Transcript FIM Functional Independence Measure

FIM
Functional Independence Measure
Functional Independence
Measurement (FIM)
• Used as an outcome measurement tool to
assess change in a patient
• FIM scores are given to the pt at
– Evaluation FIM Level
– Predicted FIM level for D/C at evaluation
– Actual FIM level at D/C
FIM is copyrighted. The following slides are descriptions similar to FIM but
may not be actual FIM descriptions or scoring.
The Burden of Care
• Task of BADL or mobility the pt can complete
• How much assistance is needed to perform the
task
• Consider:
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Time
Personnel
Assistive Devices
All personnel, all environments, 24 hrs a day
FIM
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FIM Scores include:
– Defined by a specific task
– Uses physical assistance
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Tasks
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Eating
Feeding
Grooming
Dressing
Bathing
Bowel and Bladder
Transfers – Bed mobility and surface / Toilet Transfer
Locomotion
Stairs
Expression
Memory
Problem Solving
Social Interaction
Comprehension
FIM Physical Assistance Levels
Independence
7 Complete Independence (timely,
safely, assumes responsibility)
No Helper
6 Modified Independence (device,
safety, extra time, assumes
responsibility)
Modified Dependence
5 Supervision (cueing, setup prior to
task or removal/disposal, coaxing)
4 Minimal Assistance (pt = 75% or
more: contact guard, guiding assist)
3 Moderate Assistance (pt = 50% to
74%, provides a lift to trunk)
Complete Dependence
2 Maxiamal Assistance (pt = 25-49%)
1 Total Assistance (pt < 25%, two
person assist)
Helper
Use of Code 0
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Pt did not perform activity
Pt unsafe
Pt refuses
Medical reason
Physical Assistance
• The amount of assistance a patient requires in
order to perform a task
• Definitions may vary pending institution
Physical Assistance
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Dependant/Total
Max
Mod
Min
SBA-CG or Hand hold or Hands on Assist
Mod I
Independent
Physical Assistance
• Percentage of help
• Mod for 2 LE and min for 1 LE
• Mod boost at trunk
– 75%, 50%, 25% (any time you lift from trunk they are modraise or lowering)
• Two person assist –even if 2nd person is just there for
safety.
– Is total assistance
– Equipment/SBA
• Dividing the task into parts
– Grading two parts of the task = total task
– Always default to the higher level of assistance.
• Verbal or tactile cueing (grab hand to prevent injury)
– Usually not calculated into the assistance unless SBA, Mod
I, or Indep. to assist with safety
Physical Assistance
• Documentation
– Bed Mob: supine to sit min PA
– Bed Mob: supine to sit min PA at the trunk
– Bed Mob: supine to sit min PA L LE
– Bed Mob: supine to sit log roll mod PA at
trunk x 1, min PA L LE X1 = total assist
FIM – Bed mobility and Surface
Transfer
• Pt must perform the entire supine to sit, sit to
supine and surface to surface which may
include sit to stand and stand to sit
(Get in/out of bed, sit to stand, surface to
surface mobility)
• Must use hospital bed to score
• Assess physical assistance for each task and
take the lowest score
FIM – Transfers
Slides 59 - 66
• Transfers: include bed mobility, sit to
stand, surface to surface
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Able to perform on own
Need for time, use of arms/equip
Needs to have some standing by
Needs min assist
Indep
Mod Indep
SBA
Min
7
6
5
4
Mod
3
Max
Total
UTA
2
1
0
– Steadying, assist with 1 LE
• Needs mod assist
– Assist to lift trunk, assist with 2 LE
• Needs max assist
• Needs total assist or two people
• Activity did not occur
Locomotion – Gait or W/C
Slides 72 - 79
• Distance the patient walks
– How much assistance was needed
• Distance the patient propels the w/c
– How much assistance was needed
– If independent with a w/c is still mod I because of the
w/c according to FIM
– Always score the lowest score
Locomotion – Gait or W/C
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Locomotion
If able to walk or wheel 150 ft no assist
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If able to walk or wheel 150 ft with device or increased time
Modified Indep
If able to walk or wheel 150 ft with SBA
SBA
With min asst
Min
With mod
Mod
With max
Max
If able to walk or wheel 149 -50 ft or less any assist
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Walks or wheels less than 50 ft
Independent
7
6
5
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2
Max
2
Total
1
Total
1
0
Needs total assist
Activity did not occur
Locomotion – Stairs
Slides 80-82
• Stairs – Full Flight is 14 steps
• If able to perform 12-14 stairs, no use of device
Indep
7
• If able to perform 12-14 stairs with assist or need of time
Mod I
6
• If able to perform 12-14 stairs with need of SBA SBA
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with min assist Min
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with mod
Mod
• If able to perform 4-6 stairs any assist
Max
• Less than 4 steps
Total
• Activity Did Not Occur
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4
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2
1
0