UNDERSTANDING THE FIM - PowerPoint PPT Presentation

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UNDERSTANDING THE FIM

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UNDERSTANDING THE FIM ... the primary mode of locomotion achieved at discharge Admission and ... determine the patient s actual comprehension status. – PowerPoint PPT presentation

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Title: UNDERSTANDING THE FIM


1
UNDERSTANDING THE FIM
  • Functional Independent Measure
  • Part 4

2
Important Reminders
  • 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

3
Important Reminders
  • 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).

4
Important Reminders
  • If in a hurry dont 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.

5
Important Reminders
  • 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.

6
Transfers Tub, Shower - Definition
  • Tub includes getting in and out of a tub
  • Shower includes getting in and out of a shower

7
Tub/shower - Considerations
  • Simulations cannot be rated
  • Patient must be fully undressed and wet to rate
    this item
  • Rating includes the patients approach to the tub
    or shower once the patient is in the bathroom

8
Tub/shower transfers
  • Note the ability to score only one of these
    transfers or both shower and tub transfers

9
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10
Transfers Toilet
  • Includes safely getting on and off a standard
    toilet
  • Standard toilet is a regular toilet without
    attachments such as arm rests or handles to
    assist patient
  • Includes approach to the toilet once in the
    bathroom and wheelchair set up

11
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12
Locomotion/Walk/Wheelchair Sequence
13
Expected Mode of Locomotion Considerations
  • PT identifies the expected primary locomotion
    mode at discharge, based on initial assessment
  • PT identifies the primary mode of locomotion
    achieved at discharge
  • Admission and discharge modes must match

14
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15
Locomotion Wheelchair - Definition
  • Wheelchair includes using a manual or motorized
    wheelchair on a level surface once in a seated
    position

16
Locomotion - Considerations
  • P.T. brings an oxygen tank behind is a level 5
  • If patient is pushed to the gym in a wheelchair,
    this needs to be assessed as total assist noting
    the level of assistance provided at that moment
    in time.

17
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20
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21
Locomotion Walk - Definition
  • Walk includes walking on a level surface once in
    a standing position

22
Walk - Considerations
  • Score will be affected by both distance and
    assistance
  • Only include distance without any rest periods or
    breaks.

23
Locomotion Walk/WC Exception
  • Exception to distance and assistance rule
  • If a patient routinely ambulates more than 150
    feet throughout the day but is not required to
    walk 150 feet in every situation, do not consider
    the distance for that episode of locomotion in
    the FIM rating, consider only the level of
    assistance
  • If patient does not perform maximum locomotion
    distance, do not score this sub max activity.
    HOWEVER patient must perform maximum locomotion
    distance at least once a day.

24
Locomotion Stairs - Definition
  • Includes going up and down 12-14 stairs (one
    flight) indoors in a safe manner

25
Stairs - Considerations
  • Score is affected by both number of stairs and
    level of assistance/use of devices
  • Step height is NOT a factor in rating
  • If patient requires different levels of
    assistance for ascending and descending the
    stairs, choose options for the lower rating
  • Stairs must be assessed on admission and
    discharge. Cannot put not addressed.

26
  • Note numerous types of assistive device available
    for stairs

27
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28
Comprehension - Definition
  • Understanding of either auditory or visual
    communication (e.g., writing, sign language,
    gestures)

29
Comprehension - Considerations
  • Document the amount of assistance required, NOT
    the measurement of the severity of cognitive
    deficit
  • Documentation must include the length of time of
    the interaction AND how much of the day the note
    represents
  • Patient should not receive a lower score due to
    English as a second language

30
Comprehension - Considerations
  • Remember that comprehension needs to include
    complex or abstract ideas/questions and your
    assessment must include open ended questions in
    order to accurately determine the patients
    actual comprehension status.
  • Complex and abstract questions are generally not
    part of conversation during usual sleep hours and
    therefore should not be scored.

31
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32
Expression - Definition
  • Includes clear vocal or nonvocal expression of
    language. This item includes either intelligible
    speech or clear expression of language using
    writing or communication device

33
Expression - Considerations
  • Remember that expression needs to include complex
    or abstract information and your assessment must
    include more than a yes or no answer.
  • Language of confusion should be considered a
    deficit. Language may be clearly articulated but
    if patient is confused at times, this should be
    assessed in expression.

34
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35
Social Interaction - Definition
  • Includes skills related to getting along and
    participating with others in therapeutic and
    social situations. It represents how one deals
    with ones own needs together with the needs of
    others.

36
Social Interaction - Considerations
  • In therapeutic and social situations includes
  • In the therapy gym
  • In the dining room
  • During therapeutic group activities
  • During visiting hours with family, friends
  • Sharing room and bathroom with room mate

37
Social Interaction - Considerations
  • Need to answer three questions
  • Is the patient cooperating?
  • Is the patient participating?
  • Is the patient exhibiting any inappropriate
    behaviors?

38
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39
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40
Problem Solving - Definition
  • Includes skills related to solving problems of
    daily living. This means making reasonable,
    safe, and timely decisions regarding financial,
    social, and personal affairs, as well as
    initiating, sequencing, and self correcting tasks
    and activities to solve problems.

41
Problem Solving - Considerations
  • Includes BOTH complex and routine problem solving
  • Includes 5 important skills
  • Recognizing a problem is present
  • Making appropriate decisions
  • Initiating steps readjusting to changing
    circumstances
  • Carrying out a sequence of steps
  • Evaluating the solution

42
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43
Memory - Definition
  • Includes skills related to recognizing and
    remembering while performing daily activities in
    an institutional or community setting. Memory in
    this context includes ability to store and
    retrieve information, particularly verbal and
    visual.

44
Memory - Considerations
  • Look for information related to the following
  • Recognizing people frequently encountered
  • Remembering daily routines
  • Executing requests without reminders

45
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46
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47
Summary
  • 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
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