Remember the management of Oral Medication question (M2020) refers to the ability, not the compliance or willingness

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1 OASIS C - 1 Not only are you a nurse or a therapist there are many times you must be a detective in order to find out really what is happening with the patient. Utilizing this approach will also assist you with completing the physical assessment and documentation more timely. The OASIS visit is a long and painful process for all involved. o The patient and family are very happy to be home but also anxious and tired. Doing the OASIS is mandatory but it is a long visit for them o The clinician has a great deal to accomplish on the OASIS visit and it is vitally important to understand how to answer the OASIS accurately so the patient gets the care he/she needs Start with your detective hat as soon as you make your first contact with the patient o Who answers the phone? How long does it take for someone to answer? o If caregiver answers the phone, after you introduce yourself ask how the patient is. o If patient answers does he/she sound SOB or weak? Ask how he/she is. o When you tell the patient the time frame of your visit what is the response? I live with my daughter and she will leave the door open when she leaves for work. Why can t he/she answer the door when you arrive? Think about that. o When you arrive at the home See how long it takes for someone to answer the door If it is the caregiver on the first impression - does he/she look like a reliable, solid caregiver? If it is the patient watch he/she ambulate back to couch Is he/she steady on feet? Is he/she using a device properly? Is his/her attire clean, disheveled etc? Check the back of the pants do you see any stains from incontinence? Is he/she nesting? Phone, remote, food and drink, meds etc Is the couch/chair soiled or smell like incontinence? Is it a safe pathway to the chair/couch?

2 o When you enter the home Take a deep breath - what do you smell? Does it smell like roses? Or incontinence or musty or like animals? Take a look around the room do you see family pictures Is the patient in the some of the photos? How are they dressed in the photos? How are they dressed currently. Many times how they are dressed speaks to how they are feeling emotionally. o Examples: o My Mom was teeny weeny and she always wore jeans, t-shirts and sneakers almost all the pictures, that was how she was dressed. We even buried her dressed like that. So that is what you would have looked for. o My Mother In Law was always dressed up: clip on earrings, make up so adorable as well. When we took her to the hospital at 4 am to have her bladder removed as well as a hysterectomy and hernia repair she was dressed like we were going out to dinner. (I was freshly showered but no makeup or jewels!!) In all pictures in her home she was always dressed like that. So that is what the nurse/therapist should look for and address if applicable. When you listen to his/her heart have the patient unbutton or take off his/her shirt this will be assist you when answering (M1810) ability to dress upper body. The type of shirt may be a hint to his/her ability to get dressed When you check his/her feet have the patient take off his/her own socks and shoes. If he/she are wearing slippers ask why. Maybe he/she can t get his/her socks and shoes on and off. Remember physical impairments, limited range of motion, balance problems, cognitive issues and pain can affect the ability to dress upper and/or lower body.

3 Bathing It is very important when answering the functional questions that you observe the patient don t just ask him/her. o If you ask the patient if he/she takes a shower this is what he/she HEARS: Am I clean? Not are you able to get in out of the tub/shower? Look at the shower curtain is it scrunched up (like when your kids get in and out of the tub and use the shower curtain to balance with) if so, that tells you the patient may have balance issues. o Is the tub filled with Xmas decorations if so ask why? If the tub is used for storage because the patient is unable to get in and out of the tub that is different than if the patient is capable to take a shower but chooses not to. Medications you can accomplish several tasks when doing the medication review. o Ask the patient where his/her meds are. o Watch him/her ambulate to where they are located. o If they are all right next to the patient why is that? Can he/she not ambulate safely to get to them? o If the meds are in the kitchen - take this time to check out the kitchen; o Of course, ask if you can look in the refrigerator then check it out. Is there healthy food or does the refrigerator look like a college door refrigerator soda and Roman Noodles!! Is the food expired? Is the refrigerator clean? o Is the kitchen clean? Are there dirty dishes around? Is the floor sticky? o How does the stove look? Ask the patient to show you the knobs on the stove can he/she read them? Is there a danger the stove may be left on because the patient can t see the dials? o Tell the patient that you need to enter the meds into your droid. Ask him/her for assistance. Does he/she need glasses to see the names of the meds? If yes are the glasses nearby? If the glasses are not nearby and the patient doesn t know where they are that is a good indication that he/she isn t using them. SOOO score the vision section (M1200) without the glasses Does the patient know what the names of the meds are? Or are the bottles colored coded and that is how the patient recognizes the pills? Can the patient get the lid of the bottles? Does he/she know what the meds are for? Does he/she know when to take the meds? o Remember the management of Oral Medication question (M2020) refers to the ability, not the compliance or willingness

4 Example: If patient says to you that the spouse is a retired pharmacist and gives the patient the meds, you need to ask the patient why the spouse gives the meds. The patient may say my husband has always helped me with my pills OR since he has retired it gives him something to do You then need to ask even though your husband gives you the pills can you please tell me about them? You may hear either one of these answers of course I can, I just let him give me my meds because it makes him feel good. Then the patient tells you all about the pills OR she says to be honest I use to know my meds but my husband has given me my pills for so long now that I don t know anything about them. It is so confusing so many meds and so many times to take them. o Example : Patient lives alone and you see that she has a medication diary on the bottom section of her refrigerator but it has crayon drawings on it and so it is not readable. You ask the patient about the diary she says Oh, I use to use it but last week my great grandson came over and he drew on it. He is my first great grandson and this is his first drawing I could never get rid of it. Isn t it precious? You ask her how she takes her pills and she says for now my children come over at pill time and help me. You make her a diary before you leave from your visit BUT remember when you are completing your SOC OASIS M2020 management of oral meds the answer is #3 Unable to take medication unless administered by another person BECAUSE that was the case UNTIL you made the diary. On the DC OASIS you will be able to answer #1 Able to take medications at the correct time if another person develops a drug diary or chart. This is a positive outcome!! Incontinence: this is a very touchy subject so you need to be tactful while wearing your detective hat Like we talked about earlier you may be able to smell or see incontinence. Make sure it is the patient and not another family member that is incontinent Sometimes you may need to ask the spouse/caregiver to leave the room when you are interviewing the patient - as the patient is capable of answering the questions however the spouse/caregiver keeps chiming in

5 True Example: Many years when I did visits, even though we did not do the OASIS of course you still had to do a complete physical assessment. The patient was 66 and had tripped over the dog and broke her hip. She had no cognitive issues what so ever. When we started talking about incontinence the patient denied being incontinent. The husband immediately contradicted her, he said Sue remember when you and your friends all peed yourselves last month at Bill s birthday party? The Patient was embarrassed and did not say another word. Later on I asked the husband for some time alone with the patient and I asked her again about the party. She said Jere, we were at a birthday party and I was with my yayas and we had a few glasses of wine and started laughing so hard and we all peed our pants. The harder we laughed the more of us that peed. Our husbands were so angry with us. I promise you that is the only time that has happened to me. HOWEVER she could have admitted to me that her husband was correct and that she did have some bouts of incontinence. When does Urinary Incontinence occur? (M1615) Example of time voiding defers incontinence when answering. In all due respect time voiding is similar to toilet training. It is based on scheduling toileting times to prevent being incontinent. AND if the patient has an occasional accident you can NOT choose this answer. Patient states she times going to the bathroom around her sister s daily morning call, before Kelly and Michael at 9am, before lunch, and Oprah, etc. She says sometimes my sister and I talk too long and I don t get to go to the bathroom before Kelly comes on and then I may have an accident. You know how cute and funny she is. SOO you can t answer #0 time voiding defers incontinence. You must choose #1 Occasional Stress Incontinence Remember if the patient uses a diaper at night because of safety issues he/she says I can t see very well at night and I am afraid of falling so I wear a diaper. Ask her if she is asleep when she uses the diaper OR does she choose to urinate in the diaper instead of getting up to the bathroom? If she chooses to use the diaper that is not being incontinent it is a choice to urinate in the diaper and not on the toilet/com mode

6 Patient Living Situation (M1100) o First you determine if the patient lives alone, with others or in a congregate living situation. If patient s daughter Susan - is staying with her until the home health episode is done - patient lives with others. If patient s daughter Susan is staying for several weeks patient lives alone o Secondly you determine the availability of assistance. This question can be abit confusing what is regular daytime? what is regular nighttime? what is occasional/short term assistance? When determining what regular daytime is and nighttime is- remember each patient has his/her own time. You need to ask the patient when he/she wakes up to start the day and what time he/she goes to sleep at night = regular daytime. If Mrs. Smith wakes up to start her day at 6am and goes to sleep at 8pm. Her regular day time hours are 6am to 8pm You need to verify that the patient goes to sleep at 8pm and wakes up at 6am = regular night time Example: Patient lives alone safely but has 2 very dedicated and loving daughters that assist their Mom. Tina (daughter 1) comes every morning at 6am. She does everything for her Mom. Assists her with getting up, bathing, making breakfast, does cleaning and laundry. She assists her with her lunch and makes sure her Mom is all set with all her needs and wants and leaves every day at 3p to get her kids off the bus. Marie (daughter 2) comes every day at 5p. She also does everything for her Mom. She makes her dinner, freshens her up for bed, watches her Mom s shows with her and stays with her until she falls asleep at 8pm. Originally I felt this answer would have been- Regular Daytime but I was WRONG. The patient is alone every day from 3pm- 5pm. You can only answer regular daytime when the caregiver(s) are with the patient every day with infrequent absences. Being alone every day from 3pm-5pm is not an infrequent absence. So the correct answer would be Occasional/Short Term Assistance. Sometimes the patient does not want to admit that the caregiver(s) is not home very much. It is important for the patient s safety to delicately find out the true answer.