Kohlman Evaluation of Living Skills (KELS) of the Hospitalized Patient. Family Medicine Residency Program at Wesley. Objectives

Transcription

1 Kohlman Evaluation of Living Skills (KELS) of the Hospitalized Patient Jonathan Baalman, MD Family Medicine Residency Program at Wesley 1 Objectives Identify the use of KELS Explain the elements evaluated by KELS List strengths and weaknesses of KELS Interpret the scoring from a KELS 2 1

2 Patient Case HPI: 75 y/o female with h/o COPD 3 day h/o productive cough, subjective fevers, similar to previous pneumonia. Ran out of COPD meds 1 week ago. Pneumonia 8 months ago. O2 sat 86% on room air PMH: COPD, hypertension, kidney stones, pneumonia resulting in collapsed lung, Alzheimer dementia 3 Patient Case MEDICATIONS: Ipratropium, Albuterol, Combivent, Nitroglycerin, Metoprolol, Aspirin, Namenda ALLERGIES: Penicillin, Sulfa, Keflex, Aspirin, Ceclor, Erythromycin, Ibuprofen, Codeine, Contrast dye SOCIAL HISTORY: smoked 14 year 1/2 ppd, quit 6 years ago, lives alone in apartment REVIEW OF SYSTEMS: positive for fever, congestion, chest pain, dyspnea, cough, nausea, muscle aches 4 2

3 Patient Case PHYSICAL EXAMINATION: BP 148/72, P 92, RR 20, O2 sat 100% on 3 L O2 via NC, T 98.8 Alert, in no acute distress, wheezing throughout, diminished bilaterally, 3/6 systolic murmur, RRR LABORATORY DATA: WBC 10.8, Na 131, lactic acid 1.8. Trop <0.04 RADIOLOGY: CXR: mixed opacities in R hilum and the L base, atelectasis vs infection. Small L pleural effusion, chronic pulmonary vascular congestion, hyper inflated lungs 5 Patient Case: Assessment and Plan 1. COPD exacerbation vs pneumonia. CXR, prednisone 40 mg. Levofloxacin 750 mg, O2 at 3 L and DuoNeb 2. Hyponatremia/Dehydration chronic, NS at 75 ml/h 3. Hypertension Home metoprolol 4. Heart murmur 2/2 aortic stenosis, Echo/Cardiology 5. Consult if additional concern during hospital stay 6. Alzheimer disease Home Namenda 7. Consult case management Possible KELS evaluation 6 3

4 What is a KELS evaluation? 7 What is a KELS eval? Kohlman Evaluation of Living Skills (1992) used to determine a person s ability to function in basic living skills Create recommendations for appropriate living situations for a patient 17 skills tested in 5 areas Self care Safety and health Money management Transportation and telephone Work and leisure Administered by OT and takes mins 8 4

5 What is a KELS eval? Ideal for subjects in geriatric, acute care, in patient psychiatric, cognitively disabling disorders Measures what a patient can do and areas where patient needs assistance Goal is to successfully integrate individual into his or her environment 9 Administered quickly Strengths Easy to score Can be administered in nearly any setting Measures multiple areas 10 5

6 Weaknesses Measures what client does and not what they want to do Skills not measured in natural environment Validated on small sample size Based on urban lifestyle, may not be as applicable in rural setting 11 Scoring Based on questions asked and observations while administering Two categories: Independent and Needs Assistance Independent = 0 points Needs Assistance = 1 point, except in work and leisure where it = ½ point Scoring <5 ½ = patient capable of independent living > 6 = patient needs assistance Observations and recommendations also provided by the OT at bottom of score sheet 12 6

7 Patient is 75 y/o F with pneumonia Prior level of function/equipment owned Patient lives with: Alone in apartment Steps: 0 steps to enter, no steps within the apartment Prior functional level: Independent with all ADL's and IADL s. Does not drive or work. Does not use A.D. for ambulation Patient/family goal: Would like to return to her apartment alone, does not have family close by and does not want them to be involved 13 IND NEEDS ASSISTANCE SELF CARE :N :A 1. Appearance : :X 2. Frequency of self care activities (self report) SAFETY AND HEALTH :X : 1. Awareness of dangerous household situations (from photographs) :X : 2. Identification of appropriate action for sickness and accidents :X : 3. Knowledge of emergency numbers : :X 4. Knowledge of location of medical and dental facilities MONEY MANAGEMENT : :X 1. Use of money in purchasing items :X : 2. Obtain and maintain source of income : :X 3. Budgeting of money for food : :X 4. Budgeting of monthly income : :X 5. Use of banking forms :X : 6. Payment of bills TRANSPORTATION AND TELEPHONE : :X 1. Mobility within community :X : 2. Basic knowledge of transit system : :X 3. Use of phone book and telephone WORK AND LEISURE :N :A 1. Plans for future employment : :X 2. Leisure activity involvement TOTAL:

8 SELF CARE Unable to identify the date Looked in her purse to remember her address Stated: "I have Alzheimer's, how am I supposed to remember these things Only eats 1X a day, she is not hungry to eat more SAFETY AND HEALTH Reports all health and safety questions correctly Except location of doctors/ dentist facilites Does not have either, would drive until she found a doctor s office if she needed to see a doctor 15 MONEY MANAGEMENT Refused to complete the following items, stating I am able to do these, why do I need to show you Did not complete the money purchasing items and budgeting of monthly income Gets monthly income from S.S. and would call them if it didn t come Unable to correctly fill out a check and check register Budgets $100 for food Able to correctly read a bill and state how she would appropriately take care of it 16 8

9 TRANSPORTATION AND TELEPHONE Requires assistance for transportation Receives rides from neighbor Able to dial a phone correctly, but then not able to retrieve the information from the phone call she was instructed to do Able to state how she would use the bus 17 WORK AND LEISURE No plans to work No leisure activities Stays in her apartment and likes to be alone Does not have life alert, has two phones in her apartment When asked what she would do if she fell, stated she would just crawl to the bedroom to get a phone 18 9

10 Conclusions KELS can determine a person s ability to function in basic living skills Ideal for patients with cognitive disabilities in geriatric, acute care and in patient psychiatric settings Administered quickly and easy to score Measures 17 different skills in 5 areas 19 Reference Thomson, Linda Kohlman. Kohlman evaluation of living skills. Rockville, MD : American Occupational Therapy Association,

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