OASIS Alert

Question: Our patient has multiple sclerosis and uses a mechanical lift for transfer to the toilet. She is non-weight bearing. She can only move her arms minimally and hold onto the sling, which doesn't really contribute to the transfer process. How should we respond to M1840 (Toilet Transferring)? Would we score her as a "1" or a "4"?

Answer: Toilet transferring response 1 reads "When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer." This means that the patient is able to perform the tasks required with assistance from another person. "1" is not the appropriate response when the patient is totally dependent on another person to transport them to the toilet and transfer her on and off the toilet, the Centers for Medicare & Medicaid Services said in the January 2011 OASIS Q&As.

For a patient to score a "1", she "must be able to effectively participate by contributing effort toward the completion of some of the included tasks, getting to and from and getting on and off the toilet," CMS said.

If your patient can be moved to the toilet and transferred on and off, but cannot effectively participate in the effort required, they are scored a "4" -- Is totally dependent in toileting, CMS advised.

In your scenario, since the patient cannot effectively participate in the tasks required in toilet transferring, she would be scored a "4."