Assessing Patient Medical Need

Clinical professionals across all care settings perform multiple assessments of an individual’s ability to accomplish activities of daily living.  These assessments provide an indication of the medical equipment an individual will need.

Physicians use a variety of tools to assess individuals needs for durable medical equipment.  These assessments include: 

• Activities-Specific Balance Confidence Scale
• Barthel ADL Index
• Berg Balance Scale
• Dynamic Gait Index
• KATZ Index of Independence in Activities of Daily Living
• Morse Fall Scale
• Pain, Activity and general enjoyment of life scale
• Schmid Fall Risk Scale
• STEADI Fall Risk
• Time Up and Go 
• Tinetti Performance Oriented Mobility Assessment
• Tinetti Balance and Gait Instrument
•  Amputee Mobility Predictor Assessment Tool

These assessments tools help the medical provider and the individual determine what medical equipment is needed to prevent falls and help the individual maintain independence.  

Individuals over 65-year-old, or with other medical needs, should be assessed annually for the need for medical equipment.

ADL/MRADL Assessment Across Care Setting

Health care teams use the minimum data set (MDS) to communicate individuals clinical progress as they move across care settings – from the hospital to a skilled nursing / rehabilitation facility to the individuals’ home with care from a home health agency.    A standardized assessment is used across all these care settings to evaluate the individual’s ability to perform activities of daily living.  These assessments provide important information to determine what medical equipment an individual needs.

Implications for Durable Medical Equipment:

• Patients having difficulty with Indoor Mobility should be evaluated for a walker, rollator or wheelchair

• Patients may need to move to the next level of assistive device.
  • Walker to Lightweight Wheelchair
  • Lightweight Wheelchair to Tilt-In-Space Manual Wheelchair
  • Manual Wheelchair to Power Wheelchair
• Patients may need additional equipment to maximize their function
  • Wheelchair/hospital bed – is transfer equipment (transfer board, patient lift) needed?
  • Wheelchair/hospital bed – is commode needed
  • Wheelchair/hospital bed – is pressure ulcer prevention support surface (gel mattress overlay, low air loss mattress, wheelchair cushion) needed?
• Patients are eligible for new equipment every five years – is it time for patient to get new equipment?

• Patient with difficulty with toileting hygiene should be evaluated for a commode

• Patients with difficulty rolling left and right are unable to perform independent repositioning.  These patients should be evaluated for a hospital bed with a gel mattress overlay.
• Patients with difficulty transitioning from sit to lying or lying to sitting should be evaluated for a hospital bed, with a trapeze and a gel mattress overlay.
• Patients with difficulty transitioning from sit to stand should be evaluated for a walker
• Patients with difficulty transferring from chair (wheelchair) / bed-to-chair (wheelchair) should be evaluated for a transfer board, or a patient lift.
• Patients with difficulty performing toilet transfer should be evaluated for a commode
• Patients with difficulty walking 10 feet should be evaluated for a wheelchair
• Patients with difficulty walking 50 feet with two turns should be evaluated for a walker/rollator
• Patients with difficulty walking 150 feet should be evaluated for a walker to assist with sit to stand balance issues. 
• Patients with difficulty wheeling 50 feet or 150 feet should be evaluated for a transition from their current wheelchair to a tilt-in-space wheelchair or a power wheelchair

Fall Prevention Programs

Falls and fear of falling limit older adults’ activity levels and ability to perform activities of daily living.  Durable medical equipment plays an important role in preventing falls and addressing environmental factors that increase falls.  Walkers and rollators should be considered for individuals with early stage balance issues and for individuals with fears of falling.

Wound Prevention & Treatment Programs

A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure.  

Predisposing factors are classified as intrinsic (e.g., limited mobility, poor nutrition, comorbidities, aging skin) or extrinsic (e.g., pressure, friction, shear, moisture)

The selection of medical equipment addresses the extrinsic factors of pressure, friction, shear, and moisture. 

• Tilt-in-space manual wheelchairs reduce friction and sheer for patients.
• Skin protection wheelchair cushions reduce pressure
• Gel mattress overlay reduces pressure 
• Low air loss mattresses reduce pressure and moisture

Respiratory Assessment

Oxygen therapy is often prescribed to patients to reduce shortness of breath, fatigue and cough.  Oxygen therapy can help patients increase physical capacity, improve activities of daily living and enhance overall quality of life.

Individuals have faced barriers to implantation of oxygen therapy at early disease stages, including

• Inaccuracies in pulse oximetry readings
• Size and restrictions on mobility and activities imposed by stationary oxygen concentrators
• Lack of community access to suppliers of oxygen therapy

Portable Oxygen Concentrators create the opportunity to increase early intervention with oxygen therapy and improve patient outcomes.