OASIS Alert

Ask the Right Questions

You know you need to know whether your patient has a visual impairment to answer M1200, but how do you get that information accurately from your patients? The key questions to ask are whether she wears glasses or uses reading glasses and whether she can function safely in her environment with the vision she has, says Northampton, Mass.-based Fazzi Associates in its OASIS-C Best Practice Manual.

Ask your patient about vision problems such as cataracts and whether or not she uses glasses during the health history interview, the Centers for Medicare & Medicaid Services suggests in the response-specific instructions for this item.

Observe your patient's ability to locate the signature line on the consent form, to count fingers at arm's length, and to differentiate between medications, especially if medications are self-administered, CMS says.

Be sensitive to requests from your patient to read for her. She may not be able to read though her vision is adequate.

Ask your patient to read medication label words or numbers or pick up a small object in front of him. Observe whether she routinely uses prescriptive glasses or reading glasses to accomplish tasks, Fazzi suggests.

Ambulate your patient and observe whether she can see or if she bumps into furniture and feels her way, Fazzi says. Also check to see if she can read gauges or measures on her medical equipment, see telephone numbers, and see changes in walking surfaces.

Consider physical deficits or impairments that limit your patient's ability to use her existing vision in a functional way. "If a patient sustained an injury that limits neck movement, the patient may not be able to see obstacles in their path," CMS says in an OASIS Q & A on M1200. "A patient who has sustained a facial injury may have orbital swelling that makes it impossible for them to see and they must locate objects by hearing or touching them."

Interview the caregiver and observe your patient's movement and response during the assessment visit if her cognition is too impaired to determine if he is able to see, Fazzi says.