What can I code?
Edith calls for the nurse so that she can get back in bed after therapy. The nurse provides lifting assistance to help her stand and provides support as she sits on the edge of the bed. Edith then requires trunk support as she lowers herself to a lying position. Edith is able to manage her own legs with the use of a limb lifter provided by therapy.
Sit to Sit Transfer- Substantial assist
Sit to lay- Partial assist
When is the MOST important time to input QIM scores?
the first three days (admission day and two days after)
the last 3 days (discharge day and two days prior)
Mr. C requires more than a reasonable amount of time to complete his meal due to decreased attention span. A helper must provide occasional cues to stay on task while eating.
04- Supervision!
Mr. M has left sided weakness after a stroke. Once in the bathroom, he manages to pull down his pants and underwear without assistance, and perform hygiene after a bowel movement, but needs assistance pulling up his pants once complete.
03- Partial Assist
Mrs. Y has right side upper extremity weakness as a result of a stroke and has worked in therapy to re-learn how to dress her upper body. During the day, she only requires the helper to place her clothing next to her bedside. Mrs. Y can now use compensatory strategies to put on her bra and top without any assistance. At night she removes her top and bra independently and puts the clothes on the nightstand and helper puts them away in her dresser.
05- Set-up Assist
James rings for the nurse to use the bathroom. He is sitting in the wheelchair and requires lifting assistance to get to a standing position. James transfers to the toilet via rolling walker with supervision assistance due to poor balance. He manages clothing and performs perineal hygiene without assistance. after toileting, the nurse provides contact guard assistance as he ambulates back to the wheelchair to sit down.
Sit to Stand- Partial assist
Toilet Transfer-Supervision
Toileting Hygiene- Supervision
How often should you input QIM scores?
They should be done in real time, with every activity
but AT LEAST once per shift.
Mrs. W begins to brush upper teeth after the helper applies toothpaste onto the toothbrush, but becomes fatigued and cannot finish. The helper completes the task by finishing the upper teeth and brushing the bottom teeth.
02- Substantial Assist!
Mrs. E has a severe and progressive neurological condition that has affected her endurance as well as her fine and gross motor skills. Mrs. E showers while sitting on a tub bench and washes her arms and chest. A helper then must help wash her with the remaining parts of her body due to fatigue. Mrs. E uses a long-handled sponge to rinse herself but tires half-way through the task. The CNA dries Mrs. E’s entire body.
02- Substantial Assist!
Sheila wears jeans and a brief. A CNA puts on Sheila's brief, then Sheila threads her legs into her pants, stands with support of her rolling walker and then pulls up and fastens her pants.
03-Partial assistance
Judith wakes up and needs to use the bathroom. The CNA provides trunk support as she sits up and places her feet on the floor. She stands with steading assistance and ambulates to the bathroom with her rolling walker and sits on an elevated toilet seat. She pulls down her brief and after voiding, she performs perineal hygiene while sitting She stands with the help of the grab bars. The CNA pulls her brief back up and provides contact guard assistance as she ambulates back to bed. Judith is lower onto the bed and lay back down without any additional assistance or cues
lay to sit-partial assist
sit to stand-supervision
toilet transfer- supervision
toilet hygiene- partial assist
sit to lay-independent
What items are only done by nursing on admission and REQUIRED
BIMs and Drug Regimen Review
A helper scoops each bite of food for Michele, after which Michele brings the utensil to her mouth, chews the food and swallows it. Michele drinks from a cup without assistance.
03-Partial assistance!
Diane adjusts her skirt and pulls down her underwear before voiding. Once finished, she performs perineal hygiene, which the helper repeats due to poor quality and provides assistance pulling up her underwear and adjusting her skirt.
02-substantial assistance!
Mr. B was admitted to rehabilitation following a total hip replacement. Mr. B cannot independently thread his pants or underwear onto his feet due to hip precautions. Once the helper begins to thread his pants and underwear, Mr. B pulls them up to his knees, stands and pulls them up around his hips, and adjusts the clothing and fasteners. The helper zips up his pants. The helper puts on his socks and shoes.
03- Partial Assist
It's breakfast time and Joel is HUNGRY!
He transfers from sitting on the edge of his bed to his wheelchair without assistance. Once in his wheelchair, he goes to the dining room and eats his chopped with verbal cues to slow down for safety. after eating, the nurse performs a finger sweep to check for pocketed food. Upon return to his room, the nurse positions the wheelchair, locks the breaks and moves footrests for Joel and he completes the transfer independently.
sit to sit/bed to chair transfer- set-up
eating-partial assistance
What 3 main items make up a patient's CMG?
rehab diagnosis
comorbidities
admit QIM scores
Gary sits in his wheelchair to perform oral hygiene. A helper turns on the water, adjusts the temperature and applies toothpaste to his toothbrush. Gary then brushes his teeth without any physical assistance
05- Set-up assistance
Keith transfers to the shower with partial assistance from a helper. A helper then gathers and hands him supplies as he washes, rinses and dries his arms and chest. Keith refuses to wash the rest of his body, or allow the helper to do so.
05-setup assistance
Anna wears socks and lace-up shoes. Because she complains of feeling dizzy after putting on her right sock, a helper puts on her left sock and her shoes.
02-Substantial/maximal assistance!
Natalie is discharging today and getting ready to leave!
She uses her wheelchair to gather her clothing and hygiene supplies. She sits at the sink and gives herself a "bird bath". She then pulls on her t-shirt, locks her wheelchair wheels and uses her walker for support while she stands to pull up her pants. she sits back down, and slides on her shoes. She then remains in the wheelchair and waits for her ride to arrive.
bathing-independent
upper body dressing-independent
lower body dressing-independent
wheelchair- independent
What are the main 3 items that a CMG determines?
length of stay
projected outcomes
facility reimbursement
Ian is on calorie count due to poor intake. He eats 3 meals during the day with a helper providing more than half the effort to feed him. A nurse administers IV fluids to maintain adequate hydration at night.
02-Substantial Assist!
Due to Colleens impulsivity, she requires supervision from a helper to perform all toileting hygiene tasks when she voids. Colleen adjusts her clothing before and after her bowel movement and performs perineal hygiene without assistance.
04-supervision
Jane gathers all her clothes and sits on the side of the bed to get dressed. She wears a sports bra, t-shirt and cardigan. Jane threads her arms through her bra, pulls her over her head and trunk, puts on her shirt without assistance. She threads her right arm through her cardigan, pulls behind her and threads in her left arm. Due to find motor deficits, she requires assistance from the nurse to button her cardigan.
03-partial assistance