OASIS Alert

Don’t miss: Always consider environmental barriers to independence in toileting.

When your patient has both a catheter and an ostomy for bowel elimination, how would you answer M1840 — Toilet Transferring? If you think this patient would score as “dependent,” it’s time to take a closer look at the OASIS toileting items.

Establish the Basics

OASIS item M1840 — Toilet Transferring asks you to report your patient’s current ability to get to and from the toilet or bedside commode safely and to transfer on and off the toilet or commode.

Your response options for M1840 are:

• 0 — Able to get to and from the toilet and transfer independently with or without a device.
• 1 — When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.
• 2 — Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).
• 3 — Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.
• 4 — Is totally dependent in toileting.

OASIS item M1845 — Toileting Hygiene asks you to assess your patient’s current ability to maintain perineal hygiene safely, adjust clothes and/or incontinence pads before and after using the toilet, commode, bedpan, or urinal. If managing an ostomy, this item includes cleaning the area around the stoma, but not managing the equipment.

Your response options for M1845 are:

• 0 — Able to manage toileting hygiene and clothing management without assistance.
• 1 — Able to manage toileting hygiene and clothing management without assistance if supplies/implements are laid out for the patient.
• 2 — Someone must help the patient to maintain toileting hygiene and/or adjust clothing.
• 3 — Patient depends entirely upon another person to maintain toileting hygiene.

The answers you select for both of these items should describe your patient’s ability to function within the home environment with or without assistance, says Pat Jump with Rice Lake, Wis.-based Acorn’s End Training & Consulting. Your responses to M1840 and M1845 can support your patient’s homebound status and the need for home care services, which increasingly are coming under fire in widespread medical review.

Plus, your M1840 response may affect your agency’s reimbursement directly or through an interaction with certain case mix diagnoses, Jump says. When your patient scores “2” or higher for this item, you can earn up to three points in the functional dimension. Plus, if your patient has a Neuro 1 — Brain disorders diagnosis and a score of “2” or higher for M1840, you could earn up to 10 points in the clinical domain. A score of “2” or higher and a Multiple sclerosis diagnosis could earn your agency as many as 18 clinical points, depending on the episode.

Adjust Your Viewpoint for Greater Accuracy

Despite the questions M1840 and M1845 appear to ask, these items really have nothing to do with elimination —especially M1840, says Annette Lee, RN, MS, HCS-D, COS-C, AHIMA ICD-10 Trainer with Redmond, Wash.-based OASIS Answers. Instead, these are both mobility/function items.

The correct answer to “Your patient has both a catheter and an ostomy for bowel elimination. How do you answer M1840?” is “we don’t know from this information,” Lee says. Answering “4 — Is totally dependent in toileting” based solely on the patient’s the altered elimination, is a mistake.

Even though “toilet” is right in the title of these items, neither directly relate to your assessment of the patient’s elimination status, Lee says. In order to answer M1840 correctly, you need to know the patient’s safe ability to transfer, ambulate, balance, her range of motion, etc., says Lee. “The elimination item doesn’t impact this answer.”

Other common mistakes clinicians make with M1840 and M1845 include the following, says Jump:

• Not having the patient actually demonstrate his ability but instead completing these items via interview.
• Failure to consider environmental barriers to independence in toileting. For example: If the patient is wheelchair-bound and the bathroom door is too narrow to fit through the door, client independence is affected.
• Not taking into consideration how safe the client is when completing toileting tasks.

Cover these Items in Your Assessment

Four basic steps impact your M1840 response. These include your patient’s ability to: 

• Get to the bathroom;
• Get on the toilet;
• Get off the toilet; and
• Get back out of the bathroom.

When answering M1845, be sure to consider both your patient’s perineal hygiene ability and her clothing management.