FIM® RatIng ROUnDSMargaret Freckleton, Msn, Rn, CRRn®, LHCRM, Hospital Educator

Omaira Riano, Msn, Rn, CRRn®, CnOHealthsouth sunrise Rehabilitation Hospital

Introduction• Assessment of functional status is a major duty for

clinicians practicing in rehabilitation facilities.

• FIM® rating rounds are done daily, seven days a week by clinicians caring for the patient being reviewed.

• FIM® rating rounds are done on day three of patient admission date.

• This process focuses on admission FIM® scores.

• The purpose of admission FIM® rating rounds is to capture the true burden of care.

• The lower the admission FIM® score, the greater the burden of care.

• The goal is to maximize the patients’ functional independence.

• Confirm and validate that the documentation supports the burden of care reflected in the admission and discharge FIM® score.

ReferencesCenter for Disease and Medicare Services. (2012)

The inpatient rehabilitation facility patient assessment (IRF) training manual. Retrieved March 28, 2013, from www.cms.gov/...Fee.../InpatientRehabFacPPS/.../IRFPAI-manual-2012.pdf

Dodds, T. A., Martin, D. P., Stolov, W. C., & Deyo, R. A. (1993). A validation of the Functional Independence Measurement and its performance among rehabilita-tion inpatients. Archives of Physical Medicine and Re-habilitation, 74(5), 531–536.

ConclusionSince the implementation of FIM® rating rounds:

1. FIM® score changes and patient outcome has improved.

2. Patients length of stay has decreased.

3. Clinicians have a better knowledge of accurately scoring FIM® components.

©2013:HealthSouth Corporation:621330

team Members and Responsibilities

PPS nURSEFacilitate

Discussion

CHaRgE nURSE

Examine day one nursing FIM® scores.

Report discrepancies between nurse and CNA documentation to hospital educator.tHERaPISt

Review and clarify therapist documentation to achieve FIM® score accuracy.

HOSPItaL EDUCatOR

Review day two nursing documentation.

Provide staff education as needed.

nURSIng aSSIStant

Review three days of non-credential FIM® score.

Collaborate with nurse to ensure accuracy.

PRIMaRY CaRE nURSE

Review and discuss day three nursing documentation.

Collaborate with CNA to ensure accuracy.

16.8 15.9 15.4 15.2

18.3 18.1 17.7 17.6

5

10

15

20

2010 2011 2012 2013

FACILITY NATION

SPHINCTER  ADMIT  SCORE  

6.9 7.1 7 6.8 6.6 6.7 6.7 6.6

2

4

6

8

2010 2011 2012 2013

FACILITY NATION

54.4 52.2 50.4 49.5

20

30

40

50

60

2010 2011 2012 2013

ADMIT FIM® SCORE

COGNITION  ADMIT  SCORE  

20.8 19.1

18.3 17.7

23.1 22.8 22.6 22.3

5

10

15

20

25

2010 2011 2012 2013

FACILITY NATION

83.6 85.5 87.5 88

30

40

50

60

70

80

90

2010 Prior to Implementing

FIM® Rating Rounds

2011 2012 2013

DISCHARGE FIM® SCORE

29.3

33.3

37.2 38.5

27.5 28.6 29.8 30.8

14.3 14.7 14.4 14.1

10

15

20

25

30

35

40

2010 Prior to Implementing

FIM® Rating Rounds

2011 2012 2013

FACILITY TOTAL FIM® SCORE NATION ADJUSTED FACILITY LOS

29.3

33.9 37.2 36.5

5

10

15

20

25

30

35

40

2010 Prior to Implementing

FIM® Rating Rounds

2011 2012 2013

FIM® SCORE CHANGE

FIM® Score Changes Self Care admit FIM® Score Sphincter admit FIM® Score

admission FIM® Scores Discharge FIM® Scores FIM® Score Changes

Cognition admit FIM® Score

The Continuum of Care: Navigating the Road to Recovery