Last Minute Questions
December 30, 2009
Over the last few days, I have been getting a lot of last minute OASIS questions as we are about to dive headfirst into the new dataset. Real quickly, let me address a couple of them in case you are also wondering.
First of all, the use of dataset begins January 1. That means if the response to M0090 (date assessment completed) includes ’2009′, you will use the old dataset even if the episode begins in 2010. Many of my clients point out that this make no sense. Never mind all that right now. Just do it.
Secondly, when an OASIS-C begins with, “Since the previous OASIS assessment…..” the time period includes the actual prior assessment visit. For instance, if you found your patient to have pain on admission and you called for orders for therapy and the patient has been pain free ever since, you would include the interventions performed during the admission visit.
Finally, the ‘physician ordered plan of care’ discussed at length in M2250 means that the physician plan of care has been communicated to and ‘authorized’ by the physician. If the orders have been requested but not received then the plan of care is not considered to physician authorized.
This means that a one way fax to the doctor does not count. A cursory ‘okay’ by the office nurse will not suffice unless you are confident that she has relayed the message to the MD and she is communicating the MD’s message to you.
Again, sometimes, the answer will be, ‘No’.
The date that you receive the last piece of information that you require for the care planning is the date that should be reflected in M0090. Therefore if you do the admission on Monday and it isn’t until Wednesday that you hear back from the MD, M0090 will be whatever date Wednesday falls on. A lot of the timeliness will be at the mercy of physician cooperation. However, the MD’s will never sign off on anything timely if we get it to them late. Our processes will also be reflected in these questions.
And please don’t shoot the messenger.
Referral Contact
December 28, 2009
My fear for next week is a mental health crisis affecting all physicians referring to home health. In spite of every medication and therapy known to address tinnitus, our MD’s will be driven crazy by incessant ringing of the ears.
If you want to protect the sanity of your favorite referral sources and haven’t already done so, draft a fax template for medication and care plan review. For meds, it might read something like:
URGENT FAX:
Dear Dr. Bleaux:
We have reviewed Mr. Thibodeaux’s medications and have found the following issues that might affect his plan of care:
Tagamet and Cimetidine are both ordered for this patient. Can we have a clarification order for our care plan?
Leave room for the MD to make notes and sign/date his or her signature. Place your fax number prominently on the sheet.
The last line should read something like: BEST PRACTICES MANDATE THAT WE HAVE CLARIFICATION ON THIS POTENTIAL MEDICATION ERROR BEFORE THE END OF THE TOMORROW. Sooner is better. YOUR COOPERATION IS APPRECIATED BY US AND YOUR PATIENT!
Be sure to include all pertinent information about the patient including the date of birth since many physician offices use date of birth for patient identification. The easier that you make this process for the MD, the better your response will be.
Next, start tracking response times per physician. Make a copy of any fax that is returned later than the deadline. Share these faxes with your marketing staff so that physicians can be educated (beaten up) if they do not comply.
Remember, physician contact includes two way communication. In order to document that the physician was contacted you must have verification of two way communication with the doctor. Sending a fax is not enough. Only when you receive a call back or return fax, have you met the criteria for responding Yes to MD contact within one calendar day.
OASIS-C To Do List
December 28, 2009
Here are five things that every agency should squeeze into their schedule during this short work week:
- Make sure that your OASIS-C assessments are ready to go. If you are relying on paper forms, ensure that they are in your agency. If they have been ordered but have not arrived, place a call to your vendor to make sure the order is being processed timely. If you use electronic documentation, ensure that your assessment component is up to date. Clarify any questions with your vendor.
- Gather up all old forms and prepare to destroy them the first week of January. I promise you this is a good idea.
- If you haven’t already done so, put your referring physicians on notice that due to a change in our dataset, our need for two way communication has increased dramatically. Explain that these changes are industry wide and not simply because your agency is needy.
- Put in process a place for ongoing monitoring of weights and edema for failure patients, pain monitoring.
- Review, one last time, with your nurses the medication profile review processes and all the related definitions.
Yes, you will likely be short staffed this week. Patients, especially heart failure and diabetics might still be reeling from holiday festivities, depressed patients are likely to exacerbate and yet, come midnight on Thursday, we will fall in line with the new dataset or fall out with major complications.
If you have any other helpful tips for readers, please, please post below. There is no such thing as being overly prepared when it comes to OASIS-C. In fact, there are days when I will settle for marginally prepared.
Home Health Night Before Christmas
December 23, 2009
T’was the night before Christmas when all through my car
My admit was strewn on the way to the bar
So clear and concise my voice mail recording
‘You want me to WHAT??? You’ve got to be kidding!’
My patients had meds, their pain was relieved
Compliance so great, I couldn’t believe
No forms to complete for infections or falls
The director of nursing unable to call
When out from the parking lot arose such a blast
I had to go see what was happening fast
A walker, a cane, an electronic wheelchair
Complete with my patients were all waiting there
One and two handed devices they used
O2 compressors and shared verbal cues
Diabetics, arthritics, COPDers alike
All came to invite me out into the night
The driver, a masked man, or maybe a woman
Had rales in his chest and coughed up a lung
It seemed to this tired and cranky cold nurse
That he was in failure or possibly worse
Bring Lasix, bring Lortab, Bring HCTZ
Lexapro, nitro and Claritin D
Such a vast taxing effort put forth by my patients
I was anxiously waiting in lurid suspense
I waited for pain and shortness of breath
Even a code leading right up to death
I waited for weight gain and med side effects
I knew something bad was on its way next
But calm took the place of quivering fear
As I saw all the patients holding me dear
Sipping Ensure and wishing good cheer
To me and to mine for the rest of the year.
No football or cabbage or stewed black eyed peas
For me or for mine come this New Year’s Eve
Patients to be discharged come January One
With written instructions to call 911
Merry Christmas from WOCN
December 18, 2009
The long awaited guidance from WOCN is here. Click below to read it now. We have also save it under ‘Essential links’ on the sidebar to the left for safe keeping and future reference. Let us know what you think of the new guidance below in the comments section below or email us.
