MEMORY

MEMORY: Memory includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Memory in this context includes the ability to store and retrieve information, particularly verbal and visual. The functional evidence of memory includes recognizing people frequently encountered, remembering daily routines, and executing requests without being reminded. A deficit in memory impairs learning as well as performance of tasks.

NO HELPER

7 Complete Independence—The patient recognizes people frequently encountered, remembers daily routines, and executes requests of others without need for repetition.

6 Modified Independence—The patient appears to have only mild difficulty recognizing people frequently encountered, remembering daily routines, and responding to requests of others. The patient may use self-initiated or environmental cues, prompts, or aids.

HELPER

5 Supervision—The patient requires prompting (e.g., cueing, repetition, reminders) only under stressful or unfamiliar conditions, but no more than 10% of the time.

4 Minimal Prompting—The patient recognizes and remembers 75 to 90% of the time.

3 Moderate Prompting—The patient recognizes and remembers 50 to 74% of the time.

2 Maximal Prompting—The patient recognizes and remembers 25 to 49% of the time, and needs prompting more than half the time.

1 Total Assistance—The patient recognizes and remembers less than 25% of the time, or does not effectively recognize and remember.

                             Do not use code “0” for Memory.

PROBLEM SOLVING

PROBLEM SOLVING: Problem Solving 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 the initiation, sequencing, and self- correcting of tasks and activities to solve problems.

NO HELPER

7 Complete Independence—The patient consistently recognizes problems when present, makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems until the task is completed, and self-corrects if errors are made.

6 Modified Independence—In most situations, the patient recognizes a present problem, and with only mild difficulty makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems, or requires more than a reasonable time to make appropriate decisions or solve complex problems.

HELPER

5 Supervision—The patient requires supervision (e.g., cueing or coaxing) to solve less routine problems only under stressful or unfamiliar conditions, but no more than 10% of the time.

4 Minimal Direction—The patient solves routine problems 75 to 90% of the time.

3 Moderate Direction—The patient solves routine problems 50 to 74% of the time.

2 Maximal Direction—The patient solves routine problems 25 to 49% of the time. The patient needs direction more than half the time to initiate, plan, or complete simple daily activities, and may need restraint for safety.

1 Total Assistance—The patient solves routine problems less than 25% of the time. The patient needs direction nearly all the time, or does not effectively solve problems, and may require constant one-to-one direction to complete simple daily activities. The patient may need a restraint for safety.

Do not use code “0” for Problem Solving.

COMMENT: Examples of complex problem-solving includes activities such as managing a checking account, participating in discharge plans, self-administering medications, confronting interpersonal problems, and making employment decisions. Routine problem-solving includes successfully completing daily tasks or dealing with unplanned events or hazards that occur during daily activities. More specific examples of routine problems include asking for assistance appropriately during transfer, asking for a new milk carton if milk is sour or missing, unbuttoning a shirt before trying to put it on, and asking for utensils missing from a meal tray.

SOCIAL INTERACTION

SOCIAL INTERACTION: Social Interaction includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one’s own needs together with the needs of others.

NO HELPER

7 Complete Independence—The patient interacts appropriately with staff, other patients, and family members (e.g., controls temper, accepts criticism, is aware that words and actions have an impact on others), and does not require medication for control.

6 Modified Independence—The patient interacts appropriately with staff, other patients, and family members in most situations, and only occasionally loses control. The patient does not require supervision, but may require more than a reasonable amount of time to adjust to social situations, or may require medication for control.

HELPER

5 Supervision—The patient requires supervision (e.g., monitoring, verbal control, cueing, or coaxing) only under stressful or unfamiliar conditions, but less than 10% of the time. The patient may require encouragement to initiate participation.

4 Minimal Direction—The patient interacts appropriately 75 to 90% of the time.

3 Moderate Direction—The patient interacts appropriately 50 to 74% of the time.

2 Maximal Direction—The patient interacts appropriately 25 to 49% of the time, but may need restraint due to socially inappropriate behaviors.

1 Total Assistance—The patient interacts appropriately less than 25% of the time, or not at all, and may need restraint due to socially inappropriate behaviors.

Do not use code “0” for Social Interaction

COMMENT: Examples of socially inappropriate behaviors include temper tantrums; loud, foul, or abusive language; excessive laughing or crying; physical attack; or very withdrawn or non-interactive behavior.

EXPRESSION

EXPRESSION: Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. Evaluate and indicate the more usual mode of expression (“Vocal” or “Nonvocal”). If both are used about equally, code “Both”.

NO HELPER

7 Complete Independence—The patient expresses complex or abstract ideas clearly and fluently (not necessarily in English).

6 Modified Independence—In most situations, the patient expresses complex or abstract ideas relatively clearly or with only mild difficulty. The patient does not need any prompting, but (s)he may require an augmentative communication device or system.

HELPER

5 Standby Prompting—The patient expresses basic daily needs and ideas more than 90% of the time. Requires prompting (e.g., frequent repetition) less than 10% of the time to be understood.

4 Minimal Prompting—The patient expresses basic daily needs and ideas 75 to 90% of the time.

3 Moderate Prompting—The patient expresses basic daily needs and ideas 50 to 74% of the time.

2 Maximal Prompting—The patient expresses basic daily needs and ideas 25 to 49% of the time. The patient uses only single words or gestures, and (s)he needs prompting more than half the time.

1 Total Assistance—The patient expresses basic daily needs and ideas less than 25% of the time, or does not express basic needs appropriately or consistently despite prompting.

Do not use code “0” for Expression.

COMMENT: Examples of complex or abstract ideas include (but are not limited to) discussing current events, religion, or relationships with others. Expression of basic needs and ideas refers to the patient’s ability to communicate about necessary daily activities such as nutrition, fluids, elimination, hygiene, and sleep (physiological needs).

COMPREHENSION

COMPREHENSION: Comprehension includes understanding of either auditory or visual communication (e.g., writing, sign language, gestures). Evaluate and indicate the more usual mode of comprehension (“Auditory” or “Visual”). If both are used about equally, code “Both.”

NO HELPER

7 Complete Independence—The patient understands complex or abstract directions and conversation, and understands either spoken or written language (not necessarily English).

6 Modified Independence—In most situations, the patient understands readily or with only mild difficulty complex or abstract directions and conversation. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information.

HELPER

5 Standby Prompting—The patient understands directions and conversation about basic daily needs more than 90% of the time. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time.

4 Minimal Prompting—The patient understands directions and conversation about basic daily needs 75 to 90% of the time.

3 Moderate Prompting—The patient understands directions and conversation about basic daily needs 50 to 74% of the time.

2 Maximal Prompting—The patient understands directions and conversation about basic daily needs 25 to 49% of the time. Understands only simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you). Requires prompting more than half the time.

1 Total Assistance—The patient understands directions and conversation about basic daily needs less than 25% of the time, or does not understand simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you), or does not respond appropriately or consistently despite prompting.

Do not use code “0” for Comprehension.

COMMENT: Comprehension of complex or abstract information includes (but is not limited to) understanding current events appearing in television programs or newspaper articles, or abstract information on subjects such as religion, humor, math, or finances used in daily living. Comprehension of complex or abstract information may also include understanding information given during a group conversation. Information about basic daily needs refers to conversation, directions, and questions or statements related to the patient’s need for nutrition, fluids, elimination, hygiene or sleep (physiological needs).

LOCOMOTION: WHEELCHAIR

LOCOMOTION: WHEELCHAIR: Locomotion: Wheelchair includes using a wheelchair on a level surface once in a seated position. The patient performs the activity safely. 

NO HELPER

7 This score is not to be used if the patient uses a wheelchair for Locomotion.

6 Modified Independence—The patient operates a manual or motorized wheelchair independently for a minimum of 150 feet (50 meters); turns around; maneuvers the chair to a table, bed, toilet; negotiates at least a 3 percent grade; and maneuvers on rugs and over door sills.

5 Exception (Household Locomotion)—The patient operates a manual or motorized wheelchair independently only short distances (a minimum of 50 feet or 15 meters).

HELPER

5 Supervision—The patient requires standby supervision, cueing, or coaxing to go a minimum of 150 feet (50 meters) in a wheelchair.

4 Minimal Contact Assistance—The patient performs 75% or more of locomotion effort to go a minimum of 150 feet (50 meters).

3 Moderate Assistance—The patient performs 50 to 74% of locomotion effort to go a minimum of 150 feet (50 meters).

2 Maximal Assistance—The patient performs 25 to 49% of locomotion effort to go a minimum of 50 feet (15 meters), and requires the assistance of one person only.

1 Total Assistance—The patient performs less than 25% of effort, or requires the assistance of two people, or wheels less than 50 feet (15 meters).

LOCOMOTION: WALK

LOCOMOTION: WALK: Locomotion: Walk includes walking on a level surface once in a standing position. The patient performs the activity safely. 

NO HELPER

7 Complete Independence—The patient walks a minimum of 150 feet (50 meters) without assistive devices. The patient performs the activity safely.

6 Modified Independence—The patient walks a minimum of 150 feet (50 meters), but uses a brace (orthosis) or prosthesis on leg, special adaptive shoes, cane, crutches, or walkerette; or takes more than a reasonable amount of time to complete the activity; or there are safety considerations.

5 Exception (Household Locomotion)—The patient walks only short distances (a minimum of 50 feet or 15 meters) independently with or without a device. The activity takes more than a reasonable amount of time, or there are safety considerations.

HELPER

5 Supervision—The patient requires standby supervision, cueing, or coaxing to go a minimum of 150 feet (50 meters).

4 Minimal Contact Assistance—The patient performs 75% or more of walking effort to go a minimum of 150 feet (50 meters).

3 Moderate Assistance—The patient performs 50 to 74% of walking effort to go a minimum of 150 feet (50 meters).

2 Maximal Assistance—The patient performs 25 to 49% of walking effort to go a minimum of 50 feet (15 meters), and requires the assistance of one person only.

1 Total Assistance—The patient performs less than 25% of effort, or requires the assistance of two people, or walks to less than 50 feet (15 meters).

COMMENT: If the patient requires an assistive device for locomotion (prosthesis, walker, cane, AFO, adapted shoe, etc.), then the Locomotion: Walk score can never be higher than level 6.

Flashcards about FIM Scoring!

Flashcards about FIM Scoring!

THESE ARE MY FAVORITES. THERE ARE 150 FLASH CARDS. CLICK THE YELLOW LINK.

TRANSFERS: TUB

In our facility we don't do tub transfers, but here they are ... because they might be on the exam.

TRANSFERS: TUB: Transfers: Tub includes getting into and out of a tub. The patient performs the activity safely. 

NO HELPER

 7 Complete Independence

If walking, the patient approaches a tub, and gets into and out of it. The patient performs the activity safely.

If in a wheelchair, the patient approaches a tub, locks brakes, lifts foot rests, removes arm rests if necessary, and does either a standing pivot or sliding transfer (without a board) and returns. The patient performs the activity safely.

6 Modified Independence—The patient requires an adaptive or assistive device (including a prosthesis or orthosis) such as a sliding board, a lift, grab bars, or special seat; or takes more than a reasonable amount of time to complete the activity; or there are safety considerations.

HELPER

5 Supervision or Setup—The patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (positioning sliding board, moving foot rests, etc.).

4 Minimal Contact Assistance—The patient requires no more help than touching, and performs 75% or more of transferring tasks.

3 Moderate Assistance—The patient requires more help than touching or performs 50 to 74% of transferring tasks.

2 Maximal Assistance—The patient performs 25 to 49% of transferring tasks.


1 Total Assistance—The patient performs less than 25% of transferring tasks.

TRANSFERS: SHOWER

Something to think about.....If the staff rolls the patient into the shower on a shower chair score the patient as a 1 or a total assist. 

TRANSFERS: SHOWER: Transfers: Shower includes getting into and out of a shower. The patient performs the activity safely. 

NO HELPER

7 Complete Independence

If walking, the patient approaches a shower stall, and gets into and out of it. The patient performs the activity safely.

If in a wheelchair, the patient approaches a shower stall, locks brakes, lifts foot rests, removes arm rests if necessary, and does either a standing pivot or sliding transfer (without a board) and returns. The patient performs the activity safely.

6 Modified Independence—The patient requires an adaptive or assistive device (including a prosthesis or orthosis) such as a sliding board, a lift, grab bars, or special seat; or takes more than a reasonable amount of time to complete the activity; or there are safety considerations.

HELPER

5 Supervision or Setup—The patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (positioning sliding board, moving foot rests, etc.).

4 Minimal Contact Assistance—The patient requires no more help than touching and performs 75% or more of transferring tasks.

3 Moderate Assistance—The patient requires more help than touching or performs 50 to 74% of transferring tasks.

2 Maximal Assistance—The patient requires more help than touching or performs 25 to 49% of transferring tasks.

1 Total Assistance—The patient performs less than 25% of transferring tasks.

TRANSFERS: TOILET

It's the evening shift and your patient has just arrived on the unit. They are still in the wheelchair. You feel he/she is safe enough to transfer to the toilet. Not only that they hate bedpans. The patient would like to to use the toilet or the BSC commode. This is your chance to give your patient the... ta da.... first Toilet Transfer of his/her stay.  Follow the numbers below to see how they do. Remember it is not you doing a good job, but rather it is the burden of care we are assessing.

 How much help does your patient need to transfer to the toilet? 

TRANSFERS: TOILET: Transfers: Toilet includes safely getting on and off a standard toilet.

NO HELPER

 7 Complete Independence

If walking, patient approaches, sits down on a standard toilet, and gets up from a standard toilet. The patient performs the activity safely.

If in a wheelchair, patient approaches toilet, locks brakes, lifts foot rests, removes arm rests if necessary, and does either a standing pivot or sliding transfer (without a board) and returns. The patient performs the activity safely.

6 Modified Independence—The patient requires an adaptive or assistive device such as a sliding board, a lift, grab bars, or special seat; or takes more than a reasonable amount of time to complete the activity; or there are safety considerations. In this case, a prosthesis or orthosis is considered an assistive device if used for the transfer.

HELPER

5 Supervision or Setup—The patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (positioning sliding board, moving foot rests, etc.).

4 Minimal Contact Assistance—The patient requires no more help than touching and performs 75% or more of transferring tasks.

3 Moderate Assistance—The patient requires more help than touching or performs 50 to 74% of transferring tasks.

2 Maximal Assistance—The patient performs 25 to 49% of transferring tasks.

1 Total Assistance—The patient performs less than 25% of transferring tasks.

TRANSFERS: BED, CHAIR, WHEELCHAIR

And now we interrupt this program for an important message  about limbs.....

If you lift one limb the patient is a min.

If you lift two limbs the patient is a mod.

If you lift and lower the limbs the patient is a max.

                    

TRANSFERS: BED, CHAIR, WHEELCHAIR: Transfers: Bed, Chair, Wheelchair includes all aspects of transferring from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is the typical mode of locomotion. The patient performs the activity safely.

NO HELPER 

7 Complete Independence: If walking, patient safely approaches, sits down on a regular chair, and gets up to a standing position from a regular chair. Patient also safely transfers from bed to chair.

If in a wheelchair, patient approaches a bed or chair, locks brakes, lifts foot rests, removes arm rest if necessary, and performs either a standing pivot or sliding transfer (without a board) and returns. The patient performs this activity safely.

6 Modified Independence—The patient requires an adaptive or assistive device such as a sliding board, a lift, grab bars, or a special seat/chair/brace/crutches; or the activity takes more than a reasonable amount of time; or there are safety considerations. In this case, a prosthesis or orthosis is considered an assistive device if used for the transfer.

HELPER

5 Supervision or Setup—The patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (positioning sliding board, moving foot rests, etc.).

4 Minimal Contact Assistance—The patient requires no more help than touching and performs 75% or more of transferring tasks.

3 Moderate Assistance—The patient requires more help than touching or performs 50 to 74% of transferring tasks.

2 Maximal Assistance—The patient performs 25 to 49% of transferring tasks.

1 Total Assistance—The patient performs less than 25% of transferring tasks.

COMMENT: During the bed-to-chair transfer, the subject begins and ends in the supine position.

BOWEL MANAGEMENT-FREQUENCY OF ACCIDENTS

BOWEL MANAGEMENT - Frequency of Accidents: Bowel Management - Frequency of Accidents includes complete intentional control of bowel movements and (if necessary) use of equipment/agents for bowel control.

Definition of Bowel Accidents - Bowel accidents refer to the act of soiling linen or clothing with stool, and includes bedpan spills.

NO HELPER

7 No Accidents—The patient controls bowels completely and intentionally

without equipment or devices, and is never incontinent (no accidents).

6 No Accidents; uses device such as ostomy—The patient requires a bedpan, bedside commode, digital stimulation or stool softeners, suppositories, laxatives (other than natural laxatives like prunes), or enemas on a regular basis; alternately, the patient uses other medications for control. The patient has no accidents.

HELPER

5   One (1) accident in the past 7 days. 

4 Two (2) accidents in the past 7 days.

3 Three (3) accidents in the past 7 days. 

2   Four (4) accidents in the past 7 days.

1   Five (5) or more accidents in the past 7 days.

COMMENT: The functional goal of bowel management is to open the anal sphincter only when needed and to keep it closed the rest of the time. This item deals with the frequency of accidents required to complete bowel management tasks.

BOWEL MANAGEMENT-LEVEL OF ASSISTANCE

Let's talk bowels, seems to be the Rehab RN's favorite subject. :)

BOWEL MANAGEMENT - Level of Assistance: Bowel Management - Level of Assistance includes use of equipment or agents for bowel management. 

NO HELPER

7 Complete Independence—The patient controls bowels completely and intentionally without equipment or devices, and does not have any bowel accidents.

6 Modified Independence—The patient requires a bedpan, bedside commode, digital stimulation or stool softeners, suppositories, laxatives (other than natural laxatives like prunes), or enemas on a regular basis; alternately, the patient uses other medications for control. If the individual has a colostomy, (s)he maintains it.

HELPER

5 Supervision or Setup—The patient has required supervision (e.g., standing by, cueing, or coaxing) or setup of equipment necessary for the individual to maintain either a satisfactory excretory pattern or ostomy device. 

4 Minimal Contact Assistance—Patient requires minimal contact assistance to maintain a satisfactory excretory pattern by using suppositories, enemas, or an external device. Patient performs 75% or more of bowel management.

3 Moderate Assistance—The patient requires moderate assistance to maintain a satisfactory excretory pattern by using suppositories, enemas, or an external device. The patient performs 50 to 74% of bowel management tasks.

2 Maximal Assistance—Patient performs 25-49% of bowel management tasks.

1 Total Assistance—Patient performs less than 25% of bowel management tasks.

COMMENT: The functional goal of bowel management is to open the anal sphincter only when needed and to keep it closed the rest of the time. This may require devices, medications (agents), or assistance in some individuals. This item deals with the level of assistance required to complete bowel management tasks.

BLADDER MANAGEMENT-FREQUENCY OF ACCIDENTS

Points of Interest:


*If the staff must clean up or change linens after an accident score 1 total assist. 


*An accident is only considered an accident when clothing, linen or floor gets soiled. If is is contained in the brief it is not considered an accident.

BLADDER MANAGEMENT - Frequency of Accidents: Bladder Management: Frequency of Accidents includes complete intentional control of urinary bladder and, if necessary, use of equipment or agents for bladder control. 

Definition of Bladder Accidents – Bladder accidents refers to the act of wetting linen or clothing with urine, and includes bedpan and urinal spills.

NO HELPER

7 No Accidents—The patient controls bladder completely and intentionally, and does not have any accidents.

6 No Accidents; uses device such as catheter—The patient requires a urinal, bedpan, catheter, bedside commode, absorbent pad, diaper, urinary collecting device, or urinary diversion, or uses medication for control. The patient has no accidents.

HELPER

5 One (1) bladder accident, including bedpan and urinal spills, in the past 7 days.

4 Two (2) accidents, including bedpan and urinal spills, in the past 7 days. 

3 Three (3) accidents, including bedpan and urinal spills, in the past 7 days.

2  Four (4) accidents, including bedpan and urinal spills, in the past 7 days.

1 Five (5) or more accidents, including bedpan and urinal spills, in the past 7 days

If the patient does not void (e.g., subject has renal failure and is on hemodialysis or peritoneal dialysis), then code level 7 - Complete Independence 

COMMENT: The functional goal of bladder management is to open the urinary sphincter only when needed and to keep it closed the rest of the time. This item deals with the frequency of accidents required to complete bladder management tasks.