Title: UNDERSTANDING THE FIM
1UNDERSTANDING THE FIM
- Functional Independent Measure
- Part 4
2Important 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 -
3Important 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).
4Important 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.
5Important 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.
6Transfers Tub, Shower - Definition
- Tub includes getting in and out of a tub
- Shower includes getting in and out of a shower
7Tub/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
8Tub/shower transfers
- Note the ability to score only one of these
transfers or both shower and tub transfers
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10Transfers 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
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12Locomotion/Walk/Wheelchair Sequence
13Expected 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
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15Locomotion Wheelchair - Definition
- Wheelchair includes using a manual or motorized
wheelchair on a level surface once in a seated
position
16Locomotion - 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.
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21Locomotion Walk - Definition
- Walk includes walking on a level surface once in
a standing position
22Walk - Considerations
- Score will be affected by both distance and
assistance - Only include distance without any rest periods or
breaks.
23Locomotion 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.
24Locomotion Stairs - Definition
- Includes going up and down 12-14 stairs (one
flight) indoors in a safe manner
25Stairs - 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
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28Comprehension - Definition
- Understanding of either auditory or visual
communication (e.g., writing, sign language,
gestures)
29Comprehension - 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
30Comprehension - 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.
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32Expression - 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
33Expression - 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.
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35Social 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.
36Social 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
37Social Interaction - Considerations
- Need to answer three questions
- Is the patient cooperating?
- Is the patient participating?
- Is the patient exhibiting any inappropriate
behaviors?
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40Problem 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.
41Problem 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
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43Memory - 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.
44Memory - Considerations
- Look for information related to the following
- Recognizing people frequently encountered
- Remembering daily routines
- Executing requests without reminders
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47Summary
- 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