Have you seen the new OASIS yet? OASIS-C will be here in January. I like it. Or at least most of it. There are new items we won't like but that is for another editorial. I like OASIS-C because soon we will be noting only "clinically significant" lesions, transfers will be part of the toileting and bathing process, and clinical improvement in ambulation can be better captured. Alleluia!! These changes enable the OASIS to be more clinically meaningful.

This is a hopeful change in direction after several years of CMS guidance that made the OASIS less clinically sensitive to the patient's status. For instance, consider the instructions to mark what is true for >50% of the patient's medications (M0710) or transfers (M0690). Clinically, answering an assessment item this way seems inappropriate. Making an administration error with just one "high risk" medication, or a fall during one type of transfer can cause major complications and hospitalization. Clinically, assessment items are supposed to determine the patient's needs and care planning.

Clinicians, rightly it seems to me, came to see many of the OASIS items within their assessments as having little impact on their care planning. If the OASIS indicates the patient is "independent" to safely take medications or perform transfers (because >50% can be taken/done safely), how does that piece of assessment data drive good care planning if the patient has at least one that is a major risk? Isn't the data on the assessment supposed to drive the plan of care? Clinically inaccurate assessments lead to dangerous gaps in care planning.

To make matters worse, the CMS has been providing answers on its Web site in quarterly postings. The trouble is, the guidance keeps changing and can change on a quarterly basis. These Q & A's revise, update, and even revise again information in the OASIS Item-by-Item document. This is just way too much changing information for the average clinician in the average agency to master. The result is we have some clinicians/agencies knowing the latest changing guidance, and some who do not. Hopefully, the new OASIS-C Item-by-Item guidance document, scheduled to come out later this year, will summarize all current guidance in one source document.

It is an indication of how difficult it is to keep up with OASIS guidance that a certification exam is offered so clinicians can demonstrate their knowledge of OASIS and the latest CMS guidance. A couple of years ago, prior to sitting for this exam, I asked a representative of the OASIS Certificate and Competency Board about the pass rate for the exam. Despite a preceding prep course and the optional open book (OASIS Item-by-Item document and the CMS Q & A's) only 77% of the certification seekers passed the exam.

I have hope that we can draw closer to the original vision for OASIS: enhancing home health patient care by standardizing assessment data across agencies and comparing and enhancing outcomes. The changes in the OASIS-C seem a step in the right direction-a clinically sound direction. I hope the OASIS can be a useful assessment tool, with readily accessible guidance. My suggestions for accomplishing this goal are:

* Every clinician should refer to the OASIS-C Item-by-Item document whenever they have questions about how to fit a particular patient into OASIS' responses. This document should be readily available to every clinician through key-stroke access on their laptops. It can also be printed as a pocket reference.

* If the clinician is still confused about how to score the patient on an OASIS item, the clinician should review the intent of the item and use best clinical judgment to meet the intent. (Do not use reimbursement criteria. Reimbursement will be appropriate if the OASIS is clinically accurate.)

* The CMS should not issue Q & A's that get into clinical practice in a sporadic and inconsistent way. The only reference should be the OASIS-C Item-by-Item document. This document should be updated on a regular but infrequent basis-perhaps every 3 to 5 years.

* However, the CMS should keep a database and home health managers and clinicians should continue to submit questions, concerns and confusion about OASIS items, so the CMS learns where revisions need to be made in the next OASIS-C Item-by-Item publication.

So what do all these OASIS concerns have to do with this issue of Home Healthcare Nurse? If clinicians perform accurate clinical assessments using the OASIS tool, they will find helpful strategies to plan their care and help their patients achieve good clinical outcomes from the articles within this journal. Consider how good clinical assessment data on the OASIS could help clinicians identify when to use information from:

* Depression and Suicide by Lou Etta Hicks and Norma Wood for helping patients with OASIS-identified depression.

* Research Briefs for helping patients with OASIS-identified urinary catheters and incontinence.

* Health Coaching by Melanie Huffman for helping patients overcome their clinical/functional deficits identified on the OASIS.

* Transitions in Care by Dawn Hohl for helping patients maintain health and well-being so they can stay out of emergency rooms and hospitals.

It's all about good clinical assessments, which lead to effective care planning, which results in good patient outcomes.

Sincerely,

Mary Narayan MSN, RN, HHCNS-BC, COS-C

OASIS-C FINAL VERSION

The CMS posted the final version of the OASIS-C. This is the third version issued this year and is the final data set. Versions 12.2 and 12.4 of the OASIS-C, issued earlier this year, should be discarded. Only the OASIS-C version dated July 2009 is to be used. CMS has also posted a crosswalk for the OASIS-B1 to the OASIS-C to highlight changes between the two versions.

http://www.cms.hhs.gov/HomeHealthQualityInits/06_OASISC.asp#TopOfPage