OASIS Alert

Don't let a patient's helpful family member lead to a black mark on your adverse events report.

If home health agencies aren't careful, nurses could incorrectly interpret M0780 ("management of oral medications") and cause a patient who is perfectly able to manage her own medicine regimen to appear to have substantially declined in this ability.

Nurses should take a "combined interview/ observation approach" to this question, according to the assessment strategies offered in the OASIS instrument. Watch the patient open her medication containers, and ask her to state the dosage and administration times for each prescription.

The key piece of information many nurses miss is the OASIS instrument's instruction to assess only the patient's ability to administer her own medication, not her "willingness or compliance."

In some cases, a patient's family member or another caregiver chooses to administer the patient's medication, notes consultant Cynthia Hohmann with Healthcare Management Consulting in Jacksonville, FL. But that doesn't always mean the patient wouldn't be able to do it herself if she had to. By the same token, a patient's refusal to comply with her medication regimen doesn't mean she's physically or mentally unable to comply.

Here's an example of a typical situation that gets HHAs into trouble, according to Hohmann: At start of care/resumption of care the patient is administering all her own medications, so the nurse marks '0' on M0780 ("able to independently take the correct oral medication(s) and proper dosage(s) at the correct times").

But when it comes time for the discharge OASIS, a family member or caregiver has stepped in to administer the patient's meds, and the nurse marks '2' on M0780. Since marking '2' on this OASIS item indicates that the patient is "unable to take medication unless administered by someone else," it looks like the patient has substantially declined under the agency's care.

Nurses need to keep in mind that they aren't assessing whether the patient is administering her meds, they're assessing whether the patient is able to do so, Hohmann tells Eli.

Of course, some patients really do decline in their ability to administer their own meds. In this event, the agency must take steps to ensure the patient continues to receive her medication correctly.

Sometimes the answer might be as simple as setting the patient up with a medication container that has a reminder alarm on it, Hohmann notes. In other cases, you could have to look into finding another person to assist the patient.