UNDERSTANDING THE FIM

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UNDERSTANDING THE FIM

• Functional Independent Measure
• Part 2

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Scoring of Activities
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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
• Each FIM item MUST be scored every 24 hours

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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).

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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.

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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.

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Eating - Definition

• 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.)

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Eating - Considerations

• 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.

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Eating consistency modified How to score in
Medilinks FIM

• 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)

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Grooming - Definition

• 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.

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Considerations for Grooming

• 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

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Components of Grooming

• If the patient requires physical assistance, you
  will be prompted to rate individual tasks for
  amount of assistance
• Wash, rinse, dry face
• Wash, rinse, dry hands
• Brush teeth or dentures
• Brush/comb hair
• Shave or apply make-up

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Example of documentation of assistive devices for
grooming in an independent patient in Medilinks

• 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

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Bathing - Definition

• 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.

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Bathing - Considerations

• Includes 10 body parts
• 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

• Three tasks per body part
• Washing
• Rinsing
• Drying

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Bathing - Considerations

• 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

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Upper Body (UB) Dressing Definition

• Includes dressing and undressing above the waist,
  as well as applying removing a prosthesis or
  orthosis when applicable. The patient performs
  the activity safely.

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Lower Body (LB) Dressing - Definition

• 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.

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UB and LB Dressing - Considerations

• 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

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UB and LB Dressing -Considerations

• 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).

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UB LB - Considerations

• 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.

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DOCUMENTATION EXAMPLES

• 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 patients hair.
• How would you score this?

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Scoring

• Eating Level 6, modified independence, pt
  required dentures to eat which the pt. inserted.

• Grooming, Level 4, Minimal Assistance. Nurse
  combed patients hair.

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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