice Guideline, Post-Stroke Rehabilitation, Quick Reference Guide 16, AHCPR. Measure, monitor, and Record clinical condition, expected outcomes, frequency, duration document outcomes of interventions, resp to treatment, education, progress toward goals Review and revise plan of Review, revise plan of care care Based on resident's response, team feedback MO-03-09-NHAD April 2003.

3 This material was prepared by Primaris under contract with the Centers for Medicare & Medicaid Services (CMS). The contents presented do not necessarily reflect CMS policy. Version 03/11/2003 Page 5.