OASIS Alert

Use these 5 scenarios to do the right assessment every time.

When hospitalization and recertification collide, be sure you know what to do.

OASIS assessment data is important in measuring the home care patient's status at the start and end of a period of care, explains Vienna, VA-based home care clinical nurse specialist Mary Narayan. Data processing procedures match the data taken at start of care or resumption of care with data for the same patient at transfer or discharge. Out-comes are the changes in patient status between these time points.

Accurately Evaluate Episode Transitions

But for the data to be accurate, clinicians must complete the correct assessment at each time point, experts say. And even after years of OASIS data collection, confusion continues.

To find out if you understand which assessment to complete, try your hand at answering the following scenarios:

1. Dilemma: The nurse completed the recertification OASIS assessment and got the new orders within five days of the end of the first episode. On the first day of the recert period, the patient was admitted to the hospital. When she is discharged two days later, what do you do?

Answer: Even if you completed the recertification visit, you still shouldn't make a resumption of care visit as the first visit in the new episode. You should discharge and readmit the pa-tient, says Debbie Dawson, senior consultant for HealthCare Strategies Inc. in Chattanooga, TN.

Reason: The first visit of a certification period cannot be a resumption of care visit, unless there is no change in the home health resource group, Dawson says. A recertification predicts the patient's need for the next 60-day episode. "You cannot predict, prior to the hospital stay, the patient's needs for the post-hospital time period," she tells Eli.

2. Dilemma: The patient's certification period ends on a Friday and the patient will be admitted to the hospital for scheduled surgery the next Monday. No visits are planned over that weekend. How do you handle the recertification?

Answer: Discharge the patient and readmit on discharge from the hospital for the same reason as the answer to the first dilemma.

Tip: Remember the transfer OASIS when the patient goes to the hospital acts as the discharge OASIS and you just need a discharge summary to close the episode, the Centers for Medicare & Medicaid Services says in its OASIS Q&As.

3. Dilemma: During the episode, the patient was admitted to the hospital and the clinician completed a transfer OASIS assessment. The hospital discharged the patient three days later. Your clinician was unable to reach the patient after discharge, and after several attempts, found that the patient had been readmitted to the hospital after three days at home. Do you need to complete an OASIS form to show what happened to this patient?

Answer: No. But be sure to document your attempts to contact the patient, says consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates.

Reason: You originally transferred the patient and that transfer is effective until you resume care after the patient is discharged from the current hospitalization, explains Selman-Holman.

Where the Patient Died Determines the OASIS Assessment

4. Dilemma: The patient was being transported to the hospital in an ambulance and died in the ambulance before arriving at the hospital. Which OASIS do you complete?

Answer: In this case you do the OASIS discharge, reporting death at home, CMS says in its OASIS Q&As.

Reason: If the patient dies before being treated in the emergency room or being admitted to the hospital, the patient is still considered to be under the agency's care, CMS explains.

5. Dilemma: The patient was transferred to the hospital by ambulance, arrived at the ER and was held in the ER for observation. An hour later the patient died. Which OASIS do you complete?

Answer: Complete a transfer OASIS assessment, CMS says.

Reason: Once a patient is admitted to the ER, regardless of how long the patient was there, the patient "is considered to have died under the care of the facility," CMS explains in the OASIS Q&As. To close the episode, the agency does a transfer OASIS assessment and whatever discharge documents the agency requires (such as a discharge summary), CMS says.