AlphaFIM® Instrument Guided Self Study updated July 2013 Central East Stroke Network June 2009 AlphaFIM® Instrument Guided Self Study updated July 2013 Self Study for AlphaFIM® Assessors

Note to Users AlphaFIM and FIM are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. (UDSMR). The UDSMR copyrighted materials contained herein have been reproduced with the permission of UDSMR This resource is not intended to replace the required training established by UDSMR but to be a complimentary resource for clinicians.

Ontario Implementation of AlphaFIM® Instrument Ontario Stroke System negotiated special regional licenses with UDSMR. Under this license, use for STROKE PATIENTS ONLY. Provincial data collection strategy recommends the AlphaFIM® Instrument to be completed on people with stroke on Day 3 (Day 0 is defined as day of admission to the acute care hospital setting).

UDSMR Training Resources AlphaFIM® Instrument Guide Helpful Hints for Rating the AlphaFIM® Instrument The AlphaFIM® Case Study Booklet Current versions are available on the AlphaFIM® software portal. How can you access them? Sign in to the portal at www.udsmr.org with facility code, username and password. Click on “help” on the left side of the page.

AlphaFIM® Instrument Guide Chapter 1: Introduction to AlphaFIM® Instrument Chapter 2: Uses of the AlphaFIM® Instrument Chapter 3: Implementation and Rating Overview Chapter 4: Specific Rating Instructions (note Ontario specific information in the following slides) General Rating Rules Descriptions and Ratings of 8 items

Chapter 1 – Key Points AlphaFIM® Instrument provides a means of measuring patient disability and functional status in the acute care setting. Abbreviated version of FIM® Six items Patients who walk less than 150 ft Patients who walk 150 ft or more 1. Eating 2. Grooming 3. Bowel Management 4. Transfers: Toilet 5. Expression 6. Memory 1. Transfers: Bed, Chair 2. Locomotion: Walk 3. Bowel Management 4. Transfers: Toilet 5. Expression 6. Memory

Chapter 2 – Key Points AlphaFIM® Instrument uses include: Preadmission screening for transfer to rehab Decision regarding discharge from acute care Outcome measure

Chapter 3 – Key Points ® The FIM® scoring levels contained herein are copyrighted by Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. ("UBFA" ) and have been reproduced with permission. All marks associated with FIM are owned by UBFA.  All rights reserved.

Chapter 4 – Key Points General Rating Rules: Begin by determining ability to walk 150 feet or more. Read definitions for each item carefully. Record actual performance, not capacity. Use the lowest rating. Use the best available information. Do not leave any items blank.

Chapter 4 – Key Points Specific Rating Instructions: Description Rating Guidelines Definition for each rating level

Rating Instructions Pages 11 - 21 Eating Grooming Bowel Management (see supplemental guidelines) Transfers: Toilet Transfers: Bed, Chair Locomotion: Walk Expression Memory

Suggestions for becoming an accurate AlphaFIM® Instrument Assessor Use all of your resources for accurate rating: AlphaFIM® Instrument Guide Helpful Hints for Rating the AlphaFIM® Instrument Bowel Management Guidelines Remember: AlphaFIM® Instrument is a measure of burden of care. Assess actual performance, not capacity.

Practice! Use the “AlphaFIM® Case Study Booklet” for practice before writing your mastery test.

AlphaFIM® Instrument Website Portal Chapter 5: AlphaFIM® Calculations Chapter 6: Using the AlphaFIM® Website

What is the next step? After scoring the patient on the 6 items you must complete data entry to obtain the projected FIM® scores.

Website Data Entry www.udsmr.org Select "Software Portals"

Website Data Entry Select “AlphaFIM Software“ or click on the icon below

Website Data Entry Complete Login Info

Website Data Entry Click on “Add” button in the Information area

Website Data Entry Enter facility identifier into “Patient ID” field Enter the Birth Date (mm/dd/yyyy) Enter the Assessment date. All other fields can be left blank Enter facility identifier into “Patient ID” field DO NOT ENTER PATIENT IDENTIFYING INFORMATION!

Website Data Entry Scroll down. Use the drop down menu to answer the question: “Has the patient been observed walking 150 feet or more?” Note that items to score change depending on your response to this question. (Compare with the slide on the next screen.)

Website Data Entry Observe how items to score have changed with a “yes” answer. (Compare with the slide on the previous screen.)

Website Data Entry Enter the ‘Raw Ratings’ of the 6 items you have scored using the drop down menus

Website Data Entry After entering the 6 item scores, Projected scores are now calculated After entering the 6 item scores, click on the orange ‘Calculate’ button

Option to print out website calculations or manually record them Website Data Entry Option to print out website calculations or manually record them Go to the top of the page Click on the ‘Print’ button.

Printout Double check that all values were entered correctly. Ensure it has printed. Addressograph or write the patient name or health record number on the printed sheet. Record the data on your hospital approved form. OR

Website Data Entry Then cancel or close. DO NOT SAVE. Do not leave any patient identifiers in the system.

Website Data Entry Click on Sign out

If you accidentally save … If you accidentally save, your screen will show an entry similar to the above after you close.

If you accidentally save … A popup will ask if you are sure you want to delete the record. Click on “OK” Highlight by clicking on the entry. Then click on “Delete”.

Options for Documentation

Sample Chart Note AlphaFIM® Instrument completed today. Raw scores as follows: eating – 4, grooming – 4, bowel management – 2, transfers: toilet – 3, expression – 7, memory – 6, projected raw motor score - 39, projected raw cognitive score - 32, help needed - 2 to 3 hours. Signature

Chart Note - Sticker

Approved Chart Forms

Electronic Health Record (sample 1)

Electronic Health Record (sample 2)

Questions? Contact your regional AlphaFIM® Instrument Lead