I think this might be illegal!

Specialties Home Health

Published

Hi, I just started as a new home health nurse and am getting used to the oasis documentation. The company I work for has QA staff that go over our documentation to check for errors. The QA person went over my first OASIS and found a few errors. They corrected the errors and also changed some of the data that I collected. I understand the need to correct errors, I am new and got 2 days orientation so it's not surprising that I made some. However, I am uncomfortable with them changing my documentation and then being expected to sign. For example, the QA guy changed the pain level from an 8 to a 4. Also they changed some of the ADL questions. I've redone the oasis 3 times now and they are asking me to revise it yet again. They shredded my original so the only thing I have to go on is the form they revised. I don't know how home health works, but it just seems very strange to me, especially since they want me to sign the form after they've made changes that differ from my initial assessment.

I finally got fed up and said no, I will not be revising and signing my name to the form because it is not reflective of my initial assessment.

To me this seems borderline medical records fraud, but then again I am new so what do I know? Please tell me what you think.

It is standard for hha's to change oasis data collection if it is inconsistent. Especially with the functional aspect because this is where it confirms their homebound status and brings in reimbursement. My documentation has only been altered in this area with my current agency because of inconsistencies. They reinforce "is the patient able to complete the tasks safely" and usually they are right. And if I feel that it doesn't make sense, then I do not agree with it. I back up my assessment, and so far no problems. But, I would be concerned if they are changing pain ratings. That does not make sense. If a pt rates pain an 8 for me. I usually review the pain scale and what it means. If they still say and 8 then its an 8. That's something that should not be altered. That is subjective information. The patients pain is their own.

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Specializes in Home Health.

I felt the same way you did at first. I was gathering OASIS data for two years before I became COS-C. I STILL realized I was filling the OASIS out incorrectly in some portions. I highly suggest you ask for someone with more experience to go with you when you do the next OASIS. See how much it varies between the two of you. I think if you truly read the "intent" of each and every question before you answer it, you may learn why they are changing your answers. Now, changing your pain assessment? WHOA!!! That is as serious as changing heart rhythms or lung sounds. MAJOR problem there.

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NakiaRN- I totally understand correcting inconsistencies, that's ok with me. I knew I would need some help in that department and I would welcome the help if they offered to walk me through what's being changed and why; that way I can avoid making the same mistakes again.

Unfortunately I was unable to get in contact with the specific QA nurse who made the changes as she was not in our office branch

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Wooh- I've written this reply 4 times now and it keeps getting deleted. So

If it shows up randomly later with 4 replies, I apologize. The patient is on so much pain medication that the PCP was not willing to alter the dose. Said if her pain was intolerable to go to ER, she refuses. She was pretty out of it during my visit, nodding off and such. I explained the pain scale in detail and her answer never changed, so that's what I documented. I tried to resolve the issue unsuccessfully. And in my personal opinion, more pain meds would have definitely put her at a greater risk in general since she was so out of it. This was also documented as well as the contact with the MD. It's hard not being able to help, but I'm learning that sometimes all the effort you put in does not always yield a positive result.

So far I have probably 11-12 hours of time invested in this patient with all the follow up calls and revising of the document. I've calculated how much per hour it would equate to and it's under 4/hour. I just might not be cut out for this. :(

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I was taught that NO documentation in medical records is "changed"... any needed correction is done by the responsible nurse and should be either an addendum clarifying the error OR by making a single line strikethrough, noting "entry error" and initialed by the original nurse. Medical records are legal documents. The situation you described is unethical & I think you were correct to refuse to sign. I know I did...

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oasis questions should be supported by your documentation/narratives. if they are changing the pain level answer, ask them why. it's good practice to teach the pain scale to a pt before you ask them their pain level...then support their response with your narrative. changing adl answers is common...but usually there is a logic to the change...our qa staff won't change anything without getting agreement from the clinician first...this gives the clinician an opportunity to support their choice or elaborate further with narratives to support a different oasis choice recommended by qa

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when in doubt document EXACTLY what you see...like "pt continues to nod off during assessment interview" i had a pt once who was on methadone for chronic pain, was doubling up on doses, and had fallen with injury...these are tricky....just always document what you SEE.

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Specializes in Managed Care, Onc/Neph, Home Health.

At my HHA, to me, they "tweak" the OASIS entirely too much for me. Especially with the SOB, with exertion, ambulation over uneven pavement, with walker, when people can clearly ambulate with a straight cane. I don't get that part. I am old skool home health nurse, Me not like OASIS....LOL Oh yeah, with my company, for a RCT, "teach" on the same thing.....that is shady to me......from the last 9 wks. :no:. Pt clearly need to be dc'd

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I don't know about the pain assessment and the redundant teaching but how I illustrate to our new nurses re functional assessment, I instruct them to rate the patients based on what you'd be willing to walk out and leave them alone to do safely. Pretend you have to bet your license on it. Do you still think they're safe to get up to the toilet or get their clothes out of their closet without even SBA or supervision or SBA *and* equipment?

It's not about what they do out of necessity but what you'd be comfortable saying they can do safely without *risk* of fall or injury at that point in time.

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I don't know about the pain assessment and the redundant teaching but how I illustrate to our new nurses re functional assessment, I instruct them to rate the patients based on what you'd be willing to walk out and leave them alone to do safely. Pretend you have to bet your license on it. Do you still think they're safe to get up to the toilet or get their clothes out of their closet without even SBA or supervision or SBA *and* equipment?

It's not about what they do out of necessity but what you'd be comfortable saying they can do safely without *risk* of fall or injury at that point in time.

And about the ambulating with a straight cane on a variety of surfaces, if your patient can cross curbs and stairs with a cane independently without risk of fall with no one even needing to be on the premises, then they're not home bound and you shouldn't be admitting them. If they cannot do that, if you wouldn't send them on their way alone, then they are not independent with a cane.

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But if you disagree and the 485 is put on hold, it is like the end of the world if you hold up the process.

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Specializes in Ortho/Peds/MedSURG/LTC.

Its all about safety. Can they safely ambulate without stand by assistance at all times?You can mark the Oasis lower, and they can get better in a couple of days if they will work on their safety awareness- that you TEACH. We can go back as far as 24 hours. WALK WITH ASSISTANCE pays the agency more money.

As for as pain, if a patient reads the pain scale and is taught the pain scale, and they still claim it's an 8 (when its probably a 4) we consider an 8 SEVERE PAIN, and really a patient in severe pain, not a patient that can sleep and state or claim an 8. So we will make an order, in on the POC, which will place the pain parameter, at a higher level than norm, to call and report to the physician.

Like diabetics we have the parameters, we document, all the readings since last visit, if out of parameters, we call the physician. He in return will up those parameters so that we do not have to call him. (we even chart we taught or observed patient's using their own glucometers and are able to test them to see if they are working properly.

Most of our physicians are beginning to refer to a pain specialist when their pain is always ""severe pain at an 8"". We push for those referrals.

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