Julie Bantle, MA, OT/L, Chief Operating Officer Deirdre Huneke, PT, Therapy Supervisor/FIM Coordinator Mercy Rehabilitation Hospital, St. Louis, Missouri A Partnership Between Kindred Healthcare and Mercy Hospital St. Louis FIM, UDSPRO Central, UDS-PRO Doc, and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. 1
Identify UDSMR reports to use to analyze opportunities to improve accuracy and efficacy of admission and discharge FIM ratings. Utilize the admission and discharge worksheets to extract meaningful data from UDSMR reports. Understand how to link worksheet findings to real-life change opportunities in rehabilitation facilities. 2011 UDSMR 2011 Mercy National Database Admission FIM Rating 55.4 54 Discharge FIM Rating 86.7 82.5 FIM Change 31.3 28.6 LOS Efficiency 2.57 2.24 CMI 1.52 2
3 hours of FIM training at hire, eventually increased to 4 hours All clinical staff are credentialed to rate FIM items before orientation is completed No solo patient care without credentials Nursing and therapy rate FIM items every shift, every day, for any observed activities Special training for nursing techs: a detailed sheet to assist nurses in capturing an accurate rating 2012 Mercy/Nation 2013 Mercy/Nation 2014 Mercy/Nation Admission FIM 55.8/54.6 54.7/54.4 55/54.3 Rating Discharge FIM 87.7/84 87.4/84.7 91.9/85.6 Rating FIM Change 32/29.4 32.7/30.2 36.8/31.3 LOS Efficiency 2.65/2.38 2.79/2.45 3.41/2.57 CMI 1.5 1.48 1.46 3
New Admission signage and Performance Day to capture scores at admission and discharge. Analysis of UDSMR reports, and focus on specific problem areas such as transfers, bathing, and bowel/bladder. UDS-PRO Doc documentation system Daily Leadership Huddles to challenge scores/compare to expected. Staff education ongoing! 2015: A clinical supervisor supported the PPS Coordinator by analyzing reports and providing focused direction for improvement. 2014 Mercy 2015 Mercy/Nation Admission FIM Rating 55.0 51.6/52.5 Discharge FIM Rating 91.9/85.6 90.7/84.3 FIM Change 36.8 39.1/31.8 LOS Efficiency 3.41 3.53/2.53 CMI 1.46 1.51 4
Using the reports on the UDSPRO Central website to provide direction for Day 3 Rounding and Education. If you don t know where you are going, any road will get you there. ~Lewis Carroll If you don t know where you re going, you will probably end up somewhere else. ~Laurence J. Peter 5
Describes the process we use Easy to use Introduction to the reports available Training tool for new facilities/users Accurate scoring Patient centered: capturing multiple episodes and challenges that replicate (not simulate) the patient s home environment, personal habits/preferences and goals Use the nation s scores as a benchmark 6
FIM Item (Weight) Facility Admission Nation Adj. Admission Variance Stairs (1.6) Walk/Wheelchair (1.6) Dressing Lower (1.4) Toileting (1.2) Tub/Shower (0) Bed Chair Wheelchair (2.2) Toilet (1.4) Bathing (0.9) Bladder (0.5) Dressing Upper (0.2) Grooming (0.2) Bowel (0.2) Eating (0.6) Problem Solving (0) Memory (0) Comprehension (0) Expression (0) Interaction (0) 7
FIM Item (Weight) Facility Admission Nation Adj. Admission Variance Stairs (1.6) 1.3 1.3 = Walk/Wheelchair (1.6) 1.6 1.6 = Dressing Lower (1.4) 1.7 1.8 0.1 Toileting (1.2) 2.0 2.0 = Tub/Shower (0) 2.3 1.9 +0.4 Bed Chair Wheelchair (2.2) 2.0 2.2 0.2 Toilet (1.4) 2.2 2.3 0.1 Bathing (0.9) 2.7 2.4 +0.3 Bladder (0.5) 3.0 2.8 +0.2 Dressing Upper (0.2) 3.0 2.9 +0.1 Grooming (0.2) 3.7 3.6 +0.1 Bowel (0.2) 4.0 3.7 +0.3 Eating (0.6) 4.5 4.4 +0.1 Problem Solving (0) 3.7 3.7 = Memory (0) 4.2 4.0 +0.2 Comprehension (0) 4.4 4.5 0.1 Expression (0) 4.4 4.6 0.2 Interaction (0) 4.6 4.6 = 8
1. Bathing 2. Bowel 3. Bladder Picked based on weight, prioritized, and Bowel and Bladder work together No weight It does not affect CMG Affects outcomes Reviewed reports for more info 9
0 1 2 3 4 5 6 7 Facility 23.4 14.2 22.1 17.8 18.7 3.0 0.6 0.1 Nation Adjusted 46.4 16.1 7.7 10.2 16.1 3.1 0.3 0.1 Chasing 0s FIM Change using the Scoring Report 2014 Facility: 2.3 points Nation Adjusted: 1.9 points 10
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FIM Item Percent of Cases within Each FIM Rating 0 1 2 3 4 5 6 7 1. Facility Nat. Adj. 2. Facility Nat. Adj. 3. Facility Nat. Adj. FIM Item Percent of Cases within Each FIM Rating 0 1 2 3 4 5 6 7 1. Bathing Facility 3.4 21.7 14.2 32.7 22.5 4.8 0.3 0.3 Nat. Adj. 6.7 25.9 18.8 26.1 16.8 5.4 0.2 0.1 2. Bowel Facility 35.5 1.8 2.9 5.1 2.3 44.0 8.4 Nat. Adj. 32.2 6.4 6.8 7.9 13.3 28.5 4.9 3. Bladder Facility 52.7 5.3 2.4 2.3 18.0 2.1 17.2 Nat. Adj. 50.5 6.0 6.8 7.5 19.2 4.2 5.9 12
What ratings are higher than the Nation? Bowel: Level 6 Bladder: Level 7 What ratings are lower than the Nation? Bowel: Levels 2, 3, 4, and 5 Bladder: Levels 3, 4, and 6 Review your FIM resources 13
PPS Coordinator Bladder/Bowel Management Guidelines (available on UDSPRO Central website) UDS-PRO Doc System (from UDSMR) Forum search (on UDSPRO Central website) Bowel/Bladder Scenarios (available on UDSPRO Central website) Focus Group: OTs, Nursing included Patient Care Assistants and Nursing Techs day and night shift We were not capturing assistive devices in the acute setting (4 day look back) Bedpans were being used, but not scored (day shift different than night shift) Bedside commodes were being used at night, and not scored No detail in scoring use of urinal, just scoring emptying (documentation issue) Not accurately capturing the burden of the brief 14
Improved review of the acute medical record to capture assistive devices Education on scoring of brief, bedpan, urinal and bedside commodes Education on UDS-PRO Doc rating of assistive devices Added bowel and bladder assistive devices to all Day 3 Rounding Rounding with Purpose Completed on all patients Speak with patient s Patient Care Assistants, Nurses and Therapists Speak with patients and family Room rounding for bowel and bladder assistive devices as needed 15
PATIENT STAFF ROOM # Today is Day 1 2 3 Please pay special attention to the following FIM items: 16
2014 Facility 2014 Nation Difference 2015 Facility 2015 Nation Difference Bathing 4 22.5 16.8 5.7 18.8 16.2 2.6 Bowel 6 44.0 28.5 15.5 31.7 27.1 4.6 Bladder 7 17.2 5.9 11.3 8.2 5.3 2.9 17
Allow 4-6 weeks to see if you are making a difference Patients need to be admitted and discharged Are our patients making progress? Can we improve our program? Discharge scores affect UDSMR Program Evaluation Model (PEM) Report 18
FIM Item Facility Discharge Nation Adj. Discharge Variance Stairs Walk/Wheelchair Dressing Lower Toileting Tub/Shower Bed Chair Wheelchair Toilet Bathing Bladder Dressing Upper Grooming Bowel Eating Problem Solving Memory Comprehension Expression Interaction 19
FIM Item Facility Discharge Nation Adj. Discharge Variance Stairs 3.3 2.8 +0.5 Walk/Wheelchair 4.9 4.4 +0.5 Dressing Lower 4.7 4.2 +0.5 Toileting 4.4 4.3 +0.1 Tub/Shower 4.6 3.8 +0.8 Bed Chair Wheelchair 4.5 4.5 = Toilet 4.6 4.5 +0.1 Bathing 4.9 4.4 +0.5 Bladder 4.5 4.5 = Dressing Upper 5.6 5.0 +0.6 Grooming 6.0 5.4 +0.6 Bowel 5.3 5.0 +0.3 Eating 6.0 5.7 +0.3 Problem Solving 5.1 5.0 +0.1 Memory 5.5 5.1 +0.4 Comprehension 6.0 5.6 +0.4 Expression 5.9 5.7 +0.2 Interaction 6.0 5.7 +0.3 20
1. Bed/Chair/Wheelchair (=) 2. Bladder (=) 3. Problem Solving (+0.1) 4. Toileting (+0.1) Hint: To help prioritize, you can compare your points of change compared to the nation-adjusted points of change. 21
FIM Item Percent of Cases within Each FIM Rating 0 1 2 3 4 5 6 7 1. Facility Nat. Adj. 2. Facility Nat. Adj. 3. Facility Nat. Adj. 22
FIM Item Percent of Cases within Each FIM Rating 0 1 2 3 4 5 6 7 1. Bed/Wheelchair Facility 0 7.9 4.5 9.2 18.8 31.6 20.7 7.3 Nat. Adj. 0 8.3 4.6 8.3 21.0 25.4 27.4 5.1 2. Bladder Facility 27.2 3.0 2.5 2.5 23.0 6.5 35.3 Nat. Adj. 23.7 2.7 3.7 5.9 25.3 15.3 23.3 3. Facility Nat. Adj. Review FIM Resources 23
Auditing of 30 patient charts with Bed/Chair/Wheelchair Transfer ratings of level 5 revealed that 14/30 patients were rated level 6 by therapists and level 5 or 6 by nurses, with the level 5 ratings occurring more frequently during the evening shifts. Education on using levels 5, 6, and 7 was added to transfer training class and provided to evening nursing staff Performance Day: audits and staff education Improve communication between shifts and disciplines to identify discrepancies in function and maximize patient s independence (ADL Communication Sheet) Put T (transfer) score on the schedule board that is updated by therapy 24
Bed/Chair 5 Bed/Chair 6 2014 Facility 2014 Nation Difference 2015 Facility 2015 Nation Difference 31.6 25.4 6.2 30.0 24.7 5.3 20.7 27.4-6.7 20.9 26.2-5.3 25
Admission FIM Rating by RIC Discharge FIM Rating by RIC Goal Attainment by FIM Item Rehab Metrics And many more We just ran these reports and plugged in the data based on the current quarter and found it very helpful. While we are generally doing better than the region and nation, it is enlightening to see the facts and we especially found the frequency of FIM report helpful and have already started brainstorming ways to shift those percentages. 26
Julie Bantle: jbantle@mrhsl.com Deirdre Huneke: dhuneke@mrhsl.com 27