FIM and the UDSMR logo are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

FIM and the UDSMR logo are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

Embracing the Technology Wave: How We Improved Our FIM Ratings through the Use of Our Electronic Medical Record and Our Unit Practice Council Monica Haldar, RN, MSN, CRRN, NE-BC Director, UCLA Neuro Rehab Unit Cindy Jaeger, OTR/L, MS, SWC Inpatient Manager, UCLA Therapy Services Image ID: lwea00842, NOAA's Location: Hawaii Photographer: Ian Masterson 2

Disclosure Disclosure: The speakers do not endorse any specific vendor. The speakers have no financial relationships or interests with any commercial topics that are discussed in this activity. 3

Objectives Discuss what the Unit Practice Council (UPC) is and its role in staff education related to FIM ratings Describe ways the unit enhanced the documentation to improve FIM ratings Discuss modes of training Compare progress to date 4

UCLA Neuro Rehab Unit 11 bed unit Located in Los Angeles, California Approximately 200 patients per year Primarily stroke and non-traumatic brain injury 80% discharged to home RNs, Care partners, PT, OT, ST, SW, TR (dedicated to the unit) Charge nurse is not out of ratio 5

Relationship-Based Care Leadership Delivery of Care Resources Patient & Family Teamwork Outcomes Professional Practice 6

Unit Practice Council (UPC) UPC born out of Relationship-Based Care (RBC) Role and members UPCs on other units are only nursing staff Rehab is unique by including therapy-all frontline staff Primary goal is to lead process and practice changes by engaging staff who are directly affected by the changes 7

Prioritization Inaccurate FIM ratings across all disciplines Inconsistencies, especially with float staff Documentation limitations 8

Analysis Documentation did not emphasize FIM rating No prompts for specific functional areas Limited documentation choices No clear process for tracking FIM change RN end of shift summary Therapy notes Team conference note Limited FIM training for covering staff 9

Action Plan UPC set up specific objectives of the process Outcome measure would be the FIM change Strategies included: Identifying changes needed in documentation Developing training opportunities Promoting staff engagement 10

Action Plan 2013 new software system Opportunity to enhance documentation for all disciplines UPC ready to embrace technology Improve choices for items with FIM ratings Clarify descriptors Modify the legend Evaluate changes Multiple revisions 11

Deployment Presented at staff meeting, huddles Created standard work Facilitated opportunities for staff input and feedback Encouraged compliance Supported staff throughout changes 12

Roll Out Of Education Multimodal approach Email blasts with questions and rewards Staff meetings Developed handouts and posters for staff areas Buddy system for float staff for therapy and RNs One-on-one sessions with PPS Coordinator at hire and ongoing 13

Pre Admit Screen Current Functional Status: Eating: 5 = Supervised / Set up Assistance Toileting: 2 = Maximum Assistance Bed-chair transfers: 3 = Moderate Assistance Locomotion: 2 = Maximum Assistance Bowel management: 2 = Maximum Assistance Bladder management: 2 = Maximum Assistance Expression: 5 = Supervised / Set up Assistance Memory: 5 = Supervised / Set up Assistance Bowel Assistive Devices: (if any) NA Bladder Assistive Devices: (if any) NA Diet: Regular 14

Nursing 15

Nursing Legend Row Information (not level of assist for transfer to BSC/toilet or hygiene assist)) if patient is using a BSC, only select 5 or 6: 5=Supervision/Set up (staff empties bucket for pt OR pt empties bucket w/supervision) 6=Modified Independent (pt empties bucket) if patient uses a urinal, bed pan, catheter, select one of the following: 1=Total Assist (pt does not help, staff does everything) 2=Max Assist (staff does more than ½ of the work) 3=Mod Assist (staff does ½ the work) 4=Min Assist (staff occasionally helps/provides steadying assist only) 5=Supervision/Set up (staff helps set up the equipment and/or give vc's only when needed) 6=Modified Independent (pt gathers all the equipment, self caths and disposes of bag) if patient does not use assist device or medications, select: 7=Independent 16

OT Legend 17

PT Legend 18

Team Conference 19

Nursing FIM Reference Tool 20

Reminders for Float Staff 21

Potty Post 22

Baseline 2012 23

Progress for 2015 YTD 24

FIM Change 25

Current State Revisions to documentation ongoing Regular reminders and real life patient scenarios to facilitate discussion and problem solving Continued new staff orientation and buddy system with veteran staff Reinforcement at staff meetings and huddles Monitor/audit documentation and follow up as needed 26

Questions? Cindy Jaeger cjaeger@mednet.ucla.edu Monica Haldar mhaldar@mednet.ucla.edu Thank You! Image ID: wea00836 NOAA's Collection Location: Hawaii Photographer: Ian Masterson 27