OASIS Alert

Take advantage of this hidden training resource.

When it comes to keeping your OASIS data accurate, ongoing training is a must. With quarterly Q&As, guidance manual updates, and the OASIS-C1 just around the corner, even the most seasoned clinician has something to learn. But when’s the last time you took a closer look at how you approach OASIS training?

Assess OASIS Accuracy

As clinicians, “we love taking care or patients, but we hate the paperwork,” said Rose Madden-Baer, DNP, RN, MHSA BC- PHCNS, CPHQ, CHCE, COS-C, vice president of clinical operations strategy and development with Visiting Nurse Service of New York in New York City. “Unfortunately, [paperwork] is half of what we do. It’s driving what we do in making policy changes, reimbursement, and quality,” she said during the session “The Diagnosis and Treatment of OASIS Inaccuracy” at the 2013 National Association for Home Care & Hospice annual meeting.

To begin your training improvement project, start by looking at your clinicians’ OASIS scores, said co-presenter Rhonda Will, RN, BSN, COS-C, BCHH-C, assistant director of the Clinical Competency Institute with Northampton Mass.-based Fazzi Associates. “Are they always the same? Read the comprehensive assessment and then read the plan of care. What are the goals saying? What are the interventions saying? If the plans and the assessment are meshing together, then your staff at least has the right beginning. But of they’re not relating, you need to start looking [at those inconsistencies],” she said.

Find Your Target Population

While the majority of your clinicians will likely respond well to a standard OASIS accuracy plan that includes regular training and coaching, there will still be some who need more. To find those clinicians who need a different approach a combination of joint field visits and testing can help.

Performing joint field visits with clinicians gives you the opportunity to see their assessment techniques first-hand, Will said. Plus, it helps you to uncover areas in need of additional training.

“They’re filling out their assessment and you’re filling out yours. Are they scored the same way? It’s a grand opportunity for you to see if you see and understand things the same way,” Will said.

Who is the best person to send on these joint visits? “It depends on who I ask,” Madden-Baer said. But sending along the clinician’s supervisor has proved successful, she said. When the supervisor makes repeat visits with a struggling clinician, that’s when effective coaching occurs, she said.

Conducting periodic OASIS tests can also help you to identify clinicians who need a little more help. Being able to take test data and point out the percentage of time a specific clinician makes errors in a particular area can help you to head off defensiveness, Madden-Baer said. When a clinician says “I don’t make mistakes on my OASIS,” you’ll have proof to back up your concerns.

Create a Custom Treatment Plan

Once you’ve identified which clinicians might need a different training approach, it’s time to pinpoint the areas that are most urgent. Using data from the joint visits and OASIS tests, you can determine which OASIS sections you need to focus on. Some areas of frequent concern include the functional assessment, integumentary status, and medication management items.

It’s important to provide training that meets the needs of each clinician. “You need to make sure the clinicians are all on the same page,” Madden-Baer said. A mix of online training and in-person real-time training can be effective.

Be sure to follow up with actual OASIS data as well as testing results. Some clinicians may score well in a testing environment, but still make repeated mistakes on the actual OASIS. Reports that track errors can help you to determine where to focus future training.

Watch for Training Opportunities

If your agency has an OASIS review staff, you could have a great ally in your training efforts. Review staff can fall into the habit of “giving” clinicians the answers to the items they’re scoring incorrectly, Will said. But it’s better to have reviewers help the clinician find the right answer so that in the future she’ll know where to look.

Ask the reviewer to walk the clinician through locating the resource she needs. Do your clinicians know where to find Chapter 3? Do they know how to access the OASIS Q&As? Make sure everyone know where the OASIS guidance resources are and that they are using them, Will said.

Bottom line: As clinicians “we love to narrate clinical findings, but when we look at the OASIS there can be a disconnect,” Madden-Baer said. Clinicians need to understand they’re not merely collecting data. The OASIS is a subset of the comprehensive assessment and it needs to stand on its own, she said. Accuracy is important because the OASIS data is the basis of reporting that can help determine the future success of your agency.