The premise of OASIS is simple. Clinical data is collected across the board from patients at various time points. By using the patient data, outcomes can be calculated and payment can be aligned to costs. In the past, virtually all OASIS questions following demographics have been patient specific. Now, however, in reviewing the proposed changes (see yesterday’s post), many of the questions appear to be assessing the agency instead of the patient.
Furthermore, there are questions about the ‘current’ plan of care asked throughout. Does the patient have interventions for diabetic foot care? Is pain addressed? All of these questions are vitally important for the care of the patient and sound clinical practice dictates that they are addressed. But, being as old as I am, I remember (and prefer) a time when assessment preceded care planning. Except when dire emergencies demand immediate action (ventricular fibrillation comes to mind as an example), it is almost always better to gather as much pertinent information as possible before deciding on a course of care.
Consider the diabetic foot care question. Imagine how incompetent a nurse would look if she responded that there were no interventions for diabetic foot care in a patient at risk. But me? I would have to assess the patient first and then set priorities. For instance, a newly diagnosed diabetic might have a recent stroke, out of control blood sugars, an extremely long pro time because of Coumadin therapy and a poor caregiver situation. The nurse only has 60 days to get the situation under control. Actually, being that the patient will not last 60 days in that condition, he or she has less time than that. My priority wouldn’t be diabetic foot care. I might tell the patient to wear comfy shoes and thick socks and not to hack at their toenails with clippers but I am going to focus on all that is out of control first. The second episode seems to be a really good time to work on diabetic foot care.
Pain interventions and cardiac failure interventions are also assessed. The fact that we do not yet have instructions makes it difficult to know how ‘intervention’ is defined in these questions. Is an order for lasix an intervention? Or do they mean nursing interventions that are independent of medical orders such as daily weights and teaching a low salt diet?
Because these questions seem to ‘beg’ a particular answer, I also wonder about their validity in a dataset that is designed to measure specific clinical data and compare it across time. At this early stage, my preference would be to stick to patient assessment rather than agency assessment. After all, who cares if the care plan is the best in the world if the patient still has pain, diabetic foot ulcers and heart failure? Results tell the story!
