Living arrangements There is only one item in the Living Arrangements section of the OASIS instrument. Question M1100 determines whom the patient lives with and how often this person is available and able to provide assistance to the patient if needed. Answering Sensory status The items in the Sensory Status section address the patient’s ability to see (M1200) and how often pain interferes with the patient’s activities and ability to move around (M1242). Response-Specific Instructions for this item indicate that “activities” include sleeping and recreation. If the patient has trouble sleeping or avoids some activities due to pain, the therapist should determine how often the pain interferes with these activities. The instructions also advise the therapist to measure the patient’s pain while the patient is using the pain medications agreed on by the patient and the physician. In selecting the correct response, the therapist should integrate Integumentary status The Integumentary Status section of the OASIS includes 10 questions which focus on three types of wounds: pressure injuries (5 items), venous stasis ulcers (3), and surgical wounds (2). For all these three types of wounds (M1320 – Pressure Ulcer, M1334 – Stasis Ulcer, M1342 – Surgical Wound), the therapist will need to answer the same question: What is the status of the most problematic wound? To answer these wound status questions, the therapist has four choices. The status of the wound is (0) newly epithelialized, (1) fully granulating, (2) showing early/partial granulation, or (3) not healing. To identify the accurate response, the therapist must use the definitions concerning wound status provided by the Wound, Ostomy and Continence Nurses [WOCN] Society’s Guidance on OASIS-D Integumentary Items: Best Practice for Clinicians (WOCN, 2019). This guidance is incorporated into the Chapter 3 Response- Specific Instructions accompanying each of the items. It is imperative to learn how to apply the WOCN definitions to each of the three types of wounds. The items on pressure ulcers reflect CMS’s interest in preventing these types of injuries. If the patient has pressure ulcers, the SOC/ROC OASIS asks five questions about them. Question M1306 asks if the patient has an unhealed pressure ulcer at Stage 2 or higher. If the answer is no, the clinician is directed to skip the next several questions. If the answer is yes, the clinician must answer the next question about the current number of pressure ulcers at each stage (M1311). Question M1322 asks how many Stage 1 pressure ulcers the Respiratory status The respiratory section of OASIS contains just one question. The question asks about the patient’s degree of dyspnea when performing activities that require various levels of physical exertion. This question is asked at start of care, resumption Elimination status The Elimination Status section includes two questions about the patient’s urinary status and two items about the patient’s bowel status. The urinary status questions ask about recent urinary tract infections (M1600) and urinary incontinence or use of a urinary Neuro/emotional/behavioral status The six items in the Neuro/Emotional/Behavioral Status section address the patient’s level of cognitive and mental health. Neurological and psychological conditions and diagnoses affect the patient’s ability to achieve optimal physical and functional outcomes. If the patient has these types of problems, they should be identified and addressed in the POC. Most of these items instruct the therapist to focus on the patient’s status over the past 14 days and to use patient and caregiver reports and what the therapist observes to determine the best response. When these sources of information conflict with one another, the therapist should use clinical judgment to determine the
this item requires careful review of the meaning of each of the elements in the Response-Specific Instructions. For instance, a patient is considered to be “living alone” even if the patient has paid live-in help. the patient’s verbal response and nonverbal behavior to determine the most accurate response. Thus, for the purposes of completing an OASIS, pain is not always what the patient says it is. Both of these items are included on the SOC and ROC OASIS assessments, and M1242, measuring how often pain interferes with activities and movement, is measured again at discharge to see if the patient has improved on this measure during the course of care. patient has, and M1324 asks about the stage of the patient’s most problematic pressure ulcer. The Discharge OASIS repeats several of the pressure ulcer questions found on the SOC/ROC OASIS and adds new ones. Question M1307 specifically asks if the patient has a Stage 2 pressure ulcer and, if so, when it was first identified. Question M1311, which asked about the current number of pressure ulcers on the SOC/ROC assessments, asks the question again at discharge and further asks the therapist to identify how many of these ulcers were also present on the previous SOC/ROC assessment. The next five questions are about venous stasis ulcers and surgical wounds. Question M1330 asks if the patient has a stasis ulcer. If not, the therapist skips the next two questions. But if the patient does have a stasis ulcer, the next question, M1332, asks about the number of stasis ulcers, and M1334 asks about the status of the most problematic stasis ulcer. Question M1340 asks if the patient has a surgical wound. The list of what is considered a surgical wound and what is not is included in the Chapter 3 Response-Specific Instructions for this item. For instance, ostomies – tracheostomy, thoracotomy, urostomy, colostomy, etc. – are not considered surgical wounds. Central lines and implanted venous access devices, on the other hand, are considered surgical wounds. If the patient has a surgical wound, the therapist is instructed to identify the status of the most problematic surgical wound in M1342.
of care, and again at discharge, so the degree to which the patient’s dyspnea improved, stayed the same, or worsened under the agency’s care is determined.
catheter (M1610The bowel status items focus on frequency of bowel incontinence (M1620) and if the patient has any type of bowel ostomy that is new or has recently been “problematic” (M1630). correct response. Most of these items are measured at admission and again at discharge, indicating that the therapist should be including these cognitive and mental health issues in care planning and attempting to improve the patient’s status in these areas over the patient’s stay in home care. Question M1700 identifies cognitive issues related to orientation, memory, and comprehension. Thus, the first response, “alert/oriented,” is for patients who are cognitively intact. Other responses indicate patients with progressively more severe cognitive impairments. Question M1710 inquires concerning how frequently the patient becomes confused and
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