OASIS Alert

Add to these five scenarios to test your staffers' understanding of dyspnea.

When training for M1400, offer your clinicians a few sample scenarios to determine where they're getting hung up. Discuss the correct answers as a group to help everyone get on the same page.

These sample scenarios, provided by Judy Adams of Adams Health Care Consulting in Chapel Hill, N.C. and Carol Siebert, principal with The Home Remedy in Chapel Hill, N.C. and chair of the AOTA Affiliated State Association Presidents, should get you started. Ask your staffers to create their own scenarios using your most challenging cases.

E Scenario: A patient is only short of breath at night when lying down and requires oxygen but has no shortness of breath during the day when walking or climbing stairs.

Correct response: 4 (because patient is only short of breath at rest).

E Scenario: A patient sleeps sitting up in a recliner that's filled with pillows because she was experiencing shortness of breath when lying down. However, her modifications have eliminated the dyspnea.

Correct response: 0 (because the patient is not short of breath).

E Scenario: A patient exhibits getting dressed for the clinician and experiences shortness of breath while removing her sweater. The clinician asks whether that typically happens and with what activities. The patient says she gets "short winded" while dressing, getting out of a chair, and bathing.

Correct response: 2 (because patient gets short of breath during moderate exertion).

E Scenario: A patient who uses oxygen continuously reports no shortness of breath. The clinician asks him to perform ADLs, including walking to and from the bathroom and bedroom, but the patient never loses his breath. The clinician then inquires about when the patient does lose his breath (if at all). The patient responds that he couldn't catch his breath earlier in the day when trying to walk upstairs while carrying a portable oxygen pack.

Correct response: 1 (because the patient got short of breath when walking more than 20 feet or climbing stairs while using his oxygen).

E Scenario: A patient loses her breath while giving verbal responses to a clinician's question. Her respiration becomes even more distressed when asked to rise from a chair to assess transfer and ambulation. When asked about sleeping, the patient shares that she struggles with breathing when trying to sleep.

Correct response: 2 (because she is dyspneic during moderate activity), 3 (because she struggles for breath with minimal activity like speaking), and 4 (because she is dyspneic at rest [night]).

Bonus: To receive a compilation of questions and answers from the Centers for Medicare & Medicaid Services about M1400, send an email to the editor at kellyq@eliresearch.com.