OASIS Alert

Ask a few key questions to discern patients' independence.

Your patient is both smart and physicallycapable, so you can assume that he knows how to take his oral medications, right? Wrong -- and just trusting that he's got it right can be disastrous for you both.

Item M2020 (Management of oral medications) is intended to identify your patient's ability to take all prescribed oral medications both safely and reliably at all times. But even patients who should know how and when to take their medicines have off days -- and if that off day happens to coincide with your assessment, you need to know about it.

You must evaluate whether your patient can safely and reliably take his medication at start of care, resumption of care, and discharge. During these evaluations, a few pointed questions can help you suss out whether your patient needs more help than you'd expect, such as these:

-- Do you need reminders to ensure you take your medications at the right time?

-- Are you confused about what medication or dosage to take?

-- Have you forgotten your medication?

If your patient's answers suggest that he isn't completely clear on how and when he should take his medication, or admits that he forgot to take it, you must score him as a 3 (Unable to take medication unless administered by another person),the Centers for Medicare & Medicaid Services states on the OASIS Certificate and Competency Board website.

Crucial: You should only score your patient according to what he did in the past 24 hours, notes Carol Siebert, principal with The Home Remedy in Chapel Hill, N.C. If he remembered some of the medications but forgot others, you should score him based on the medication that requires the most assistance.

Examples: A patient totally forgot his medication a month ago, but has done everything right since then. You can score him as 0 (Able to independently take the correct oral medication[s] and proper dosage[s] at the correct times).

Another patient admits that he isn't really sure when he should take his medication and was too embarrassed to call his primary care physician to ask questions about it. You notice he has used a pill planner to correctly sort the dosages. You should still score him as a 3 because he needs assistance figuring out when to take the medicine, Siebert says.

Your patient's forgetfulness or confusion can be easily remedied.

Strategy #1: If he says that he isn't sure he understands how to take the medication, coachhim on the instructions or help him create a cheat sheet, CMS advises. You could also advise his physician that the patient may need more education about future medications.

Strategy #2: And if he's forgetful, help him set alarms on his mobile phone or nearby clock or figure out a system that could jog his memory -- such as keeping his medication next to where he prepares meals. If your patient has initiated his own reminders or cues for remembering to take his medication, you would score him as 0.

Important distinction: For those without cognitive impairments, "forgetting often results from a disruption in or lack of a normal routine," Siebert points out.

Try to determine if your patient has some stable habits or routines that you can use to help him remember to take his medications. If not, helping him establish those habits and routines is the best investment of your resources and will greatly improve your outcomes, she advises.

Bottom line: Your patient's score won't change until he demonstrates that he takes the correct dosage of the correct medicine on the correct schedule, CMS states.