Bowel
Connie uses herbal tea to move her bowels daily. She does not require an assistive device for bowel management and has not had any accidents. What is Wendy’s FIM® rating for Bowel Management?
What is Level 7, Complete Independence: Connie uses an herbal tea. She does not use an assistive device and has not had any accidents
Jamie has worn a diaper since her stroke two weeks ago. Jamie does not always call a nurse for assistance and is incontinent several times during the day and night. A nurse changes Jamie’s diaper after each incontinent episode and inspects Jamie’s skin for any irritation or breakdown. Jamie has not had any bladder accidents. What is Jamie’s FIM® rating for Bladder Management?
What is Level 1, Total Assistance: The nursing staff must assist Jamie several times a day with bladder management by changing her diaper (level 1 for Bladder Level of Assistance).
Hannah adjusts her dress and underwear, cleans herself after voiding, and pulls up her underwear with supervision from a nurse. Because Hannah has occasional balance problems, she holds on to a grab bar for safety. What is Hannah’s FIM® rating for Toileting?
Level 5, Supervision/Setup: Hannah holds on to the grab bar for balance (level 6) but also requires supervision (level 5). If more than one level of assistance is identified, record the lowest rating.
Lakin transfers on and off the commode using arm rests.
What is Level 6 -Toilet transfer using adaptive equipment– (arm rests on the commode) Commode
Katrina has difficulty dressing at night because of fatigue. In the morning she dresses herself with only set up but in the evening the nursing staff does 80% of the tasks.
What is Level 1 for dressing- Lowest level throughout the day
Lee has a spinal cord injury and is on a bowel program. The nurse lubricates and inserts an Enemeez® mini-enema every other morning. The nurse uses a lift to transfer zlee from the bed to the toilet. (Today, the nurse provided digital stimulation so that zlee could evacuate his bowels.) After the nurse completes Lee's perineal hygiene, she uses the lift to transfer Lee from the toilet to the wheelchair. The nurse helped Lee clean up after one accident yesterday. What is Lee's FIM® rating for Bowel Management?
What is Level 1, Total Assistance: The nurse inserted the mini-enema and provided digital stimulation today (level 1 for Bowel Level of Assistance).
Christine has had difficulty with stress incontinence for several years. She wears a pad in her underwear. Since she has been on the rehabilitation unit, she wets the pad at least once a day, but she has not wet her bed linen or clothing. After she wets her pad, Christine calls a nurse to assist her to the bathroom, where Wendy changes her pad without assistance. What is Wendy’s FIM® rating for Bladder Management?
What is Level 6, Modified Independence: Wendy wears a pad that she manages herself (level 6 for Bladder Level of Assistance). Her incontinence is contained by the pad and thus does not qualify as an accident
Sally adjusts her skirt and pulls down her underwear before voiding. Once done with these tasks, she performs perineal hygiene and adjusts her clothing with steadying assistance from a helper. What is Sally’s FIM® rating for Toileting?
Level 4, Minimal Assistance: Sally requires steadying assistance.
Waikele uses a rolling walker to transfer from the wheelchair to the tub bench with only assistance from the helper to lift one leg over the tub.
What is Level 4 Tub transfer = - Lifting one leg
Charles refuses to participate in any grooming activities, and he does not allow a helper to complete them for him. What is Charles’s FIM® rating for Grooming
What is 0, Activity Does Not Occur: Charles refuses to work on any grooming tasks, and no staff member completes these tasks for him.
Ethan requested a suppository after his admission to the rehabilitation unit today. A nurse lubricated and inserted the suppository while Ethan lay in bed and then provided lifting and lowering assistance as Ethan transferred to the bedside commode.
What is Level 4, Minimal Assistance: The nurse inserts Ethan’s suppository.
If Dig stim was performed or he's on a bowel program, then it would rate a 1.
(This is different then what we've been thinking- but this is direct from UDS. -Robin-)
Ashley wears a diaper for bowel management only. She does not have difficulty with bladder management and has not had any accidents or incontinent episodes. Only during a bowel management episode does a nurse need to change Ashley’s diaper. What is Ashley’s FIM® rating for Bladder Management?
What is Level 7, Complete Independence: Ashley wears the diaper for bowel management, not bladder management (level 7 for Bladder Level of Assistance). She has not had any accidents (level 7 for Bladder Frequency of Accidents).
Jordan pulls down his pants and shorts without assistance. He uses a toilet aid to clean himself after a bowel movement and then pulls up his pants and shorts without further assistance. What is Jordan’s FIM® rating for Toileting?
Level 6, Modified Independence: The toilet aid is considered an assistive device for this item.
Dianne needs minimal lifting to get out of the wheelchair, then only steadying assistance for the pivot and assistance lowering onto the toilet.
What is Level 2 Toilet transfer - Lifting and Lowering during transfer
Kathie sits in a wheelchair when she performs grooming tasks. After a helper turns on the water and adjusts the water temperature, Kathie completes her grooming tasks without assistance. What is Kathies’s FIM® rating for Grooming
What is Level 5, Supervision/Setup: The helper turns on the water and adjusts it but does not provide physical assistance. Kathies’s use of a wheelchair as he grooms is not part of the rating for this item.
Jennifer uses a bedpan for bowel movements. A nursing assistant pulls down Jennifer’s pants, positions the bedpan, and holds it in place while helping Jennifer roll onto the bedpan. Once Jennifer is finished, the nursing assistant helps her with her perineal hygiene, helps her roll off the bedpan, and adjusts her pants. The nursing assistant then empties the bedpan. Jennifer has not had any accidents. What is Jennifer’s FIM® rating for Bowel Management?
What is Level 2, Maximal Assistance: Jennifer requires assistance to position the bedpan, hold it in place, and roll herself on and off. Jennifer participates in less than 50% of the activity but more than 25% (level 2 for Bowel Level of Assistance).
Todd had his Foley catheter removed yesterday while he was in the acute hospital. He was admitted to the rehabilitation unit this morning. Todd has been using a urinal as needed throughout the day. Todd calls the staff after each use to empty the urinal and return it to his bedside. Todd had one accident three days ago in the acute hospital when his Foley clip opened, wetting Todd’s bed linen. A nurse changed Todd’s bed linen. What is Todd’s FIM® rating for Bladder Management?
What is Level 5, Supervision/Setup: Todd uses a urinal that is emptied by the staff (level 5 for Bladder Level of Assistance). He had one accident in the acute hospital. The cleanup did not represent a burden of care for the rehabilitation unit.
After walking to the toilet with minimal assistance, Robert pulls down his sweatpants and sits down on the toilet. Robert cleans himself, but a helper pulls up his pants. What is RobertFIM® rating for Toileting?
Level 3, Moderate Assistance: Robert performs two of the three toileting tasks.
Tom requires assistance from two helpers when he transfers from his bed to his wheelchair. What is Tom’s FIM® rating for Transfers: Bed, Chair, Wheelchair
Level 1, Total Assistance: Tom requires assistance from two helpers to transfer
Robin wears underwear, a skirt, and slip-on shoes. She gathers her clothing and dresses herself without assistance from a helper. What is Robin’s FIM® rating for Dressing – Lower Body?
What is Level 7, Complete Independence: Robin gathers her clothes and dresses independently.
A helper provides steadying assistance as Angie transfers onto a commode that has been placed over a standard toilet. Angie does not require additional assistance and has not had any accidents. What is Angie's FIM® rating for Bowel Management?
What is Level 7, Complete Independence: Angie uses a commode placed over a standard toilet (level 7 for Bowel Level of Assistance).
The commode frame and the helper’s steadying assistance are rated under Transfers: Angie does not use an assistive device and has not had any accidents.
A commode at bedside is considered a "device" and is then scored under bowel & bladder assist.
Sue uses a bedpan. A staff member positions the bedpan under Sue, holds it in place during use, and provides assistance as Sue rolls on and off the bedpan to avoid spillage. Sue has not had any accidents. What is Sue’s FIM® rating for Bladder Management?
What is Level 2, Maximal Assistance: Sue requires assistance to position the bedpan, hold it in place while in use, and assist her in rolling on and off the bedpan to avoid spillage (level 2 for Bladder Level of Assistance). She has not had any accidents (level 6 for Bladder Frequency of Accidents).
With Carolyn positioned supine in bed, a nurse pulls down her pants, removes her soiled diaper, cleans her, puts on a new diaper, and redresses her. What is Carolyn’s FIM® rating for Toileting
Code 0, Activity Does Not Occur: Carolyn did not have a continent episode
*Patient did not get to the toilet
Sara is on bedrest and does not transfer from her bed to a chair or wheelchair. What is Sara’s FIM® rating for Transfers: Bed, Chair, Wheelchair?
Code 0, Activity Does Not Occur: Sara has not completed any transfers
Rita wears a T-shirt, a front-buttoning shirt, and a TLSO brace. She threads both arms into the T-shirt and pulls it over her head. A helper pulls the shirt down Rita’s trunk and then applies Rita’s brace with the assistance of another helper. Rita threads one arm into the front-buttoning shirt, but the helper must pull the shirt around the back of the TLSO brace and thread Rita’s other arm. Rita leaves his shirt open. What is Rita’s FIM® rating for Dressing – Upper Body?
What is Level 1, Total Assistance: Rita requires two helpers to apply his TLSO brace