Create comprehensive inservice on OASIS
These ideas will get staff up and running
You have about a month to prepare staff before the Oct. 1 deadline to begin collecting data for the Outcome and Assessment Information Set (OASIS). So how can you make the most of the remaining time to begin education or reinforce it?
Homecare Education Management asked several home care experts to explain how they handled OASIS education. Here are their suggestions:
1. Give staff a reason to believe in OASIS.
Education managers who already have taught nurses and therapists how to use an OASIS tool have found it's not enough to say, "This is a Medicare requirement." Employees often are unenthusiastic about learning a new and initially time-consuming task that is mandated by the government. And if they don't see the benefit of OASIS, they might be sloppy in implementing it.
Here are a few good reasons for nurses to welcome a switch to an OASIS tool:
· Nurses will be able to do better assessments when they use an OASIS tool, says Suzanne Hatch, BSN, MED, CPHQ, quality manager and staff development coordinator for the Lee (MA) Visiting Nurse Association. (See sample pages from Lee VNA's OASIS assessment tool, inserted in this issue.)
"You can't begin to think about setting up interventions for a patient if you haven't clearly assessed the patient's needs and found the patient's problems," Hatch explains. "So with OASIS, you get all this information upfront, and it helps to identify what's going on and what needs to be done."
· Home care agencies could sell the concept of OASIS to their staff clinicians as a quality improvement tool, suggests Alan Wright, RN, MS, director of network development for the Visiting Nurses Association of New England in Needham, MA.
"In the past, quality improvement was based entirely on sentinel event analyses and subject to medical records review processes, and these tended to result in punitive approaches to quality improvement," Wright says. That style proved frustrating and gave employees the feeling that supervisors were constantly looking over their shoulders, he adds.
However, with the OASIS data collection tool, home care agencies will be able to turn their quality improvement processes into an objective process backed up by specific facts.
· OASIS data will have more uses than just meeting Medicare requirements.
Education managers at the Affiliated Commu nity Visiting Nurse Association Inc. in Rockland, MA, convinced nurses they were not gathering the information solely to send it to the Health Care Financing Administration, says Joanne O'Regan, RN, MS, vice president of admissions. The information also would be used to help the agency manage its care and improve its performance, she says. "Part of the educational program was to talk to nurses about what the benefits are of using OASIS data set items."
· An assessment form that incorporates OASIS data may eliminate the need for some other forms.
The Affiliated Community VNA integrated the OASIS data set into several agency processes, including the central intake process, the admission process, and the physician order process. This eliminates data collection duplication, says Joanne Dalton, RN, CS, PhD, program development manager for the agency.
That showed nurses the agency was going to do its best to make everything more efficient and not simply to add more work to their schedule.
Dalton and O'Regan told nurses to look at all processes and clinical operations to see if there were other forms that could be eliminated or incorporated into the OASIS tool. "We tried to make it as succinct as possible with no need to write anything twice," O'Regan explains.
2. Add some sugar and spice to the inservices.
The Affiliated Community VNA jazzed up its first round of OASIS orientations by giving staff continuing education credits for attending and by making it a pineapple juice and pizza party.
Groups of 10 to 12 nurses got together during lunch to eat pizza while learning about OASIS, O'Regan says. "It wasn't an attitude of 'Here are the regulations we have to meet and we hate to do it.' We made it fun so they could see it was a very positive thing."
3. Divide the education into several smaller inservices.
The Visiting Nurse Association of Central Connecticut Inc. in New Britain held three OASIS classes, each lasting between one and two hours. The agency also divided the inservices according to districts and provided separate inservices to nurses and physical therapists in each district, says David McKinnon, RN, supervisor of total quality improvement. The VNA of Central Connecticut began using the OASIS tool in July 1997.
McKinnon says the inservices followed this general format:
· The first class, which lasted about an hour, gave employees a chance to review the handouts and the 18-page OASIS tool and to practice one admission on an OASIS worksheet. "Also, the first class gave them an overall introduction into the what and the why of OASIS," he says.
· The staff reviewed the OASIS tool line-by-line during the second class. Time was provided for staff to ask questions.
· The third class came after staff had time to start using OASIS. This gave them an opportunity to ask any last-minute questions or make suggestions or criticisms about the tool, explains McKinnon.
"Most of the issues that came up had to do with a misunderstanding of the intent of the OASIS tool, and people tend to read a lot more into questions than needs to be read into them," McKinnon says.
The Visiting Nurse Association of Middlesex East in Stoneham, MA, held formal inservices, says Jeannette Sheehan, RN, MS, chief operating officer and clinical director. The agency also displays OASIS tips on posters that feature decision trees, which give staff answers to common problems.
4. Give nurses one-on-one time and detailed training.
Hatch made herself available to work individually with each nurse. They would go over the OASIS assessment case by case if the nurse needed this help. "If they had a problem, they could come to me and we worked through the problems," she says.
Hatch also helps nurses go over the form step by step. "I tell them it's imperative that they read through the entire form before they go out to meet a patient." She even suggests they read the form three or four times because it helps them make mental shortcuts when they first use the form during an assessment. Practice does make the process more perfect, she notes.
When staff first began using the OASIS tool, it added 20 minutes to their assessments. Now the extra time is down to five minutes, Hatch says.
5. Follow training with more instruction and spot checks.
Hatch conducts quality checks of the admission paperwork. If she finds something that needs to be improved, she will leave a voice-mail message for that nurse or a group message if problems are repeated by a majority of nurses.
The message takes this form: "Remember, on a certain assessment item that you need to look at it in a particular way and complete it as follows . . . ."
The VNA of Central Connecticut includes OASIS training in its new employee orientation, and staff continually are given updates about any changes made in the process, McKinnon says.
"This may be done in formal inservice sessions or team meetings, depending on what information has to be passed on," he explains.
The VNA of Middlesex East reviews OASIS each year, and if employees are not completing the form correctly, the agency will hold additional inservices, Sheehan says.
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