Addition of process measures means more prep for OASIS C
2010 implementation will require staff training; software changes
Although the proposed OASIS C is often described as more user-friendly than the current OASIS, the addition of process measures will be a major change for many agencies. Other changes, however, will make completion of the OASIS simpler even though the initial implementation will require additional training for staff.
"Process measures look at certain points in time during the episode and ask home health nurses if specific tools were used to evaluate the patient and change treatment plans if indicated," explains Judy Adams, RN, BSN, HCS-D, COS-C, a Chapel Hill, NC-based home health consultant. Although many agencies may already use tools to evaluate pressure ulcers, depression, and other areas that OASIS C process measures address, quite a few agencies will need to identify tools to use and train staff members in their use, she says.
The comment period for OASIS C ended in mid-January, with the final data set and instrument planned for Spring 2009, for full implementation in January 2010. Although no one can accurately predict what the final instrument will look like, experts interviewed by Hospital Home Health are generally pleased with the draft.
Even with the positive changes, home health managers will have a lot of work to do within their agencies to handle the new OASIS, says Adams. "Given the number of changes in the document, agencies and their information technology vendors will have to revise software used for point-of-care documentation, and all agencies will have to retrain staff members," she says.
Items in the current OASIS that are not used for determination of reimbursement or measurement of outcomes have been deleted from the proposed OASIS C, points out Adams. "For example, rather than asking if the patient can handle laundry, shopping, or house cleaning, the nurse now assesses if there is a change in the patient's ability to handle daily tasks that he or she handled prior to the home health admission," she explains. This makes more sense, because many patients, especially men, did not handle those specific activities anyway, she says.
Assessment items were simplified in many places in the proposed OASIS C, says Adams. This simplification involved rewording, renumbering, and changing the order of many questions, she explains. "This will present a challenge to agency trainers, because home health nurses are so familiar with the OASIS that they've been using," she says. "Although there were a few changes in 2002, some changes in 2003 with the addition of V-codes, and some minor tweaking throughout the years, we've basically had the same OASIS since it was introduced in 1999," she points out.
"I like the proposed OASIS C, because it is more like the [CMS Form] 485 than the current OASIS," says Rhonda M. Will, RN, BS, COS-C, HCS-D, senior clinical consultant for Fazzi Associates in Northampton, MA. "All of the information a clinician needs to develop a plan of care is in the OASIS C," she explains.
"Overall, the proposed form is more user-friendly, with wording that is easily interpreted," says Will. "As CMS redesigned the form, focus groups comprised of home health nurses who work in the field were asked for input," she says. This was an important step to take to ensure that nurses would be able to complete the form easily as they sat in a patient's home, she adds. "Home health nurses don't need a form that requires multiple reference books in order to answer the questions accurately," she points out.
Even though no one knows what the final OASIS C will include, it is important that home health managers start to plan what they need to do to be ready, suggests Will. "You can't do anything definitive now, but every manager should be thinking about how information flows from one department to another and how changes in OASIS will affect admissions, billing, and quality improvement," she says.
Training for the new OASIS also should include all disciplines to some extent, suggests Will. "Nurses should not be unduly burdened, because all disciplines are capable of assessing the patient," she says. "Also, there are times that a patient is discharged by a therapist rather than a nurse, so everyone should understand OASIS requirements," she adds. If your agency uses contract therapists, be sure that they have access to electronic medical records, so that they know what they need to document, especially in relation to the process measures, she suggests.
In some cases, a manager may just need to develop a flow sheet that lists items that are necessary and who is responsible for what activity, suggests Will. The key to successful implementation of OASIS C will be thinking about it now, so that once everything is approved, you are ready to proceed, she says.
"I believe that the attitude of managers and trainers will be important to the successful implementation within agencies," says Will. "One of the mistakes we all made when OASIS was first introduced was to present it to staff members as an awful burden on our daily jobs. This time we need to present it in a positive manner. It is improved, and we need to position it that way when we talk to staff."
Sources
For more information about OASIS C training and implementation, contact:
Judy Adams, RN, BSN, HCS-D, COS-C, Home Health Consultant, 204 Lexington Drive, Chapel Hill, NC 27516. Phone: (919) 960-6739. E-mail: [email protected].
Rhonda M. Will, RN, BS, COS-C, HCS-D, Senior Clinical Consultant, Fazzi Associates, 243 King Street, Suite 246, Northampton MA 01060. Telephone: (941) 492-6988. Fax: (941) 492-6955. E-mail: [email protected].
To see a copy of the proposed OASIS C go to: www.cms.hhs.gov/HomeHealthQualityInits/06_OASISC.asp.
Although the proposed OASIS C is often described as more user-friendly than the current OASIS, the addition of process measures will be a major change for many agencies.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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