Pt FIM Competency - 2nd Qtr
Mrs P is a 75 y. O. Married woman who lives with her husband. She was in fair health until 3/15/13 when she had a left anterior cerebral artery occlusion. She was admitted to the acute care hospital, became medically stable and was transferred to SCC for rehabilitation.
- 1.TRANSFERS; Bed/Chair/Wheelchair: Mrs. P does a stand pivot transfer from bed to the wheelchair. She needs a helper to arrange her wheelchair next to the bed, so that she transfers toward her strong side, only requiring contact guard assistance. When moving from wheelchair to the bed, she needs lifting assistance rather than just contact guard, but she still does the majority of the work in transferring. What is this patient's level of assistance?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Max Assist - 2
- D.
Mod Assist - 3
- E.
Dependent - 1
- 2.TRANSFERS; Toilet: Transferring onto a regular toilet seat, Mrs. P uses her quad cane and a helper provides verbal assistance to help her get situated on the toilet. Mrs. P needs just a slight amount of lifting assistance when rising from the toilet. What is her level of assistance?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Mod Assist - 3
- D.
Max Assist - 2
- E.
Dependent - 1
- 3.COMPREHENSION: It is difficult to assess Mrs. P's comprehension for complex ideas, because she has such a great delay in response. Mrs. P follows one-step commands with repetition. She responds appropriately to directions about her basic daily needs with prompting approximately 50%-74% of the time. The information she understands consists of more than just simple statements. What level of assistance is needed?
- A.
7 - No assistance required. Patient comprehends complex or abstract directions and conversation, and understands either spoken or written language.
- B.
3 - Moderate: Patient understands directions and conversations about basic daily needs and ideas 50-74% of the time.
- C.
1 - Total Assistance: Patient understands only simple, commonly used spoken expressions or gestures about basic daily needs less than 25% of the time, despite prompting.
- D.
5 - Comprehends directions and conversation about basic daily needs requiring prompting no more than 10% of the time to be understood.
- E.
4 - Minimal: Understands directions and conversations about basic daily needs and ideas 75-90% of the time.
- 4.EXPRESSION: Mrs. P communicates by gesturing and using only single words. Staff members are usually able to understand the basic information that she is trying to express. When staff members need to prompt her to repeat herself more than 50% of the time, she becomes frustrated and waves them off, or laughs and cries inappropriately. What level of assistance is needed?
- A.
6 - No assistance required - Patient expresses complex or abstract ideas but requires a computer to assist with expressing ideas.
- B.
4- Minimal assistance - Patient expresses basic daily needs and ideas 75-90% of the time.
- C.
2 - Maximal Assistance required - Uses only single words or gestures to express basic needs; requiring prompting more than 50% of the time.
- D.
0 - activity did not occur
- E.
1 - Total Assistance - Expresses basic needs appropriately or consistently less than 25% of the time despite prompting
- 5.SOCIAL INTERACTION: Mrs. P is emotionally labile and inappropriate the majority of the time. When her physicians come in to see her on the morning rounds, she starts crying uncontrollably and when her nurses greet her in the morning, she laughs hysterically. Mrs. P is successfully redirected by the staff more than 50% of the time. What level of assistance is needed?
- A.
7 - No assistance to re-direct needed. No activity limitations
- B.
5 - She requires redirection, only under stressful or unfamiliar conditions, but no more than 10% of the time, she is encouraged to participate.
- C.
1 - Requires total assistance all or most of the time. Patient is appropriate less than 25% of the time.
- D.
2 - Maximal direction needed. Patient is appropriate 25-49% or less than half of the time.
- E.
4 - Minimal/occasional direction. Patient is appropriate 75-90% of the time.
- 6.PROBLEM SOLVING: Mrs. P is able to tackle routine problems more than 50% of the time. Sometimes she needs verbal cues and prompts to come to an appropriate solution to the problem. What assistance is required to make appropriate decisions to solve problems?
- A.
7- None. Consistently carries out sequence of steps to solve complex problems.
- B.
3 - Moderate Assistance; Some direction needed. Patient solves routine problems 50-74% of the time.
- C.
1 - Total Assistance - All or almost all of the time. Patient solves routine problems less than 25% of the time.
- D.
5 - Only under stressful or unfamiliar conditions, but no more than 10% of the time.
- E.
6 - No assistance needed. Only mild difficulty but is able to self correct and/or requires extra time to solve complex problems.
- 7.MEMORY: Mrs. P recognizes her husband and children, but she needs occasional reminders, about once or twice a day , re: where she is, where her room is, or how to use a call light. What level of assistance does she need?
- A.
4 - Minimal Assistance needed; Occasional prompting. Patient recognizes and remembers 75-90% of the time.
- B.
1 - Total Assistance needed: All or almost all of the time. Patient recognizes and remembers less than 25% of the time.
- C.
7 - None needed. No activity limitations
- D.
2 - Max Assistance; A lot of prompting. Patient recognizes and remembers 25-49% of the time.
- E.
5 - Only under stressful or unfamiliar conditions, but no more thatn 10% of the time.
- 8.The moment an activity requires physical assistance by a caregive that is greater than 50% such as holding or physically lifting (generally more than one limb), then based on your clinical judgement, the level of assistance is either a 1- Total assist or a 2- Max assist.
- A.
True
- B.
False
- 9.LOCOMOTION: Walk - Mrs. P is able to walk 100 feet with her quad cane, before she requires a helper to remind her to stand up straight and pick up your left foot. Without stopping to rest she is able to continue another 60 feet. She does not have shortness of breath during rest or exertion. In preparation for her discharge, she has vowed to walk more than she would use the wheelchair. Her house is not wheelchair accessible. What is her mode of locomotion?
- A.
Wheelchair
- B.
Both
- C.
Walk
- 10.Re: the above. How many feet would you assess she walked, without rest.
- A.
50 ft
- B.
100 ft
- C.
Over 150 feet
- 11.Re: the above. Scoring this item requires consideration of both the level of assitance AND the distance walked. What is her level of assistance based on walking 160 feet using a quad cane, requiring no physical assistance only verbal cues?
- A.
4 - Min Assist
- B.
5 - Supervision
- C.
2 - Max Assist
- D.
6 - Mod I
- E.
3 - Max Assist
- 12.LOCOMOTION: Stairs -On admission, Mrs. P is only able to climb 4-5 stairs, using her quad cane. She is not able to climb the full set of stairs. She needs a helper to stand by. What is the level of assistance needed?
- A.
5 - Supervision
- B.
1- Total Assist
- C.
3 - Mod Assist
- D.
2 - Max Assist
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