Don’t let a fear of the medication regimen prevent you from excelling.
Therapists frequently admit they’re uncomfortable completing the OASIS medication items. But that shouldn’t prevent them from completing the OASIS for a therapy-only patient. Therapists should take a collaborative approach and look to their strengths to become more comfortable with this important aspect of the OASIS.
Don’t Skimp on the Drug Regimen Review
Not only is the drug regimen review on the OASIS, it’s one of the few items that’s also a Medicare condition of participation, says Karen Vance, OTR, supervising consultant with BKD in Colorado Springs, Colo.
“A review of all medications the client is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy,” is required in the COPs.
The drug regimen review must be completed each time the comprehensive assessment, including OASIS, is conducted, Vance says. And it should be documented in M2000 — Drug Regimen Review, with any issues or interventions documented in and M2002 — Medication Follow-up and M2004 — Medication Intervention.
You’re not Alone
Unlike with some OASIS data items, collaboration is allowed with the medication OASIS items, says Pat Jump with Rice Lake, Wis.-based Acorn’s End Training & Consulting. “Such collaboration is particularly important in therapy-only cases.”
You as a therapist might not feel you’re competent to do this review, but that doesn’t mean you can’t complete the OASIS, says Vance. In therapy-only cases, the therapist can complete the medication list and then the nurse in the office can complete the drug regimen review manually or with software.
For best results, when collaborating, Jump and Vance recommend the following steps:
Potential clinically significant medication issues include the following, Jump says:
Look to Therapy Strengths in Uncovering Medication Issues
The OASIS medication items bring up three separate but related issues, says Vance:
1. Is the medication regimen appropriate and effective for the patient?
• This answer can be determined using appropriate software.
2. Is the patient capable of implementing the medication regimen?
This answer requires assessment that goes beyond medication teaching.
3. Is the patient (or caregiver) managing medications effectively?
• This answer is critical to achieving optimal patient outcomes.
Looking beyond the medication regimen items to M2020 — Management of Oral Medications, therapists have an opportunity to make certain a patient’s ability is more accurately documented, Vance says. “The nurse may watch the patient take his meds. But does she know what the patient’s routine is? Does she know how to help the patient with cuing? Does she know that the patient watches the ‘Price is Right’ at the same time everyday and that would be a perfect cuing mechanism?”
“Management of oral meds is totally different from the drug regimen review,” Vance says. “You’re looking at the patient’s ability to safely take her oral medications. These are routines that we should be assessing when we do our ADL assessments.”
Consider this: According to the World Health Organization, medication routines are a self care activity focusing on looking after and maintaining one’s own health.
Medication management is an Instrumental ADL, Vance says. IADLs are more complex than basic self-care skills. “We are missing the chance to optimize outcomes if we don’t focus on medication management as an activity,” she says.
Bottom line: When it comes to the OASIS medication items, all skilled clinicians should be able to: