Home Health & Hospice Week

If you're like many agencies, OASIS C is giving you headaches due to the integumentary section, look back items, physician notification questions, and more (see Eli's HCW, Vol. XIX, No. 7, p. 50).

Making OASIS C work for your agency may seem overwhelming, but heeding this expert advice will put your feet on the path to mastery of the new patient assessment tool:

1. Focus on training. Agency managers should be thinking three words, says Kathleen Anderson with the Ohio Council for Home Care and Hospice -- "education, education, education." OASIS C "changes are complex and it is vital the agencies get it right," Anderson says. "It is well worth the investment of providing education to agency employees."

Now's the time to load up on the education efforts, experts advise. Since clinicians are now actually using the tool, the education sessions should pack more of a punch than the ones you held  efore Jan. 1 implementation, says consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C. "Those who have now had a chance to really use [OASIS C] ask more detailed and specific questions," Laff says of the training sessions she's conducted since the year began. "Even though they may feel that they did enough training in November or December," agencies should realize "it means more to the clinicians now."

2. Educate docs, too. If you hope to get high marks on your physician notification measures, you'll need to let docs know about the change to the OASIS assessment and their responsibilities under the new form.

Physicians must realize their response timing affects all HHAs, says Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C.

3. Find an OASIS star. In the coming weeks and months, staffers are going to continue to have lots of questions about new OASIS C items. To help clinicians get it right, you should find an OASIS C go-to person they can turn to.

"Select a clinician that is a quick learner and on the way to becoming an expert with OASIS C," Anderson advises. Then "designate this person as a specialist."

4. Go to the source. You need to make Chapter 3 of the OASIS User's Manual, which contains the item-by-item guidance, required reading for your assessing clinicians. In fact, "because of the vast number of changes, clinicians should carry a copy of Chapter 3 ... with them," Adams recommends. That way, "they can refer to the assessment tips and guidance on responses until they become more familiar with the new document."

5. Prioritize. You won't be able to tackle every OASIS C problem at once. Providers should "triage their issues," counsels Chicago-based regulatory consultant Rebecca Friedman Zuber. Address "accuracy first and then productivity."

6. Tap tools. The new so-called look back items that ask about plan of care provisions and interventions are killing clinicians time-wise (see Eli's HCW, Vol. XIX, No. 7. p. 50). To get OASIS C under control, you must establish or refine a tool to let you fill out the look back OASIS C items quickly and efficiently.

Consultant Pam Warmack with Clinic Connections in Ruston, La. recommends using an event tracking sheet at the front of the chart for agencies that use paper records. Tools that address dates of vaccinations, development of pressure ulcers, and responses to congestive heart failure symptoms or problems can provide a quick reference when filling out transfer or discharge assessments, she explains.

For software users, Sharon Litwin with 5 Star Consultants in Ballwin, Mo. recommends documenting the look back items in a consistent place -- for example, the MD orders and  Notes/Communication sections. "For software agencies, if they use the orders and communication sections, that is easy enough that a separate tracking tool may not be necessary," Litwin believes.

And you can benefit from more than a look back tool. "Agencies need to be looking at tools to help their clinicians with all of these changes," Adams urges. For instance, the items asking about screenings for various conditions require clinicians to use screening tools.

7. Add or revise P&P. You'll need more than just new tools to handle OASIS C. Chances are you'll want to revise your policies and procedures in light of some of the new items.

For example: For the physician notification items, HHAs will need to decide how to address a case where the physician isn't responsive, Laff says. "Agencies must develop policies and procedures about how to handle these issues."

Agencies need to look at their internal agency processes to see if they are still appropriate under OASIS C, Adams advises. "Many will need to be modified because it is a new situation."

8. Split up the assessment. "Clinicians need to spread the assessment over at least two visits to avoid extreme fatigue by patients and allow enough time to complete the assessment correctly,"

Adams maintains. The clinician can identify the immediate care needs and begin addressing those on the first and second visit, and defer parts of the assessment until the second visit, along with providing the needed actual patient care. "This would ... require HHAs to change the timeframe for completing a Start of Care OASIS to more than a 24- or 48-hour time period," Adams acknowledges. The Centers for Medicare & Medicaid Services "has always allowed up to five days to complete the SOC OASIS because they recognized clinicians may not be able to do everything in one day," she points out.

For example, things like a full medication review or teaching on some of the patient's meds could wait for a second visit, Adams suggests (see related story, this page).