Discharge oasis vs Admission oasis discrepancies

[AnnemRN]

I was recently approached about my discharge oasis showing a decline in condition when compared to the admission oasis. I call it as I see it, but have been told that I need to make a copy of the admit oasis and review it before discharging a patient to make sure my oasis would match or show improvement. I'm wondering if this is how other home health agencies handle discharges. Even though I was the nurse doing the discharge visit, it was decided that the case manager would have the ultimate decision in the discharge oasis outcome. Apparently, the powers that be are going to go with whatever the case manager decides even though she didn't do the visit. Something doesn't smell right, I've never experienced this before in home health.

[caliotter3]

I would go with having a copy of the admit oasis so that you have the info available to you. But agree with you that you should call it as you see it. If the patient declined, then they declined. As far as your agency doing shady practices, that may not be the case everywhere, but you can expect to find some deviance along the way. One of the biggest discrepancies I have found is a lack of taking corrective action when nurses report things. This puts the reporting nurse in a bad position. How many nurses want to report their employer to authorities for fraud, waste, and abuse when they know that it will mean they lose their job? Not many. That is why so much goes on that is not lawful, moral, or good patient care practice.

[AnnemRN]

I would go with having a copy of the admit oasis so that you have the info available to you. But agree with you that you should call it as you see it. If the patient declined, then they declined. As far as your agency doing shady practices, that may not be the case everywhere, but you can expect to find some deviance along the way. One of the biggest discrepancies I have found is a lack of taking corrective action when nurses report things. This puts the reporting nurse in a bad position. How many nurses want to report their employer to authorities for fraud, waste, and abuse when they know that it will mean they lose their job? Not many. That is why so much goes on that is not lawful, moral, or good patient care practice.

Thanks for your reply. What I told my supervisor is that the patient was not evaluated accurately on admission, that's why it seemed like she declined on discharge. I agree that nurses look the other way in regards to shady practices to avoid losing their job.

[HmarieD]

CMS (Center for Medicare and Medicaid Services) says you should not reference the prior assessment when completing a new assessment. In practice, everybody does it, and most agencies do review the DC OASIS for declines. HOWEVER... your Case Manager or anyone else absolutely cannot change your documentation without your permission. My agency uses an "OASIS change report" on which all changes are noted and the clinician's signature is obtained. Do not sign anything you are not in agreement with. This is your name and license on the bottom line.

Keep in mind that OASIS can be interpreted very differently by different clinicians. Often you have to leave logic and reason at the door to arrive at the appropriate answer per CMS definition. Be open to what your supervisor tells you and ask for clarification about "Moo" questions if you need it. I recommend looking at Chapter 8 in the OASIS Manual as well.

It is not unusual for a "decline" to occur on paper because the prior OASIS was scored incorrectly. In that case, the case manager needs to go back to the last OASIS clinician and discuss possible changes with them.

[homehealth43130]

My question to the staff is if the OASIS reflects that the patient status has declined and that decline was not anticipated, why are we discharging them. If the scoring was wrong on admission, then there needs to be education with the entire staff so that everyone is looking at the questions the same way. This scenario is also why it is preferable to have the admitting clinician discharge the patient.

[AnnemRN]

My question to the staff is if the OASIS reflects that the patient status has declined and that decline was not anticipated, why are we discharging them. If the scoring was wrong on admission, then there needs to be education with the entire staff so that everyone is looking at the questions the same way. This scenario is also why it is preferable to have the admitting clinician discharge the patient.

In this case it really came down to assessing the patient correctly on admission. The patient was incontinent of urine, has been for years but that was not selected on the oasis admission. On discharge incontinence was selected and that's what became the issue. The agency doesn't want to have anything that shows a decline, and in this case that could have been avoided.

[Aredhel13]

This is a common problem, and sometimes not easy to solve. It shows the importance of a very acurate initial assessment. Whenever possible we try to have the case manager (who is likely the admitting nurse) do the discharge visit.

[AnnemRN]

This is a common problem, and sometimes not easy to solve. It shows the importance of a very acurate initial assessment. Whenever possible we try to have the case manager (who is likely the admitting nurse) do the discharge visit.

That might help , but with staffing issues it's not always possible. Ultimately, being careful with oasis selection on admission would be the best option in my opinion.

[jnette, ASN, EMT-I]

Agree with all the above.

The admission assessment is extremenly important, and if not assessed correctly, can cause problems down the road. It is important to keep this in mind all through the SOC OASIS. Watch for the little things which are often easily overlooked as stated above re incontinence, vision, and watch for discrepencies in scoring pt abilities when it comes to performing ADLS, etc.

You will need to learn to probe.. play detective a bit when asking the patient questions. :)