ADLs Flow Sheet

Usually you chart at the end of the shift. You can't really chart on something that hasn't happened yet. However, it's a pain in the butt to stand around at the end of the day waiting for your turn for the books, so I try to get it done a little bit early. After our last rounds we have side work to do, like linens and passing more snacks. I'll do my charting before I start the side work. If it's check-off charting, you can usually do that early, then go back later to quickly skim through the book and make sure it was all done and mark your refusals, if you had any. If you don't know your residents very well you may have to make notes on a lot of little things and it's actually better to do that early on in the shift. You don't want to be charting at the end of the day and realize that you were supposed to put skin sleeves on someone 8 hours ago.

As for the sheets where you have to chart how well the resident participated in their ADLs or something like that, you can't do it before you've done the care. I have seen other CNAs just copy the codes from the previous day, and that's not always accurate. Some residents' abilities change daily depending on their mood, meds, condition, etc.

As you get to know the residents it becomes easy to remember everything. When I first started I had to write everything down. Now if you asked me how much each of my residents ate or drank yesterday, how many times they were incontinent, and who had a bowel movement, I could tell you :)

I have my own system for doing the ADL sheets. At the beginning of the shift, I flag each ADL sheet for my shift out of the top of the binder and leave it in a cubby on the hall, or somewhere where it is "safe." I fill it out throughout the entire shift; as soon as I do cares for someone, I run over to the book and mark how they did (independent, x1, or x2). Whenever I complete the sheet for a certain resident, I unflag it. I don't save ADL sheets for the end, because that means MORE stress that I have to deal with.

If I mark someone as doing something one way, then later in the shift they end up doing it another way, then I go back and change it on the ADL sheet to reflect this. For instance, if Mr. John was independent with a walker, but then later in the shift he falls and needs 2 people to help get him up, then I will change the ADL sheet to x2. They are supposed to reflect the "most help" the resident needed during the shift.

All in all, I may spend 20-30 minutes doing the ADL sheets. If I am working rehab for the first time in awhile and I don't know the residents very well, it will take slightly longer.

A lot of people DO copy the prior day's information, but it is so important not to do this. The information that CNAs write is used to determine the amount of money the facility will receive in reimbursement from Medicare. If incorrect information is used, the facility will lose money.

I sometimes look at the ADL sheets for residents I am less familiar with. It helps me to know how well they have been doing their cares and how much assistance they require. CNA care plans are great, but they don't always contain accurate and up-to-date detailed information. The MDS coordinator looks at the sheets and uses them in care-planning as well as the Medicare reimbursement I mentioned.

Thank you very much fuzzywuzzy and coffeemateCNA for the reply, it was very helpful.

QUESTIONS:

I have some patients that eat/drink in the dinning room and some in their bedroom. And sometime I was assigned on the floor to feed the pt and sometime in the dinning room. So let's say I'm assign on the floor to feed the pt then I would know how much these pt eat and drink but for those pt that eat in the dinning room I'm not there w/ them so I dont know much they eat/drink.

So how do we suppose to know how much the patient drink if we're not the one there to feed them? Even if I'm not there to feed my pt I can still figure out how much they eat b/c they charted in the diet binder so all I have to do is look there. But this diet binder doesnt chart down how much the pt drink so how am I know how much they drink b/c I'm not there to feed them so I dont know about it?

I asked this one CNA how to figure how much the pt drink and she told me that if they charted in the diet book that the pt eat 100% then that mean the pt drink 100% too. But what if the pt eat 35%, 50%, ect.then how do we know how much they drink? I know it easy if I'm there to feed them b/c I would know but I'm not there so how do we find out about it? I'm very confusing about figure out how much the pt drink. Please help!!!

And one more question, how do you figure out how many time your independent pt go poo and pee? Do you ask them to get the info inorder to know it so you can chart it down on the ADLs sheet? For the dependent pt it easy to figure out but for the independent one I dont know b/c they didnt need help take to the toilet so I have no idea. So do you ask your independent pt like how many BM they have or how do you figure out about it so that you can put it down in the ADLs? IDK but I feel weird to ask my pt about that.

It sounds like there are problems with the form your facility is using for charting. There should be a space to indicate fluid intake during the meal.

At my facility, we have one person to chart meal intake (including fluids). It goes in its own special book. Everybody, though, is responsible for their own fluid intake records between meals. This is includes water from their water pitcher, fluids used to give meds, etc. We record it on intake and output sheets that are part of the care plan, but like I said, it only includes fluid between meals. We are not responsible for recording fluids given with meals, since that information is already present in the other book.

You will have to ask your independent residents those questions each shift. Try to ask them before they go to bed, that way you won't have to go wake them up later (when you're doing your charting at the end of the shift, if that's when you do it). It feels weird, but I guarantee you are not the only person who asks them this; they are used to it.