AM-PAC 6 clicks

Question 1

What is the AM-PAC 6 clicks used for?

Answer 1

Used to decide where a pt is going following acute care

- assesses inpatient ADLs and basic mobility

Question 2

What are the 6 questions for basic mobility short form?

Answer 2

How much difficulty does the pt currently have:

1. Turning over in bed (incl adjusting bedclothes, sheets, and blankets)
2. Sitting down on and standing up from a chair with arms?
3. Moving from lying on back to sitting on the side of the bed?

How much help from another person does the pt currently need:

4. moving to and from a bed to a chair?
5. to walk in the hospital room?
6. Climbing 3-5 steps with a railing?

Question 3

What are the 6 questions for inpatient ADL short form?

Answer 3

How much help from another person does th pt currently need:

1. putting on and taking off regular lower body clothing?
2. bathing?
3. Toileting, which includes using toilet, bedpan, or urinal?
4. putting on and taking off regular upper body clothing?
5. Taking care of personal grooming such as brushing teeth?
6. eating meals?

Question 4

What ICF domain does the AM-PAC 6 clicks measure?

Answer 4

Activity

- designed for post acute rehab, but now utilized broadly in the acute setting

Question 5

What does a lower score on this assessment indicate?

Answer 5

greater impairment

• pts with more than 1 visit in acute care had lower first visit scores on both forms compared with pts with only one visit
• older pts have lower sores

Question 6

What is the basic mobility MDC? ADL MDC?

Answer 6

basic mobility MDC = 4.75

ADL MDC = 5.49

Question 7

What is the cut of score on the basic mobility form? ADL cut off score?

Answer 7

mobility = 43.7 (or 42.9 on another slide)
ADL = 39.4

Question 8

True or False:
Pts who were discharged from the acute hospital to the physical therapist recommended discharge destination were re-admitted less frequently than those discharged to an alternate location

Answer 8

True

Question 9

What are key action statements for management of individuals with venous thromboembolism?

Answer 9

1. advocate for a culture of mobility and physical activity
2. screen for risk of VTE
3. provide preventative measures for LE DVT
4. Recommend mechanical compression as a preventative measure for LE DVT
5. ID the likelihood of LE DVT when S and S are present
6. Communicate the likelihood of LE DVT and recommend further medical testing
7. verify the patient is taking an anticoagulant
8. mobilize pts who are at a therapeutic level of anticoagulation
9. recommend mechanical compression for pts with LE DVT
10. mobilize pts after IVC filter placement once hemodynamically stable
11. consult with the medical team when a pt is not anti coagulated and w/o an IVC filter
12. screen for fall risk
13. recommend mechanical compression Wien S and S of PTS are present
14. Implement management strategies to prevent future VTE

Question 10

What are the risk factors for VTE (with scores on screening tool)?

Answer 10

1. Active cancer = 3
2. Previous VTE (excludes superficial VTE) = 3
3. reduced mobility = 3
4. already known thrombophilic condition = 3
5. recent (=1 month) trauma and/or surgery = 2
6. Elderly (>/=70yrs) = 1
7. Heart and/or respiratory failure = 1
8. Acute MI or ischemic stroke = 1
9. Acute infection and/or rheumatologic disorder =1
10. Obesity (BMI >/=30) = 1
11. Ongoing hormonal treatment

High risk score >/= 4

Question 11

What are well’s criteria for likelihood of a presence of DVT?

Answer 11

1. Active cancer = 1
2. Paralysis, paresis, or recent plaster immobilization of the LE = 1
3. Recently bedridden for 3d + or major surgery w/in 12 wk requiring general or regional anesthesia = 1
4. localized tenderness along the distribution of the DV system = 1
5. entire leg swollen = 1
6. calf swelling at least 3 cm larger than asymptomatic side = 1
7. pitting edema on symptomatic side = 1
8. collateral superficial veins = 1
9. previously documented DVT = 1
10. Alternative diagnosis at least as likely as DVT = -2

DVT likely = 2 points or more
DVT unlikely = <2

Question 12

What should you do if a pt is classified as DVT likely?

Answer 12

Pt should immediately undergo a duplex ultrasound

• if negative, pt is considered safe to mobilize
• if positive, PT should defer mobility until medical tx has achieved therapeutic levels

Question 13

What should you do if a pt is classified as DVT unlikely?

Answer 13

Pt should under go a D-dimer test

• negative D-dimer = <1% have DVT, so mobility considered safe
• high D-dimer, further testing is necessary

Question 14

Do anticoagulants dissolve blood clots?

Answer 14

no - they do not actively dissolve a blood clot, but prevent new ones from forming

Question 15

What are anticoagulants you may see in patients?

Answer 15

1. Low-molecular weight heparin (LMWH)
2. Fondaparinux
3. Unfractionated heparin
4. Novel oral anticoagulants (NOAC)
5. Coumadin

Question 16

What do INR levels need to be for mobility in pts taking Coumadin?

Answer 16

<2 = no mobility
2-5 = mobilize
>5 = check with physician