Toilet Transfer
Mr. H has paraplegia, pneumonia, and COPD. Mr. H prefers to use the bedside commode when moving his bowels. Due to his severe weakness, history of falls, and dependent transfer status, two helpers assist during the toilet transfer.
01- Dependent
Score Roll Left and Right
Mr. R has a history of skin breakdown. The nurse instructs him to turn onto his right side providing step-by-step instructions to use the bedrail, bend his left leg, and then roll onto his right side. The patient attempts to roll with the use of the bed-rail, he indicates he cannot do the task. The nurse then rolls him onto his right side. Next, the patient is instructed to return to lying on his back, which he successfully completes. Mr. R then requires physical assistance from the nurse to roll onto his left side and return to lying on his back to complete the activity.
02-Substantial Assist
Score Sit to Stand
Mr. M has osteoarthritis and is recovering from sepsis. Mr. M transitions from a sitting to a standing position with the steadying (touching) assistance of the nurse’s hand on Mr. M’s trunk
04- Supervision
Beth has a SCI and has no control of her bladder. Because of a pressure ulcer on her buttocks, she does not wear a diaper in bed to prevent additional breakdown. Her bladder program has been very difficult since admission and she wets her chux pad several times per day. The nurse changes the pad after each episode.
04- Always incontinent
Peter is on a regular diet. He is impulsive because of a TBI and requires supervision and cueing while eating to stay focused and finish his meal.
B- Modified food consistency/supervision
Peter requires supervision to eat his food safely.
Shirley uses a rolling walker to ambulate to the bathroom. Once in the bathroom, she transfers to and from a raised toilet seat without additional assistance. A member of housekeeping staff flushes the toilet for Shirley
06- independent
Score Sit to Lay
Mrs. H requires assistance from a nurse to transfer from sitting at the edge of the bed to lying flat on the bed because of paralysis on her right side. The helper lifts and positions Mrs. H’s right leg. Mrs. H uses her arms to position her support body. Overall, Mrs. H. performs more than half of the effort.
03- Partial Assist
Score Sit to Sit
uMs. P has metastatic bone cancer, severely affecting her ability to use her lower and upper extremities during daily activities. Ms. P is motivated to assist with her transfers from the side of her bed to the wheelchair. Ms. P pushes herself up from the bed to begin the transfer while the helper provides trunk support. Once standing, Ms. P shuffles her feet, turns, and slowly sits down into the wheelchair with the helper providing trunk support. Overall, the helper provides less than half of the effort.
03- Partial Assist
Code 0- always continent
David eats regular solid foods that he chews and swallows safely, but his liquids must be thickened in order to prevent aspiration.
B- Modified food consistency/supervision
David is on a regular diet, but drinks must be thickened
A helper provides lowering assistance and Marcus transfers onto the toilet. When Marcus is finished, the helper lifts him off the toilet and provides contact guard assistance as he ambulates out of the bathroom.
02- Substantial assistance!
Score Lay to Sit
Ms. P is being treated for sepsis and has multiple infected wounds on her lower extremities. Full assistance from the helper is needed to move Ms. P from a lying position to sitting on the side of her bed because she usually has pain in her lower extremities upon movement.
01- Dependent
Ellen's nurse positions her wheelchair and removes the leg rests, after which Ellen stands on her own without additional assistance
05- Setup/Supervision
Sam had prostate surgery and no longer has urinary sphincter control. He wears a condom catheter continuously to protect his clothing and collect urine.
09-Not Applicable!
Joyce passed a barium swallow test in acute care and was placed on a regular diet. At the time of her admission to the IRF, she remains on a regular diet, but requires daily flushes to maintain the patency of her g-tube
A- Regular food.
Joyce is on a regular diet, she is having her tube flushed in order to maintain patency, it is not being used to supplement her diet.
Marla is on bedrest and requires a bedpan for both bladder and bowel management. a helper positions the bedpan, which Marla holds in place while she uses it. The helper empties the bedpan.
88- not attempted due to medical conditions or safety concerns.
Code Sit to lay
Chris requires assistance from a nurse to transfer from sitting at the edge of the bed to lying flat on the bed. The nurse lifts and positions Chris' left leg and Chris uses his arms to position his upper body and right leg.
03-Partial Assistance.
Code Sit to Sit:
Cathy requires assistance form a helper as she gets out of bed to her wheelchair. the helper provides CGA as Cathy stands up from the side of the bed. The help then provides trunk support as Cathy pivots and sits down in the wheelchair
03- Partial assistance!
Mary did not have a bowel movement for several days prior to IRF admission. Stool softeners and a laxative were ordered and administered on day 1. On Day 2 and 3, Mary soiled her clothing with feces before she could get to the bathroom.
04-Always incontinent.
Karly is on a regular diet with thickened liquids. Because her calorie count is low, she is supplemented daily with tube feedings.
B and C Modified food consistency/supervision and tube/parenteral feeding
Once standing, a helper provides contact guard assistance to George as he ambulates to the bathroom with a rolling walker and sits down. After using the toilet, George stands without assistance and uses the safety bars to support himself while performing hygiene. He has difficulty pulling up his pants, and despite cues, the helper must assist with pulling up his pants. He ambulates back to bed using the RW as the helper provides contact guard assistance.
04-Supervision/steadying assistance.
*be careful not to merge toilet transfer and toileting hygiene!
Code lay to sit
Roxanne requires some lifting assistance from the CNA to sit upright in bed. The CNA provides steading assistance as Roxanne scoots to the edge of the bed. The CNA then lowers Roxanne's feet to the floor.
02-Maximal/Substantial Assist!
Sarah uses a slide board to get from bed to wheelchair. A helper provides lifting assistance for Sarah's torso and both legs as she goes from supine to sitting position at edge of bed. The helper then positions the slide board and provides a boost to Sarah as she begins the transfer. Sarah completes then completes the transfer without further assistance.
03- Partial assistance
*be careful- some items run together!
Annie has urinary incontinence during her first night at the rehab unit, was continent throughout day 2, and had one episode of incontinence during day 3.
02- incontinent less than daily.
Jake was on a modified diet in the first two days of his IRF stay. After an eval by speech, Jake was upgraded to a regular diet with thin liquids.
A and B- regular food and modified food consistency/supervision
Jake was initially on a modified diet, then upgraded to regular diet. must code all three days.