oasis-d practice makes perfect mahc presentation baker · 2019-04-03 · star ratings outcomes ......

3/22/2019

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Practice Makes Perfect: Mastering OASIS‐D

Instructor:Claudia Baker, RN, MHA, HCS‐D, HCS‐O

Objectives

• Understand the overall impact of OASIS assessment items.

• Know best practice assessment strategies for key OASIS assessment items, including accurate functional status responses.

• Describe how to integrate team member collaboration into agency practices.

• Learn the latest updates from CMS Question & Answers sessions regarding OASIS-D.

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OASIS‐D

Quality Care

Re‐hospitalization

Care Planning

CoP

Compliance

Agency Payment

Star Ratings

Outcomes

Patient Satisfaction

OASIS – Important Data

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Doing it Right

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Overview of Oasis Changes – 2019

6 NEW items:

• GG0100 – Prior Functioning: Everyday Activities.

• GG0110 – Prior Device Use.

• GG0130 – Self‐Care.

• GG0170 – Mobility.

• J1800 – Any Falls Since SOC/ROC.

• J1900 – Number of Falls Since SOC/ROC.

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Overview of OASIS Changes ‐ 2019

Revisions:

• M1028 – Added “None of the Above” option.

• M1306 – Updated terminology.



• M2102 – Response options removed at different time points.

• M2310 – Reduced response options.

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Overview of OASIS Deletions ‐ 2019

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Item Description

M0903 Date of Last Home Visit

M1011 Inpatient Diagnosis

M1017 Dx Medical/Treatment Change

M1018 Conditions Prior to Change

M1025 Optional Diagnosis

M1034 Overall Status

M1036 Risk Factors

M1210 Ability to Hear

M1220 Understanding Verbal Content

M1230 Verbal Expression of Language

M1240 Has Patient had Pain Assess?

M1300 Pressure Ulcer Risk Assess?

M1302 Patient have PU Risk?

M1313 Worsening in PU Status?

Overview of OASIS Deletions ‐ 2019

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M2102 Types and Sources of Assistance

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SOC

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Revised Skip Patterns ‐ 2019

Item Description

M1000 Inpatient Facility Discharge

M1051 Pneumococcal Vaccine

M1306 Unhealed Pressure Ulcer/Injury Stage 2 or Higher

M1311 Current Number of Unhealed PU/Injuries

M1340 Does This Patient Have a Surgical Wound

M1610 Urinary Incontinence or Catheter Presence

M2001 Drug Regimen Review

M2410 Which Inpatient Has Patient Been Admitted

M2420 Discharge Disposition

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OASIS‐D Guidance Manual Updates

Guidance Manual Changes:

• Item Intent ‐ wording changes

• Time Points Collected – if the specific time point at which this item is collected has changed (either it is collected at a new time point or it is no longer collected at a specific time point)

• Response Specific Instructions – guidance has been updated regarding the instructions for how to select a response

• Examples ‐ new examples were added or examples were updated

• Data Sources and Resources – item includes changes to data sources and resources the clinician can use to answer the item

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“One Clinician” Guidance

“The comprehensive assessment is a legal document and when signed by the assessing clinician, the signature serves as an attestation that to the best of his/her knowledge, the document, including OASIS responses, reflects the patient status as assessed, documented and/or supported in the patient’s clinical record.”

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Role of the Assessing Clinician

• Completes Start of Care/recertification documents.

• Collaborates with physician, pharmacist and/or other agency staff.

• Documents findings and communicate to case manager.

• Responsible for the content on the OASIS.

• Approves all changes to the OASIS.

• Findings guide the primary diagnosis and focus of the plan of care.

• Collaborates with physician and obtains verbal order for care.

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Collaboration

• Information must be relayed among team members TIMELY• One on one or smaller team/patient discussions• Increased use of admission/recertification narratives• Create a formal process for at least weekly teammeetings, butencourage immediate communication among team members

• Clinicians need to know what is done during OASIS/POC reviewand they need to be doing it themselves

• Involve your utilization review experts in the meetings• Learn what your software vendor has in place for team conferencing

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M1028 Active Diagnoses

• Identify whether these diagnoses are present and active. • Physician documented diagnosis at time of assessment

• Verbal diagnoses from physician must be documented in clinical record

• Direct relationship to:• Current functional, cognitive, mood or behavior status.

• Medical treatments.

• Nurse monitoring.

• Risk of death.

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M1060 Height and Weight

“Only enter height/weight directly measured by agency staff.”

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National Pressure Ulcer Advisory Panel (NPUAP)

• Pressure Injury• A pressure injury is localized damage to the skin and underlying

soft tissue usually over a bony prominence or related to a medical or other device.

• The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear.

• The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co‐morbidities and condition of the soft tissue.

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M1306 Unhealed Pressure Ulcer/Injury

• If pressure is not primary cause of lesion – do not score as pressure ulcer.

• Keep in mind that some Pressure Injury questions were removed:• M1300: Pressure Ulcer Risk Assess done?

• M1302 Does the patient have PU Risk?

• M1313 Worsening in PU Status?

• M1320 Status of Most problematic?

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NEW Functional Status Items

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GG0100 Prior functioning: Everyday Activities

• 3 ‐ Independent with or without device.

• 2 ‐ Partial assist from another person.

• 1 – Dependent on another person.

• 8 or 9 would be rare responses.20

GG0100 Everyday Activities

• Prior to current illness, injury.

• “Need for assistance”.

• Note what is involved in each area.

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GG0110 Prior Device Use

• Mechanical lift: any device a patient or caregiver requires for lifting or supporting the patient’s bodyweight.

• Stair lift

• Hoyer lift

• Bath tub lift

• Walker, All types of walkers. • Pick‐up walker

• Hemi‐walker

• Rolling walker

• Platform walker22

GG0130 & GG0170 Performance Scale

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GG0130 & GG0170 Performance Scale

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•Completes activity unassisted06 – Independent

•Caregiver SETS UP or CLEANS UP; patient completes activity.

•Caregiver assists only prior to or following the activity

05 – Setup or clean‐up assistance

•Caregiver must provide VERBAL CUES or TOUCHING/ STEADYING assistance as patient completes activity.

•Assistance required throughout the activity or intermittently

04 – Supervision or touching assistance

•Caregiver lifts, holds, or supports trunk or limbs, but provides LESS THAN HALF the effort.

03 – Partial/moderate assistance

•Caregiver lifts or holds trunk or limbs and provides MORE THAN HALF the effort.

02 – Substantial/maximal assistance

•Caregiver must provide ALL of the effort.

•Patient is unable to contribute any effort to complete the activity; OR the assistance of two or more caregivers is required for the patient to complete the activity.

01 – Dependent

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GG0170 Mobility Performance Scale

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07 – Patient Refused

• Not attempted and the patient did not perform this activity prior to the current illness, exacerbation or injury

09 – Not applicable

•Example, lack of equipment, weather conditions10 – Not attempted –environmental limitations

•Caregiver lifts, holds, or supports trunk or limbs, but provides LESS THAN HALF the effort.

88 – Not attempted –medical or safety concerns

GG0130 Self Care

A.Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the patient.

B.Oral Hygiene: The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to remove and replace dentures from and to the mouth, and manage equipment for soaking and rinsing them.

C.Toileting Hygiene: The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.

E.Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower.

F.Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable.

G.Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.

H.Putting on/taking off footwear: The ability to put on/take off socks/shoes or other footwear appropriate for safe mobility; including fasteners, if applicable.

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GG0170 Mobility

A. Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back on the bed.

B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.

C. Lying to sitting on side of bed: The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.

D. Sit to stand: The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed.

E. Chair/bed‐to‐chair transfer: The ability to transfer to and from a bed to a chair (or wheelchair).

F. Toilet transfer: The ability to get on and off a toilet or commode.

G. Car Transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt.

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Not at F/U

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GG0170 Mobility

I. Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space. (If SOC/ROC performance is coded 07, 09, 10 or 88, skip to GG0170M, 1 step).

J. Walk 50 feet with two turns: Once standing, the ability to walk 50 feet and make two turns.

K.Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space.

L.Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.

M.1 step (curb): The ability to go up and down a curb and/or up and down one step. If SOC/ROC performance is coded 07, 09, 10 or 88, skip to GG0170P, Picking up object.

N.4 steps: The ability to go up and down four steps with or without a rail. If SOC/ROC performance is coded 07, 09, 10 or 88, skip to GG0170P, Picking up object.

O.12 steps: The ability to go up and down 12 steps with or without a rail.

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GG0170 Mobility

P. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor.

Q. Does the patient use wheelchair and/or scooter?0. No – skip GG0170R, GG0170RR1, GG0170S, & GG0170SS11. Yes – Continue to GG0170R

R. Wheel 50 feet with two turns: Once seated in WC/scooter, the ability to wheel at least 50 feet and make two turnsRR1. Indicate the type of wheelchair/scooter used

1. Manual2. Motorized

S. Wheel 150 feet: Once seated in WC/scooter, the abilityto wheel at least 150 feet in a corridor or similar spaceSS1. Indicate the type of wheelchair/scooter used1. Manual2. Motorized

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GG Versus M Item Comparisons

ADL/IADL Item GG Item M Item

Grooming/oral

hygiene

GG0130 – B: Oral Hygiene M1800: “washing face and

hands, hair care, shaving or

make up, teeth or denture care,

or fingernail care”Dressing Upper Body GG0130 – F: Ability to dress

and undress above waist

M1810: Dress Upper Body

Dressing Lower Body GG0130 – G: Ability to dress

and undress below waist but,

does not include footwear.

M1820: Dress Lower Body

(includes shoes)

Putting on/off

footwear

GG1030 – H: ability to put

on/take off socks/shoes

appropriate for safe mobility;

including fasteners

M1820: (included as a task here)

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Toileting hygiene GG1030 – C ‐ ability to

maintain perineal hygiene,

adjust clothes before/after

voiding or bowel

movement. If managing

ostomy, include wiping the

opening but not managing

equipment

M1845: Ability to maintain

perineal hygiene, adjust

clothes, incontinence pads

before/after using toilet,

BSC, bedpan, urinal. If

managing ostomy, includes

cleaning around stoma, but

not managing equipment.Eating GG0130 – A ‐ ability to use

suitable utensils to bring

food and/or liquid to mouth

and swallow food and/or

liquid once the meal is

placed before the patient

M1870:

Current ability to feed self meals and snacks safely. eating, chewing, and swallowing

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Mobility: Ambulation GG0170 – I, J, K, L –

progressively functional ability

to walk distances and turn

(regardless of device use –

measures how much human

assistance is required)

M1860 – 0‐3: Responses that

determine how much assistive

device and/or human assist

required

Stairs/Steps GG0170 – M, N, O M1860 – 0‐3: Ability to

negotiate stairs w/ and w/o

AD, human assist.

Mobility: Balance GG0170 – P ‐ bend/stoop from

standing position to pick up a

small object from floor.

N/A

Mobility: Wheelchair GG0170 – Q, R, S –

progressively functional ability

use wheelchair and turn

M1860 ‐ 4‐5: Responses

related to wheelchair use

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Transfer: Bed/chair GG0170C – A, B, C, D, E (Bed

mobility and bed/chair

transfer)

M1850 – Moving from

bed/chair or turn/position

in bed if bedbound.

Transfer: Toileting GG0170‐F: The ability to get

on and off a toilet or

commode (not getting

to/from it)

M1840: Ability to get to/

from toilet or BSC AND

transfer on/off toilet/BSC

Transfer: Car GG0170‐G in/out of a car/

van on passenger side. Does

not include open/close door

or fasten seat belt.

N/A

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GG0130 & GG0170 Discharge Goals

Clinicians can establish a patient’s discharge goal based on the patient’s prior medical condition, SOC/ROC assessment, self‐care and mobility status, discussions with the patient/family, professional judgment, the profession’s practice standards, expected treatments, patient motivation to improve, anticipated length of stay, and the discharge plan.

• Goals should be established as part of the patient’s care plan.

• Collaborate with care team.

• Do not use 07, 09, 10 & 88.

• DC goals may be same as, higher than or lower than performance at assessment.

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Resources

• OASIS Guidance Manual• https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/HomeHealthQualityInits/Downloads/draft‐OASIS‐D‐Guidance‐Manual‐7‐2‐2018.pdf

• OASIS Q & As• https://oasisanswers.com/content/linksanddocs

• WOCN OASIS‐D Guidance on OASIS‐D Integumentary Items: Best Practice for Clinicians

• https://cdn.ymaws.com/www.wocn.org/resource/collection/7406B652‐D19C‐41C7‐906C‐0578AABC356B/OASIS‐D_Best_Practice_Document__2019_.pdf

• National Pressure Ulcer Advisory Panel (NPUAP)• http://www.npuap.org/resources/educational‐and‐clinical‐resources/npuap‐pressure‐injury‐stages/

• January 2019 CMS Quarterly OASIS Q&As• https://qtso.cms.gov/system/files/qtso/CMS_OAI_4th_Qtr_2018_QAs_Jan%202019_Final_508.pdf

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800.949.0388 | Simione.com

Corporate Headquarters

4130 Whitney Avenue

Hamden, CT 06518

California Office

50 Professional Center Drive, Suite 200

Rohnert Park, CA 94928

Massachusetts Office

54 Main Street, Unit 3

Sturbridge, MA 01566

Claudia Baker, RN, MHA, HCS‐D, HCS‐O [email protected] 203‐287‐9288

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