OASIS Alert

Tip: New online training from CMS offers instruction on all OASIS medication questions.

Improving medication management is one of the most important things you can do to decrease avoidable hospitalizations and improve patient outcomes. Make sure you're accurately assessing your patient's ability to manage his oral medications with new resources from the Centers for Medicare & Medicaid Services.

Focus on Ability

M2020 -- Management of oral medications asks you to assess your patient's current ability to prepare and take all oral medications reliably and safely. This includes the ability to administer the correct dose at the right time.

Answer M2020 based on the patient's ability, not necessarily on his actual performance, willingness, or compliance, says Ann Giles, RN, BSN, HCS-D, COS-C, director of ICD-9 coding & OASIS review services with Biloxi, Miss.-based PPS Plus Software.

When answering M2020, you should asses the following, CMS says in its new online training module:

• Deficits with vision, memory, or judgment;
• Ability to read the medication bottle;
• Ability to take the right medication, at the right time, every time;
• Environmental barriers such as access to the kitchen or other medication storage areas, stairs, narrow doorways;
• Physical impairments such as limited manual dexterity; and
• Ability to manage all oral medications.

For example, suppose you are caring for an elderly patient. His wife brings him his medication each morning, but there is no reason he couldn't get out of his chair to get the medication himself. You could mark this patient 0 -- Able to correctly take the correct oral medication(s) and proper dosage(s) at the correct time, Giles says.

Actually observing your patient's ability is essential for this item. CMS suggests that you begin by asking questions like:

• What time do you take these medications?
• How many times a day do you take them?
• Does your family or a care taker set up a pill planner for you?
• Is the pill planner correct?

For a practical demonstration of your patient's ability, have him read the medication bottle and assess his ability to read and explain the administration of the medication, CMS suggests. Or, ask the patient to prepare his medication for the day and assess his knowledge and ability to accurately prepare his medication. This method allows you to assess his ability even if there are literacy issues.

Remember to consider your patient's physical, mental, emotional, and cognitive statuses when answering this question, Giles says. "If your patient has dementia, is he really able to take his medication reliably and safely?" Or if your patient had a total joint replacement and the pain medications are making her groggy, is she able to manage her medications reliably and safely?

Score Based on Most Assistance

For example: Suppose your patient has been on Norvasc, iron, and a beta blocker for the past three years. He takes these medications every day at the same time with no problem. But now he has recently been put on Coumadin and just can't seem to get into the routine. He is confused about which dosage to take which day of the week. He can't get the hang of it. Answer M2020 based on the level of assistance he needs with the Coumadin, Giles says.

If your patient uses a pill box or sets a time to remind himself to take his medications, is he automatically dependent? No, says CMS. If the patient sets up his own planner device and is able to take the correct dose at the correct time, you can score him 0 -- Able to correctly take the correct oral medication(s) and proper dosage(s) at the correct time.

But if your patient is independent in taking his oral medications provided another person sets up his planner and/or develops a drug diary he relies on to take his medications appropriately, you would respond 1 -- Able to take medication(s) at the correct times if individual doses are prepared in advance by another person or another person develops a drug diary or chart.

And if your patient requires daily reminders to take his medications, whether or not he can prepare his own individual doses and/or keep his drug diary, you'll respond 2 -- Able to take medication(s) at the correct times if given reminders by another person at the appropriate times.

Note: To take CMS's free online training on the OASIS medication items, visit: www.cmstraining.info/data/OASISC/Module1/OASIS-C_MEDICATION_MODULE_1.htm.

To see a PPS Plus presentation on answering M2020 and M2030, visit: www.ppsplus.com/news/oasis-tip-of-themonth-july-2011.