Oasis Form/HH Confusion

  1. I've had my RN license a few weeks and have been on the job in HH for a week and a half. The agency is in a state of chaos right now, they were sinking fast and in an attempt to save the agency they brought in a new admin/DON and medical director. Unfortunately, there wasn't enough time to clear things up before the state came in to inspect, and now we have been told to expect the state inspectors to be on the agency's a$$ every 45 days for the next two years. The agency's major downfall was documentation, namely the OASIS forms not being turned in and locked in a timely manner.
    So, I'm really busting it trying to keep up. But there are some things that weren't really explained to me. Actually, I did one visit with a preceptor and then they started handing me packets and told me to go at it. The forms are as confusing as I thought they would be. Just seems like some of the questions asked are not exactly cut and dried. One example is on the back of the recert forms, where they want you to write a nursing diagnosis, are they actually wanting you to develop a careplan with goals and interventions?

    Also, the VS ranges, is there a guideline I should follow, or do I decide what ranges are appropriate for the patient?
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    About Jo Dirt

    Joined: May '04; Posts: 3,422; Likes: 1,296
    Specialty: 9 year(s) of experience


  3. by   NRSKarenRN
    each agency is free to develop it's own oasis forms based on mo questions, so can not address your specific forms.

    if you have not done so already, spend your next day off reading these articles:

    helpful tips on completion of the oasis -- updated 4/12/09, no longer available

    medicare reference guide: home health coverage guidelines updated 4/12/09

    it will help info sink in.

    check out this book as really helped me writing 485 plan of treatments:
    [color=#003399]handbook of home health standards and documentation -- guidelines for reimbursement--get 4th edition (seen it at borders) can chedk out few pages online link.

    some like robin rice book too but i've not seen it so can't comment.

    look at links at top of forum for other helpful info.
    Last edit by NRSKarenRN on Apr 15, '09
  4. by   NRSKarenRN
    This is outline i use with my new staff and students to get picture of patient.

    How to obtain Homecare services

    1. Homebound status: need reason
    SOB on walking 20 ft
    Wheelchair bound and unable leave home unassisted
    Unable to use stairs
    Restricted to home post surgery per Dr.: no stairs, lifting, driving
    Oxygen dependent high flow using l or 2 liquid tanks, unable walk more thatn 5-10 ft
    Bedbound with contractures
    Hoyer lift transfer bed-chair only
    WC bound, unable to self transfer

    2. Functional status: think of the word DEFICIT

    Diagnosis: what aspect of illness is MOST ACUTE illness /reason for care
    Any issue re non-compliance, misunderstanding meds/treatment regimen
    Need teaching regarding meds, wound, injections, foley care, or
    tube care, tube feedings

    Environment: Any issues with home - heat, electricity, running water available;
    have windows/doors intact; rodent/bugs issues?; dirty or cluttered, poor repair
    live in high rise--elevator working? ;
    # stairs person needs to enter/exit building ;
    live high crime area-need AM visit or escort/ 2 person visit
    Fire alarm present; oxygen safety followed?

    Family: supportive or non existient; Able and WILLING to assist?

    Insurance: Medicare, Medical assistance or Managed care issues?
    Problems obtaining or paying for meds? Large unpaid bills

    Caregiver: Lives aline? Who is asssiting client: family/friends, availablilty issues
    Care giver willing AND able?
    Caregiver issues: own health poor, frail elderly, forgetful, refusing assistance

    Independence: Pt self care or dependent on assist devices/ others for meals,
    food prep, bill paying, house keeping

    Therapies: History of falls, balance issues -need for ptdafety assement;
    Any need for adaptive equipment or equipment poor repair,
    "borrowed"from spouse/neighbor

    Support Services/friends/supervision: Need for 24hr supervision - ?receiving it
    Involved in office of aging program, Adult day care, meals on wheels

    3. Amount of services to request for Managed Care clients:
    Eval: Home Safety/Situation/ Medication Management
    if unable to get much clinical info to ask for more visits upfront

    1-2 wk/2wks (will usually approve) for
    Physical assessment check BP, Medication Management + Eval compliance,
    Teaching : care giving, Diabetic, COPD, CHF Mgmt; insruct disease process,
    simple wound care to eval compliance and wound healing;
    eval nutrition/hydration/diet compliance if wt loss/ gain in recent hospitalized
    pt or noted at Drs.

    Daily: wound care (measurements), SQ/IV Meds list
    Last edit by NRSKarenRN on Apr 15, '09
  5. by   NRSKarenRN
    Case examples ...
  6. by   renerian
    Karen your always able to post just the right things for people. UGH I cannot imagine a survey that often.......

    Goes to show that if you hire people who don't know what they are doing (agency leaders), you get what you pay for. Alot of people do not realize how complicated it is in home health.

  7. by   DtwSailor12
    I share the same sediments on the thought of a visitor, every 45 days.

    In looking at the OASIS documentation, I would also suggest that you grab a copy of the 3M National OASIS integrity project, which you can download from www.fazzi.com.

    This document walks through all the questions in the assessment with examples on how to get the data, and what each answer means.

    This is importnat as the industry moves to p4p and our payments will be based on all agencies answers to the M00 questions.

  8. by   NRSKarenRN