VAHHA OASIS TRAINING WORKSHOP

OUTCOME ASSESSMENT INFORMATION SET

 

COURSE OUTLINE

 

·        INTRODUCTION TO OASIS

·        RFA/TIMEPOINTS

·        CASE MIX/HHRG/REIMBURSEMENT

·        CHAPTER 8

·        CODING

·        OBQI/OBQM

·        QUIZ

·        Q&A

 

OUTCOME ASSESSMENT INFORMATION SET

 

·        1999

·        109 ITEMS

·        24 ITEMS DETERMINE PAYMENT

·        5 SPECIFIC ASPECTS OF DATA COLLECTION

1.      PATIENTS FOR WHOM DATA IS COLLECTED

2.      TIME POINTS FOR DATA COLLECTION

3.      THE “RULES” TO OBSERVE IN COLLECTING AND RECORDING DATA

4.      THE MEANING OF EACH OASIS ITEM

5.      HOW OASIS DATA ARE COLLECTED IN THE CONTEXT OF THE COMPREHENSIVE ASSESSMENT

 

OASIS ACCURACY WORKSHOP-WHAT WE LEARNED

 

             Death in ER-Died under care of Facility-Transfer inpatient/DC

             Death in route/before adm to ER-Death at home

 

                   Self Pay-If patient pays out of pocket for meds essential to home care episode

                                  DME-RX and OTC meds

 

                    Start of Care is day “0”

                    Skilled Nursing Facility if:  (all must be yes)

                                                              Medicare Certified Facility

                                                              Receiving care under Med A

                                                              Receiving care under Med A 14 days prior to       

                                                              HHA admission

                    Other Nursing Home-if other type of Nursing Home stay in past 14 days

 

                     Only those diagnoses of focus of home care treatment

                      No diagnosis of mere historical interest

 

                     Therapy receiving or expected to receive at home, regardless of whom

                      manages it, as a result of the assessment

                      #1-IV flushes, pumps, PCA’s, insulin pumps

                      #3-Must deliver nutrition-Do not check if water flushes only

 

                     Expected to recover from this episode of illness

 

                     Not assessing reading ability

 

                     If the patient restricts an activity to be pain free, pain interferes with activity

                     Other examples of pain interfering

                                                                   Activity takes longer to complete

                                                                   Activity is performed less often

                                                                   Requires additional assistance

                     Pain does not have to totally prevent the activity to interfere

  

                     Three components to intractable-all must be present

                                                        Not easily relieved

                                                        Occurs at least daily

                                                        Affects sleep, physical energy, ability or desire to

                                                        perform physical activity-Quality of Life

 

                     Healed Stage I or II pressure ulcer-No

                     Healed Stage III or IV-Yes

                                                 MO460-Fully granulating

                     Muscle flap procedure to pressure ulcer-no surgical wound

                     Debridement to pressure ulcer-remains pressure ulcer at worse stage

 

                     Pressure ulcer covered by eschar or nonremovable dressing or cast cannot be

                     staged, only selection “e” is marked yes

 

                     Medi-ports, implanted infusion devices, venous access devices, ortho pin

                     sites, stapled or sutured incisions, debrided graft sites, wounds with drains,

                     take-down of an ostomy, peritoneal dialysis catheter sites-All are surgical

                     wounds

                     PICC lines are not surgical wounds-peripherally inserted

 

SEE WOCN GUIDANCE HANDOUT

 

                     Direct Observation not interview on day of assessment

                     Use of O2 continuously, observe while in use

                     Use of intermittent O2, observe without

 

ADL’S=Patient’s ability, not necessarily willingness or actual performance.  Don’t focus on willingness and compliance.  Availability of help dose not change the patient’s ability.  Determine the patient’s ability to perform the tasks safely; evaluate the risk for injury.  Do not base responses on the patient’s appearance.  If the patient would not be safe without support, then they are not independent.

 

PRIOR-Pick a specific date/day 14 days prior to SOC

 

                     Response describes the patient’s ability in the majority of tasks

 

                     Consider what they routinely wear, not what they are wearing

 

                     Is equipment needed, who bathes hard to reach areas, how does fear of  

                     falling impact use of tub/shower? 

                     If equipment needed to safely complete process, answer is 4

 

                     When ability varies, consider the majority of the time. Dose the patient have

                      the physical and cognitive ability to perform the task. Disregard the

                      presence/absence of caregiver to complete task.

 

                     Assess the ability to transfer safely the majority of the time.  Transfer in

                     all three areas must be considered.

 

                     Ability to eat, chew and swallow.  No food prep and no transport of food to 

                     the table.  Response based on assistance once food in front of patient,

                     includes meal set up.

 

                    Complies and prepares foods within their medically prescribed therapeutic

                     diet.

 

                    Prescribed and OTC meds, the majority of the meds the majority of the time.

                    Assisted Living-assess to determine if the patient is able to take the correct

                    oral meds and proper doses at the correct times.

 

                     SINCE THE LAST OASIS WAS COLLECTED

                     Emergent MD visit-24 hour guideline

 

 

THE GOOD NEWS?

 

 

                 MISSED WINDOW-No need to discharge the patient and readmit-BUT

 

                 UNPLANNED/UNEXPECTED DISCHARGE-Based on data collected by the 

                                                       last visit by a qualified clinician