CNA ADL training


Hi, everyone. I left MDS a couple years ago to do floor nursing, and I just recently started back in MDS. One of the tasks I've been assigned is to shadow CNAs to observe their ADL care, and then match the care I've observed to how they're documenting the ADL care.

I know ADL documentation is an issue in every building, probably everywhere in the country...but because this is part of the money making, this building is trying to ensure as much ADL accuracy as possible. My question is:

Does anyone have any pointers or suggestions for training CNAs how to correctly document the care they're providing for residents? Occasional in-services definitely don't work, colorfully printed graphics explaining the difference between independent, supervision, limited assistance, extensive assistance, and total dependence don't seem to work.

Other problems I've encountered is trying to explain the difference between walking and locomotion, charting before actually caring for the residents, when they should chart "activity did not occur." and generally being diligent about charting their ADL care for residents.

Thanks for any tips and pointers!


1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.

Rather than obligating the CNAs to learn the same terminology the MDS compel nurses to understand and code, try to rephrase the definition in a simple easy-to-associate manner. Avoid the words supervision, limited assistance, extensive assistance, total dependence and their definitions. And, if possible deflect from using number "8" during ADL training.

0 - no see, no look, no watch

1 - watch or talk, but no touch

2 - touch to guide but not hold or support

3 - do part, partly hold or support, patient participates (CNA effort less 100%)

4 - do all, full strength hold or support, patient does nothing (CNA effort = 100%)

X - activity did not happen this shift (nurse, of course, realizes this means 8). Albeit with e-record, X is not an option.

There may be several mnemonics but only persistent education and reeducation will prevail.

classicdame, MSN, EdD

2 Articles; 7,255 Posts

Specializes in Hospital Education Coordinator.

Create scenarios for each of the areas requiring attention, then have each CNA come in one at a time to "test" orally. I would try to test them in 1-2 days so they do not have much time to share notes. You need to be able to ask why they chose that answer and why it does not meet expectations. I found this mnemonic in an HC-PRO program regarding evaluations. BEER. What is the behavior that is not meeting expectations? What effect does that behavior have on the patient and the unit in general? What is the expectation? What would be the result if the wrong behavior was consistently being practiced? Focus on 1-2 topics in the beginning and later you can have another session on another topic. If someone excels in a specific area, ask that person to coach their co-workers.

Has 9 years experience.

I explained the importance of documentation for reimbursement and lack of documentation = lack of monetary reimbursement to all nursing and CNAs in my first months of working as a MDS Coordinator I had a significant increase in accurate and complete documentation from all shifts and positions.


77 Posts

At my facility I do an orientation with the CNA's and participate in the Daily Huddles to pass along tips and pointers for accurate documentation. The SNF CNA's are for the most part accurate in their documentation. My problem, however, is that we frequently have float CNA's pulled from our Inpatient Rehab Facility on a different floor who rush through the ADL documentation, so I often see documentation that bilateral amputees and residents with bilateral lower extremities contractures WALKED in the room and hallways when they in fact DID NOT. When I have adequate documentation from Therapy and Nursing that makes it clear the resident could not ambulate, I code an 8, but always worry that their rushing through is going to cause an inaccurate code.

savoytruffle, BSN, RN

1 Article; 154 Posts

The first thing I did as an MDS dept leader was to cut down the CNA documentation. The RN doing the MDS had a difficult enough time with ambulation vs locomotion. I needed the late loss info directly from care givers. Once they only had to worry about learning those four ADLs they had an easier time. We would run a contest with prizes during nursing week. Trivia questions based on adl scenarios. The CNA and LPN staff could enter an a drawing was held from al the correct answers. We inserviced twice a year on coding. Any new hire received education as part of orientation. There were laminated cue cards by each care tracker and I would give out my extension to anyone having a hard time. Once in a while I would be called to a unit by an aide or the RN to settle a debate on an ADL question.