Consider a patient’s safety in performing ADL tasks, not just the ability to perform them

I recently heard from an agency with this patient: He has end-stage COPD with dyspnea on almost all ADL’s, even on 3 liters/minute of oxygen.  His O2 saturation remains at 96-98% even when having significant dyspnea, as long as he remains on O2.

He lives with his son and is alone during the day.  He is able to do his own grooming, make his lunch, transfer on-off his toilet  and walk in the home without a device.  He is, however, very S.O.B. doing these things. Breathing, however, is not considered for things like toilet transfer.

Is he scored as being able to do these items independently?

It is important to remember that the ADL questions include the patient’s safety in performing the tasks, not whether he has the ability to perform the tasks. Dyspnea doesn’t necessarily make the patient unable to perform the task safely. On the other hand, if the patient becomes so dyspneic that he collapses, that would indicate he is unsafe. The questions also do not consider efficiency. For example, if he has to take rest breaks during the tasks, those rest breaks do not impact the scoring. The rest breaks actually may increase the safety.

Remember to consider safety as you rate your patients.

One Comment to “Consider a patient’s safety in performing ADL tasks, not just the ability to perform them”

  1. The patient may tell you he can do ADLs independently, but until you actually observe him doing these tasks as a “dry run” that is the only way to actually determine the safety factor. Please avoid “arm chair assessments”.

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