adl sample exercises -...

Training - August 7th, 2014

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ADL SAMPLE EXERCISESADL SAMPLE EXERCISES


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EXAMPLE #1

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date

ARDDay 6Day 5Day 4Day 3Day 2Day 1

Toilet Use - How resident uses the toilet room, commode, bedpan, or urinal;transfers on/off toilet, cleanses self after elimination; changes pad; manages ostomy or catheter and adjusts clothes.

N=Nights D=Day E=Evenings

Transmitted Correctg p g y jDo not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag.

7NS77E

NS1FS4ES2ES2ES3ES0ES2D

TSFS7TS3FS4FS4ES4NSelf

Perform

IntIntIntIntIntIntInt

TransmittedValue

3

CorrectValue

2 2 3 6

X X 2

8

87

3 2

707E

02200D

0343NSupport Provided

7NS77E

3ADL Score

4ADL Score

2 2 x

8

24

1Applicable Rule of 33. When an activity occurs 3 or more times and at multiple levels,

b t t 3 ti t l l l th f ll ibut not 3 times at any one level, apply the following:c. When there are 3 or more episodes of a combination of full

staff performance, weight-bearing assistance, and/or non-weight-bearing assistance code limited assistance (2)

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weight bearing assistance, code limited assistance (2).


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EXAMPLE #2

Total assistance (4) occurred four times Li it d i t (2) d fi ti Limited assistance (2) occurred five times

• 4,4,4,4, 2,2,2,2,2

Answer:D Code 3D. Code 3

Applicable Rule of 3pp2. When an activity occurs 3 or more times at multiple levels,

code the most dependent level.

3


4


EXAMPLE #3

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date


Bed Mobility-How resident moves to and from lying position, turns side to side,and positions body while in bed or alternate sleep furniture.


TransmittedValue

CorrectValue

NS2TS0ES0NS2NS3NS3NS0E


TS0FS0FS0FS0TS0TS0TS0NSelf

Perform

IntIntIntIntIntIntIntValue

0

Value

1

2002220E

0000000D

0000000NSupport Provided2 2

ADL Score

0ADL Score

0 1

Applicable Rule of 3Applicable Rule of 3If none of the above are met, code Supervision (1)

4


5

EXAMPLE #4

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date


Transfer - How resident moves between surfaces including to or from: bed, chair, wheelchair, standing position(excludes to/from bath/toilet).


TransmittedValue

CorrectValue

NS1ES2ES2NS1ES7NS1NS1E

ES0FS0ES0ES0ES0ES0ES0D

TS3FS8TS4FS8TS8TS7TS8NSelf

Perform


3 1

2221221E

0000000D


ADL Score

2ADL Score

02 0Applicable Rule of 32 When an activity occurs 3 or more times at2. When an activity occurs 3 or more times at

multiple levels, code the most dependent level.

5


6

EXAMPLE #5A

5/21/135/20/135/19/135/18/135/17/135/16/135/15/13Date


Transfer - How resident moves between surfaces including to or from: bed, chair, wheelchair, standing position


C tg g p

(excludes to/from bath/toilet).



Perform


TransmittedValue

4

CorrectValue

7

8888888E

8838888D



3 3ADL SADL Score

4ADL Score

0Exceptions for the Rule of 3:Exceptions for the Rule of 3:• Code 7 – as this code only applies if the activity

occurred only 1 or 2 times.

6


7

MEDICAL DOCUMENTATIONEXAMPLE #5BEXAMPLE #5B

5/19/13 @ 8:00 AM: Resident required total assistance of one CNA when transferred from bed to chair Ed Skeleton RNbed to chair. Ed Skeleton, RN

5/19/13 @ 12:00 PM: Resident required total assistance of two CNAs when transferred from chair to bed for nap. Ed Skeleton, RN

5/19/13 @ 2:00 PM: Resident required total assistance of one CNA when transferred fromassistance of one CNA when transferred from bed to chair prior to attending activities. Ed Skeleton, RN

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EXAMPLE #5B

5/21/135/20/135/19/135/18/135/17/135/16/135/15/13Date




Transmittedl

CorrectValue(excludes to/from bath/toilet).




Perform


7

Value

4

8888888E

8838888D


ADL Score ADL Score

0 4Exceptions for the Rule of 3:• Code 0, Code 4, and Code 8 – as the definition for these coding

levels are finite and cannot be entered on the MDS unless it is the level that occurred every time the ADL occurred.

8


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MEDICAL DOCUMENTATIONEXAMPLE #5CEXAMPLE #5C

5/19/13 @ 8:00 AM: Family (daughter and son) @ y ( g )provided total assistance when transferring from bed to chair. Ed Skeleton, RN

5/19/13 @ 12 00 PM T h i t ff id d 5/19/13 @ 12:00 PM: Two hospice staff provided total assistance when transferred from chair to bed for nap. Ed Skeleton, RN

5/19/13 @ 2:00 PM: Daughter provided total assistance when transferring from bed to chair prior to attending activities Ed Skeleton RNprior to attending activities. Ed Skeleton, RN

9


10

EXAMPLE #5C

5/21/135/20/135/19/135/18/135/17/135/16/135/15/13Date




TransmittedValue

CorrectValue( / / )




Perform


4

Value

8

8888888E

8838888D


ADL Score

4ADL Score

4 0Exceptions for the Rule of 3:• Code 0, Code 4, and Code 8 – as the definition for these coding

l l fi it d t b t d th MDS l it ilevels are finite and cannot be entered on the MDS unless it is the level that occurred every time the ADL occurred.

• Family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period

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for that activity over the entire 7 day period.


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EXAMPLE #6

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date


Toilet Use - How resident uses the toilet room, commode, bedpan, or urinal;


transfers on/off toilet, cleanses self after elimination; changes pad; manages ostomy or catheter and adjusts clothes.Do not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag.

NS1FS1ESES3ES3ES1ES1D


P f


TransmittedValue

3

CorrectValue

10

1 0 0

0000000E

0002200D


NS1TS1ES1NS1NS1NS1ND1EPerform3

2 2

10

3

0

ADL Score

2ADL Score

0Improper correction process

Applicable Rule of 31. When an activity occurs 3 or more times at any one level,

d th t l l

11

code that level.


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EXAMPLE #7

5/21/135/20/135/19/135/18/135/17/135/16/135/15/13Date


Transfer - How resident moves between surfaces including to or from: bed chair wheelchair standing position


CTransfer - How resident moves between surfaces including to or from: bed, chair, wheelchair, standing position(excludes to/from bath/toilet).



Perform


TransmittedValue

4

CorrectValue

2

2822223E

1221222D



3 3ADL SADL Score

4ADL Score

1Applicable Rule of 32. When an activity occurs 3 or more times at multiple

levels, code the most dependent level.

12


13

EXAMPLE #8

5/21/135/20/135/19/135/18/135/17/135/16/135/15/13Date


Transfer - How resident moves between surfaces including to or from: bed chair wheelchair standing position


CTransfer - How resident moves between surfaces including to or from: bed, chair, wheelchair, standing position(excludes to/from bath/toilet).



Perform


TransmittedValue

4

CorrectValue

2

2822223E

1221222D



3 3ADL SADL Score

4ADL Score

1Applicable Rule of 32 Wh ti it 3 ti t lti l2. When an activity occurs 3 or more times at multiple

levels, code the most dependent level.

13


14


EXAMPLE #9

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date




TransmittedValue

CorrectValue

8888883N




Perform


1 18

8888888E

8280828D


ADL Score

0ADL Score

8

0

Applicable Rule of 3If none of the above are met, code Supervision (1)

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MEDICAL DOCUMENTATIONEXAMPLE #10EXAMPLE #10

Resident is tube fed for all nutrition all seven days of the look back period; staff provides the tube feedingthe look-back period; staff provides the tube feeding (resident does not participate in the task)

Resident started working with speech therapy on the fourth day of the look-back period

On the fourth and fifth days, the resident participated in eating some pureed food with speech therapist eating some pureed food with speech therapist (resident tried to pick up the spoon each day)

On sixth day, the resident was able to swallow the food offered by the speech therapist but the therapist neededoffered by the speech therapist but the therapist needed to spoon feed it to the resident with no participation by the resident

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MEDICAL DOCUMENTATIONEXAMPLE #10EXAMPLE #10

How would you code Column 1; Self-PerformanceHow would you code Column 1; Self PerformanceE. Code 4

Applicable Rule of 31. When an activity occurs 3 or more times at any one level,

code that level.

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EXAMPLE #11

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date




TransmittedValue

CorrectValue

0000000N




Perform


0 1

0002020E

0000000D


ADL Score

0ADL Score

00 0Applicable Rule of 3If none of the above are met code Supervision (1)If none of the above are met, code Supervision (1)

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EXAMPLE #12

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date


Eating-How resident eats and drinks regardless of skill. Do not include eating/drinking during medication pass.Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition,

IV fluids administered for nutrition or hydration)


Transmitted CorrectV lIV fluids administered for nutrition or hydration).




Perform


2

Value

2

2222222E

2222222D


ADL Score

1ADL Score

11 1Applicable Rule of 31. When an activity occurs 3 or more times at any one level,1. When an activity occurs 3 or more times at any one level,

code that level.

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EXAMPLE #13

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date


Eating-How resident eats and drinks regardless of skill. Do not include eating/drinking during medication pass.Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition,

IV fluids administered for nutrition or hydration).TransmittedValue

CorrectValue

1TS1NS3E


FS4FS4TS4TS4TS4NSelf

Perform


4 3

22E

2111112D


ADL Score

3ADL Score

23 2Applicable Rule of 33b. When there is a combination of full staff performance

and weight bearing assistance that total 3 or more times—code extensive assistance (3).

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EXAMPLE #14

5/15/135/14/135/13/135/12/135/11/135/10/135/09/13Date




TransmittedValue

CorrectValue

0000000N




Perform0 1

0000010E

0000000DSupport Provided1 1

ADL Score

0ADL Score

00Applicable Rule of 3If none of the above are met, code Supervision (1)If none of the above are met, code Supervision (1)

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MEDICAL DOCUMENTATIONEXAMPLE #15

Resident was in facility for less than 24 hours. Bed mobility only occurred six times

EXAMPLE #15

y y Once the resident was totally dependent Twice the staff needed to pull the resident up in bed;

he pushed up with his feet both times Three times the resident required verbal

encouragement to change positionsencouragement to change positions How would you code Self-performance?

Code of 1Code of 1Applicable Rule of 31. When an activity occurs 3 or more times at any one level,

d th t l l

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code that level.


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MEDICAL DOCUMENTATIONEXTRA CREDIT EXAMPLE 16EXTRA CREDIT EXAMPLE 16

3 0 1 2 0 0 23 0 1 2 0 0 20 4 0 0 1 0 4

How would you code Self performance?0 0 0 0 3 0 0

How would you code Self-performance?Code of 1

Applicable Rule of 3If f th b t d S i i (1)

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If none of the above are met, code Supervision (1)

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