OASIS Alert

Make sure you’re asking the right questions to uncover medication issues.

Getting the OASIS drug regimen review and medication follow-up/intervention items right is essential for accurate process measures and good patient care. Could your approach to these items use a brush-up?

Accuracy with the medication assessment is critical because it affects so many aspects of success at home for the patient and family, says Patricia Jump, with Rice Lake, Wis.-based Acorn’s End Training & Consulting.

Problem: The medication list your agency receives as part of the discharge summary from an institution is seldom accurate, Jump says. Part of the reason for this inaccuracy centers around not asking the right questions. Developing effective questions will help you to ascertain all of the medications the patient is taking, including over-the-counter medications, she says.

It’s important for all clinicians to receive training regarding medication assessment. Although this is not an exhaustive list, try incorporating the following questions from Jump to assist in obtaining a more accurate list of medications.

Medication Assessment Questions

• Do you ever take expired medications?
• Have you disposed of all expired medications?
• Do you have any medications stored in places other than the medicine cabinet (shoe boxes, above the refrigerator, under the sink, etc.)?
• Do you ever “borrow” medications — for example from your spouse?
• Do you take any vitamins, mineral, home remedies, herbals, over-the-counter medications?
• Do you have any topical (apply to skin) medications or lotions you use on a regular basis?
• Are you aware of medications that should not be taken if you are of a certain age group?
• Are you aware of which drugs are considered high-risk?
• Do you know the interaction between medications and certain foods (for example: asparagus and Coumadin)?
• Do you need reminders or assistance to take your medications?

Master these Medication OASIS Items

Three OASIS items focus on your patient’s drug regimen and medication follow-up/intervention. As with many OASIS items, understanding the nuances of answering these questions is important:

M2000 — Drug Regimen Review;
M2002 — Medication Follow-up; and
M2004 — Medication Intervention.

When looking at these items, keep several things in mind to ensure your answers are accurate, Jump says.

Be thorough: When completing the drug regimen review for M2000, remember that this item includes all medications. They can be prescribed and over the counter, and administered by any route. That includes oral, topical, inhalant, pump, and injection medications.

Don’t miss problems: When assessing the patient for potential problems related to medications, keep in mind that a variety of situations can be considered potential problems. This includes:

• List of medications from the inpatient facility discharge instructions that doesn’t match medications the patient or family shows the clinician at the SOC/ROC assessment visit.
• Diagnoses or symptoms for which the patient is taking medications that are not adequately controlled.
• Patient doesn’t have all medications prescribed.
• Client seems confused about when or how to take medications.
• Patient has signs or symptoms that could be adverse reactions from medications.
• Patient takes multiple non-prescribed medications (OTCs, herbals) that could interact with prescribed medications.
• Patient has a complex medication plan with medications prescribed by multiple physicians and/or obtained from multiple pharmacies so that the risk of medication interactions is high.

Target these Areas with the Physician

Communication with the physician regarding medication concerns is very important, Jump says. Don’t assume that the physician is aware of the issues. Be sure to alert the physician of the following situations when appropriate:

• Medications are contraindicated for age (Beers Criteria)
• Symptoms are not adequately controlled
• Patient or family seem confused about meds
• Significant change in health status related to medications
• Fluctuating blood sugars for clients on insulin
• Respiratory changes (wheezing, shortness of breath, lung sounds, changes related to asthma)
• Mental status changes
• Cardiac symptoms (changes in heart sounds/pulse rate/rhythm, angina, dizziness, syncope)
• New or changed medications
• Patient has not obtained medications or indicates she won’t take as prescribed because of financial, access, cultural, or other issues
• Client takes multiple OTC or herbal medications that could interact with prescribed medications