Transcript FIM Part 3 Training

UNDERSTANDING
THE FIM
Functional
Independent
Measure
Part 3
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.
Patient asks to go to the
bathroom
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How many FIM items could be addressed in
this episode of care?
Possibly 12
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Transfers: Bed, Chair,
wheelchair
Locomotion: Walk,
wheelchair
Transfers: Toilet
Toileting
Bladder Management
Bowel Management
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Grooming
Problem Solving
Memory
Expression
Possibly Comprehension
and Social Interaction
Toileting - Definition
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Includes maintaining perineal hygiene and
adjusting clothing before and after using a
toilet, commode, bedpan or urinal. The
patient performs this activity safely.
Toileting Considerations
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If level of assistance for care differs between
voiding and bowel movements, record the
Lower Rating.
Adjusting clothing:
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Moves gown out of the way and puts it back
Pulls down and back up underwear, pants, shorts,
pantyhose, etc
Toileting - Considerations
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Diapers & briefs are not articles of clothing
and are not rated as part of this item.
Diapers & briefs are assistive devices for
bladder and bowel management
Toileting - Considerations
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Does not matter if a pt uses a toilet,
commode, bedpan, or urinal
Includes 3 toileting tasks
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Adjusting clothing before void or BM
Perineal hygiene
Adjusting clothing after void or BM
Toileting - Considerations
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Rate the patient only during a continent
bladder or bowel episode
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Exception: Pt is always incontinent of both bowel
and bladder and is therefore rated Level 1, Total
Assistance
Toileting Considerations
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Rating for colostomy:
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Adjusting the clothing before and after emptying
Cleansing/wiping the end of the bag after
emptying
DO NOT rate rinsing the appliance as this is part
of bowel management
Bladder ManagementDefinition
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Includes complete and intentional control
of the urinary bladder and, if necessary, use
of equipment or agents for bladder control.
Bowel Management - Definition
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Includes complete and intentional control
of the bowel and, if necessary, use of
equipment or agents for bowel control.
B&B Function Modifiers
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An accident is defined as the act of soiling
linen or clothing with urine or feces
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It includes bedpan and urinal spills as well as
colostomy and Foley leakage
It does NOT include stool or urine contained in a
diaper (this is incontinence, not an accident)
Bowel Management
Considerations
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Agents include:
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Stool softeners
Suppositories
Laxatives
Enemas
OTC (Senekot, Miralax, Metamucil)
Does NOT include:
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Natural laxatives such as prunes, fiber cereal,
herbal tea
3 and 7 day look backs
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The bowel and bladder scores include
accidents for 4 days prior to admission and
the first three days on the unit. Therefore, it
is imperative to include all incontinent
episodes in the documentation.
B&B considerations
Bladder equipment
 Foley catheter
 Urinal
 Bedpan
 Urostomy bag
 Bucket from bedside
commode
 Absorbent pad
 Diapers
 Condom Catheter
Bowel equipment
 Bedpan
 Colostomy bag
 Diapers
 Bucket from bedside
commode
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Note equipment choices in Medilinks on the
next slide
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Note choices for incidental assistance to
place bedpan and resultant score on the next
slide
B&B considerations
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If a patient receives hemodialysis or
peritoneal dialysis and does not void, the
patient will be rated a level 7 for bladder
management – there is no burden of care
B&B considerations
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Standby assistance is usually for safety &
should not be rated under B&B management
Running water for a pt to void is NOT
assistance
Timed voiding program is NOT an assistive
device
B&B considerations
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Timed voiding program
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Level of assistance is determined by how many
times the pt remembers to call for assistance or
goes to the bathroom independently
If the patient is totally dependent on staff to
implement the timed voiding this would be a level
1 level of assistance.
Timed voiding schedule
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Note choices for timed voiding schedule on
the next slide
Bowel Management Level of
Assistance
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Note a possible sequence of choices for
patients requiring physical assistance on the
next slide
Transfers - Definition
Includes all aspects of transferring from
supine in bed (not a mat) to a chair
OR
 a bed (not a mat) to a wheelchair
OR
 coming to a standing position if walking is the
typical mode of locomotion.
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Transfers – Considerations
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Based on overall performance, do NOT rate
each skill or component of the transfer
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Consider the percentage of the ENTIRE task that
the patient performs
Bed, chair, and wheelchair transfers must
begin OR end in a supine position from a
BED (not a mat).
Bed mobility IS included in the rating
Bed/chair/wheelchair Transfers considerations
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If a patient transfers out of a wheelchair and
the helper moves the wheelchair out of way
for convenience of the staff member and then
the helper needs to reposition the wheelchair
back next to the bed for the patient, this is
NOT counted as set-up. (If the patient was at
home, the wheelchair would not have been
moved.)
Assistive Devices
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Note in the next slide, the various types of
assistance for transfers which may include
bed rails, elevating the head of the bed or
elevating the entire bed and the dropped
score
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