OASIS Alert

Published on Wed Jul 31, 2013 PDF

Choosing your M1860 — Ambulation/Locomotion responses requires careful consideration of your patient’s ability. Read through the following scenario from Annette Lee, RN, MS, HCS-D, COS-C, AHIMA ICD-10 Trainer with Redmond, Wash.-based OASIS Answers to give your skills a test.

Scenario: Nurse Lee is performing a start of care (SOC) comprehensive assessment. She notes Mr. Kim uses a motorized wheelchair for most of his mobility around the home, but when asked, he is able to ambulate. He needed some assistance to transfer out of the chair, but once in a standing position, he ambulated, with poor balance, by holding onto the walls and furniture.

Nurse Lee asked Mr. Kim if he has a walker or cane that he uses. Mr. Kim stated he “used to use those things,” but gave it to a relative once he got his scooter. It appears Mr. Kim needs an assistive device while ambulating to be safe, and the nurse phones the physician for a physical evaluation order.

Nurse Lee documented her assessment thoroughly in the comprehensive assessment, and then selected M1860 response “4,” since the patient was in the wheelchair most of the time. Upon review, her QA partner at the agency asked her to reconsider, because M1860 doesn’t fit the “majority of the time” OASIS convention. Nurse Lee then turned in a correction where she chose a “2,” since it appeared Mr. Kim would be safe if he was using a walker, and just needs assistance on and off the scooter.

Which response for M1860 is correct? See the story on page 98 for a complete list of M1860 responses.

Answer: The correct response would be a “3 — Able to walk only with the supervision or assistance of another person at all times,” says Lee. The patient is ambulatory, so you can’t say he is “chairfast,” she says.

Remember also that the transfer is not included in the response for this item, Lee says. When assessing the patient’s current safety, his ambulation was unsafe, and he was holding onto objects for balance at all times.

Although the nurse feels that an assistive device is appropriate and may be helpful, you can’t make an assumption about a piece of equipment that the patient does not have, and you have not yet assessed. “At this time, the only correct answer is that the patient should have someone with him at all times to be safe, even if the patient does not currently have that level of assistance,” Lee says.