Medications The Medicare patient population has many adverse medication problems. These problems are related to confusion about the medication plan in the transition from inpatient to home care, medications that do not adequately treat the problem for which they were prescribed, medications that cause serious adverse effects, and intentional and unintentional noncompliance. Thus, six of the seven OASIS questions about medications are meant to identify these problems before they can cause the patient harm. At admission and ROC, M2001 asks if the therapist performed a complete review of the patient’s medications. Such a review includes performing a reconciliation of the medications the patient has in the home with the medications on the patient’s discharge medication list or with the list supplied by the physician and a review to ensure that the patient’s medications are appropriate and effective and that the patient is adherent and takes them safely. Question M2001 further asks if the review has unearthed any “clinically significant” medication issues. If medication issues were discovered – anything from a discrepancy with the reconciliation to nonadherence related to a lack of financial resources – M2003 asks if the therapist reported and resolved these issues with the physician (or designee) in a reasonably urgent period of time (by midnight of the day Care management The Care Management section consists of two items. Because both items are related to the Patient Living Arrangement (M1100) section of OASIS, it may be most efficient to complete these sections at the same time. Item M1100 asks about whom the patient lives with and how often this person is available and able to provide assistance to the patient if needed. At the SOC, Therapy need After completing the Care Management section, the therapist has basically completed the OASIS assessment items and has identified the patient’s status and needs on multiple OASIS items. In the Therapy Need and Plan of Care section of OASIS, the therapist begins coordinating the patient’s care with other rehabilitation therapists and begins identifying interventions that will help meet the patient’s needs. Question M2200 asks the therapist to identify how many physical therapy, occupational therapy, and speech-language Emergent care The Emergent Care section, consisting of two items, is completed only on Transfer and Discharge OASIS assessments. Question M2301 asks if the patient was treated in an emergency room since the patient was last admitted to home care services or resumed home care services. In an effort to encourage agencies in providing proactive care that forestalls the need for avoidable emergency department care, the CMS tracks Discharge The last four OASIS items include items that apply only to the Transfer and Discharge OASIS assessments. Item M2401is completed at transfer and discharge. This item asks if “best practice” interventions for diabetes, fall risk, depression risk, pain status, pressure ulcer risk, and pressure ulcer treatment were not only included on the patient’s POC but also implemented during the patient’s stay in home care. Question M2410 is also completed on transfer and discharge. It asks if the patient was transferred to an inpatient facility and, Conclusion The best way for a therapist to master the guidance required to answer OASIS items accurately is to take several hours to become proficient at understanding the OASIS-D Guidance Manual and its nuances by practicing how to use it with a real patient’s OASIS data. First, the therapist needs to assess a patient for the data required by the OASIS and then take a couple of hours to review the completed OASIS with the
following the day the issue was discovered). Also, at admission and ROC, M2010 asks if there was any education given concerning any high-risk medications, such as opioids, insulin, or anticoagulants. At transfer and discharge, OASIS M2005 and M2016 repeat the questions asked at admission and ROC regarding providing education about medications, but at transfer and discharge the questions are about any medication issues throughout the patient’s stay in home care and about providing education about all the medications the patient takes. Two questions – asked both at start of care and resumption of care, and then again at transfer and discharge – measure the patient’s ability to manage oral medications (M2020) and injectable medications (M2030). State practice acts may prohibit some therapists from performing a drug regimen review (DRR). Although the governing boards for therapists allow DRR because of curricula regarding medications, not all states take these curricula into account. It is the responsibility of therapists to be aware of the state regulation concerning therapists completing a DRR. For those therapists who are restricted, a qualified nurse in the office can collaborate on these items per the OASIS-D Guidance Manual . item M2102 identifies the patient’s need for caregiver assistance and the ability, willingness, and competence of caregivers to provide care related to supervision and safety needed due to cognitive impairments; at Discharge, the item expands to include three other domains – ADLs, medication administration, and medical procedures and treatments. pathology visits, combined, are planned for the patient during the certification period. This OASIS item requires the therapist to communicate with the patient’s other therapists after they have evaluated the patient and determined how frequently they will see the patient and for how long during the certification period. The information needed to answer this OASIS question is obtained from the care plans the therapists develop, which identify the visit frequency/duration orders they have obtained from the physician. emergency department utilization by agency. Item M2310 contains a list of some of the most common reasons home care patients seek emergency department care. By carefully identifying the reasons their patients needed emergency services, therapists can help their agencies develop performance improvement projects that decrease the need for these services. if so, to which type of facility: hospital, rehabilitation facility, nursing home, or inpatient hospice. If the patient was transferred to a hospital, the therapist is instructed to complete M2430, which asks about the reason the patient was hospitalized. If the therapist selects “no inpatient facility admission,” the therapist progresses to M2420, which asks about the patient’s discharge placement – at home in the community or to hospice. Item M0906 identifies the patient’s transfer, discharge, or death date. Guidance Manual. The therapist should review each item and its guidance before deciding on a final answer for each item. As therapists review the guidance with real patient data, they may be surprised by how frequently the guidance alters their assumptions about what they first thought the answer should be. Even after therapists have mastered OASIS and can complete an OASIS assessment quickly and accurately, they will find that
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