LHCR / Home Health Newsletters

January 2008

AMBULATION/LOCOMOTION

Ambulation/Locomotion (M0700) identifies the patient’s ability to safely walk, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

The most important thing is ensuring your staff consistently understands the question and knows how to answer it correctly.  Observe the patient during ambulation and determine the amount and/or type of assistance required for safe mobility.  A combination of assessment, observation and interview with the patient and/or caregiver may be required to make the correct determination.  Here are some tips to make your assessment smoother:

• In determining the amount of assistance required by patient, consider the patient contribution should be at least 75% of the effort.  

• Determine if medical restrictions are impacting the patient’s ability to ambulate safely.  As restrictions change, so will the patient’s ability.

• Endurance should not be included.

• Focus on ability and safety, not on compliance or willingness.  Patients who combine walking and wheelchair use should be assessed on their ability to walk safely.

• If patient’s gait is unsteady and they rely on furniture for support, consider requesting an assistive device.

We know the importance of interpreting the OASIS terminology by all staff members in the same way.  We also know this can be a challenge so we’ve listed some clarifications for your review. 

• Assistance includes any combination of hands-on assistance, standby assistance, supervision, verbal cueing or reminders.  Assistance should be equal to or less than 25% of the total effort. 

• A patient is considered chairfast even if they can stand, bear weight and take one to two steps to complete the transfer but otherwise unable to ambulate.

• If a patient is chairfast, determine their ability to use their wheelchair. 

• Wheelchair use includes both manual and powered wheelchairs.

We’ll leave you with one last thought.  Don’t just observe your patient’s ability to ambulate.  Ask yourself if anything could help them.  Some suggestions are:

• Would therapy potentially help the patient be more independent and safer? 

• Are there any DME aids (i.e., cane, walker) the patient could rent temporarily or purchase?

• Could the home environment benefit from any minor modifications?

Proper and consistent assessment is important in managing your patient’s health status.  We can provide you with the tools to improve performance and increase efficiency while still providing patient centered care.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.