Transcript FIM Part 2 Training

UNDERSTANDING
THE FIM
Functional
Independent
Measure
Part 2
Scoring of
Activities
Important Reminders
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You must understand the definition of the
each item in order to document accurately
Do NOT merge tasks
Do not rate simulations, clinical judgments
NEVER copy and paste from a previous
document because your FIM scores will not
be recorded
Each FIM item MUST be scored every 24
hours
Important Reminders
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A number does not support a number! (You must
supply detailed documentation within the
document.)
Min, Mod or Max does not support a number.
(You must document why the need the assistance,
i.e., decreased balance, decreased strength)
“More than reasonable time” to complete a task
independently is defined as 3 times the norm and
would be scored as modified independence (6).
Important Reminders
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If in a hurry & don’t have time to allow the patient
to do a task & the therapist/nurse does it for the
pt, this is max assist.
Consider: How much assist did the pt require in
this point in time? Who performed the task? Do
not modify the assist in order to factor in how
busy you are. If you do perform the task for a
patient due to your time constraints, document
the assistance and the reason (i.e. time
constraints) this level was needed to perform the
task.
Important Reminders
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Plan the care you provide by allowing
adequate time for the patient to perform the
task versus performing the task for the
patient. This is rehab, doing the task for the
patient should be a rare occurrence.
Eating - Definition
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The ability to use suitable utensils to bring the
food to the mouth.
The ability to chew & swallow the food (once
the meal is presented in the customary
manner on a table or tray).
The ability to use a cup or glass to bring to
the mouth, and the liquids are swallowed.
(The patient performs this activity safely.)
Eating - Considerations
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Placing a tray/table next to the patient is NOT
assist
If food consistency is the only modification this is
not considered assistance and is rated a 6
If food consistency is modified and assist is
needed, highest possible score is a 5
If the patient is using a PEG, G, or NG tube and
eating, both must be scored.
Eating consistency modified –
How to score in Medilinks FIM
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Choose “no assistance needed” if patient
does not require any form of cuing or
assistance
Choose “requires device, extra time, modified
food, safety considerations, etc.
Dentures are an assistive device
Select requirements from list in medilinks
branch
This will provide a score of 6
(as noted in next 2 slides)
Grooming - Definition
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Includes oral care, hair grooming (combing &
brushing), washing, rinsing, and drying the
hands & face, & either shaving or applying
make-up. If the patient neither shaves nor
applies make-up, grooming includes only the
first four tasks. The patient performs this
activity safely. This item INCLUDES
obtaining the articles necessary for grooming.
Considerations for Grooming
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If a helper must bring the grooming supplies
to the sink from the bedside table, this is
setup assistance.
Consider where the items will be stored in the
discharge setting
Do NOT include assistance needed to get to
the sink (This is walk/wheelchair, not
grooming)
Patient can be sitting or standing
Components of Grooming
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If the patient requires physical assistance,
you will be prompted to rate individual tasks
for amount of assistance:
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Wash, rinse, dry face
Wash, rinse, dry hands
Brush teeth or dentures
Brush/comb hair
Shave or apply make-up
Example of documentation of
assistive devices for grooming
in an independent patient in
Medilinks:
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Was grooming assessed – click “yes”
Click “no assistance needed”
Click “requires special equipment, extra time,
safety considerations, etc
Click on appropriate device
See next slide
Bathing - Definition
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Includes washing, rinsing & drying the body
from the neck down (excluding the neck &
back) in either a tub, shower, or sponge/bed
bath. The patient performs the activity safely.
Bathing - Considerations
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Includes 10 body
parts
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Chest
Left arm
Right arm
Abdomen
Perineal area
Buttocks
Left upper leg
Right upper leg
Left lower leg including foot
Right lower leg including foot
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Three tasks per body
part
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Washing
Rinsing
Drying
Bathing - Considerations
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Bathing can be performed anywhere
Location of bathing does not affect FIM rating
Assistance in & out of tub/shower is NOT
included in FIM rating for bathing
Not all body parts need to be bathed to rate
bathing (rate only the parts you observe)
If a patient is a amputee, you would select
“not applicable for that body part”
Upper Body (UB) Dressing –
Definition:
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Includes dressing and undressing above the
waist, as well as applying & removing a
prosthesis or orthosis when applicable. The
patient performs the activity safely.
Lower Body (LB) Dressing Definition
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Includes dressing and undressing from the
waist down, as well as applying & removing a
prosthesis or orthosis when applicable. The
patient performs the activity safely.
UB and LB Dressing Considerations
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Clothing must include clothing appropriate to
be worn in public
Includes patient obtaining clothes from
customary places (drawers or closet)
Putting on and taking off scrubs may be
appropriate for purposes of assessment
HOWEVER, BEST PRACTICE is utilizing
clothing that will be worn in the discharge
setting
UB and LB Dressing Considerations
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You will be prompted to rate assistance for
each step for each article of clothing
Diapers, pull-ups and Depends are assistive
devices NOT underwear. Do not score the
on and off of these, as this will be scored in
bowel and bladder management.
Do not score TEDS as socks (they are
orthotics).
UB & LB - Considerations
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Incidental help – Assistance with buttons,
zippers or snaps only. BE CAREFUL – this
means help with one zipper or one set of
snaps or buttons.
If help is needed on every article of clothing,
it is NOT incidental help.
DOCUMENTATION EXAMPLES
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Pt ate breakfast seated at bedside without
assistance after inserting his dentures.
Supplied patient with washcloth, soap, water,
dry towel, electric razor and comb. Nurse
supervised as patient washed, rinses and
dried his face and hands and shaved his face
with electric razor. Nurse combed patient’s
hair.
How would you score this?
Scoring
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Eating: Level 6,
modified
independence, pt
required dentures to
eat which the pt.
inserted.
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Grooming, Level 4,
Minimal Assistance.
Nurse combed
patient’s hair.
Summary
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Read the prompts carefully each time in order
to document accurately
Remember we are documenting the burden
of care required to help the patient at home
perform basic personal tasks
Burden of care can be translated into
financial cost
Careful documentation will support the
burden of care and our payments