I recently started a new job as a home care RN. I did home care visits in the late 1980's and early 1990's, but things have changed. Most changed of all is OASIS. I have been answering the ADL questions incorrectly; my preceptor, who hasn't seen the patient, insists that the patient can do certain things I know s/he can't do. She can't or won't explain why the answers have to be the way they are. She has stated that she will extend my probation if I don't start getting the answers correct. She has also stated that my clinical judgement plays no part in answering these questions. "That's not the information we're looking for."
I am angry and frustrated, almost to the point of putting this job behind me and moving on. I've been an RN for 32 years and this is the first time I've encountered this type of problem.
Can anyone explain OASIS to this stupid old woman or should I just move on?
Thanks for the help.
Oct 19, '06
i think your preceptor has it all wrong, i have worked home health for over 18 yrs and since the inception of oasis has always been answered using clinical judgement, i don't know where she is coming from with her attitude. the key to answering the questions is not so much if the pt can do it BUT can they do it safely.!! sound more to me that she doesn't understand oasis. has anyone offered to you to read "chapter 8" with regards to answering the oasis questions. if not you can type in a search engine--oasis chapter 8 and it can be downloaded. it gives you different senerios on answering the oasis. wished you lived in VA, we are in need of a RN!!!
i have never encountered a person like the one you are describing. best wishes
Oct 19, '06
Thanks for the reply. I have read what I was given on chapter 8, but I will go and download it as it's easier to carry around on a floppy! Thanks for letting me know that I can download it. I did ask her if OASIS is trying to equate being able to dress independantly with meal prep, but she refused to answer and said she was turning me over to Quality Assurance!
Oct 19, '06
I would recommend that you do not chart false info. Your nurse preceptor is probably charting to Medicare requirements to be sure that reimbursement is ensured, or whatever program they are on.
Ask for a few minutes of the Home Care director's time, and ask about the Oasis charting requirements...maybe the whole staff has been instructed to be sure that all patients "qualify" in any way possible. Leave your opinion about the "right and wrong" of this practice to yourself, at least until you hear her(his) expectation...then be careful...weigh the value of keeping the job with your ethical standard. I always feel that honesty is the best policy, but not everyone does.
Oct 19, '06
I've been in home care about a year. My understanding is that you should record what the patient can SAFELY do. If they can only safely take a shower when someone is present then that's what you mark. It doen't matter if they sometimes do it alone. It says something to that effect right on the questionere.
I would be concerned about the person changing your answers, especially if they are changed to ones that you disagree with (not just marked the wrong thing by mistake). I would also wonder if she is entering her name as the one who made the changes, or submitting it as if that is what you charted. I would ask if you don't know. I know that when our office people make a change they chart it as "changed per conversation with admitting RN . . ."
Oct 19, '06
[font="comic sans ms"]reimbursement is tied to the answers on the oasis form. i'm sure this isn't new info for you.
when i first did homecare, there was a big "push" to make the patient as low-functioning as possible ("sure, they might qualify for an aide....if you fill out the oasis correctly...")
when i was leaving homecare, there was a big push to make it look as though you were "doing the paitent good," meaning that successive oasis forms were showing that the agency was "making progress" with its interventions. (as though the bed-bound x10 yr cva patient was going to start ambulating due to our pt efforts :uhoh21: )
i'm wondering if that isn't what your preceptor isn't getting at? it has been a while since i've done home care, so i apoligize if i'm way off mark, but that is the first thing i though of when i read your post.
Oct 20, '06
welcome to the home health forum!
check out our thread:
helpful tips on completion of the oasis
chapter 8 cms oasis guidlines
part i chapters [zip 1.2 mb]
[font=verdana, arial, helvetica, sans-serif]national 3m oasis integrity project
[color=#999966]new release october 2005
updated recommended questions and techniques for oasis m0 items
[font=verdana, arial, helvetica, sans-serif]use these references to guide your practice.
Last edit by NRSKarenRN on Oct 20, '06
Oct 28, '06
I would agree that the best way to answer the OASIS questions is thru your observation and assessment, one needs to observe the patient in their environment and answer the ADL questions appropriately, without these observations a correct answer is impossible. At our agency we teach, observe, observe, observe.
Reimbursement is always a concern, but ethically, we are bound to be truthful in our assessment.
Oct 28, '06
You have gotten some really good answers to your question, so I wont repeat anything............ Just wanted to give you food for thought regarding OASIS
OASIS: Our Attempt to Systematically Inflict Suffering.................
One of the CEO's that I used to work for told us that was Medicares definition for OASIS
Oct 30, '06
Interrater reliability with OASIS is very low, and as such, many agencies have decided to answer questions in a certain way to help increase that reliability - just look at how a RN and PT will assess the same patient at the same time. You also need to assess what the patient can safely do for over 50% of the time for over 24 hours and at start of care what they are like at the beginning of the visit not at the end. She may be trying to get you to be on the same OASIS page as the rest of your agency but dosen't know how to explain it to you. OASIS isn't easy - our QIO just sponsered an in-service on MO 690 that was over an hour long - one moo question. With P4P coming up, outcomes are becoming increasingly important and like it or not, outcomes are the responses to the OASIS questions.
Oct 31, '06
Is it posssible, via online or elsewhere, to get a copy of the intake assessment data sheets one uses in Home Health?
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