Tips for OASIS Accuracy

Accurate completion of the OASIS assessment is important for home health clinicians.  Unfortunately, some clinicians have had no training, minimal training or have been given incorrect information. The Director of Nursing at a large home health agency recently shared with us that they performed an exercise where two clinicians were asked to independently complete an OASIS assessment on one of their patients. The results were startling. The clinicians documented two rather different assessments of the same patient!

To be able to improve patient outcomes, home health agency clinical leadership teams must understand and communicate to staff the intent of the OASIS. They must also have a strong commitment to educating clinicians on an ongoing basis how to accurately complete OASIS assessments.

There are so many variables that the clinician must consider to properly complete an OASIS assessment.  Understanding the OASIS conventions for completion of the assessment is an excellent first step.  The OASIS conventions are the general rules that must be observed when completing an OASIS assessment.  Sadly, many clinicians have not heard of these basic rules or received adequate training on them.

There are 16 general OASIS conventions and three ADL/IADL item specific conventions; they are located in chapter 1 of the OASIS-C Guidance Manual.[i] The OASIS conventions are as follows:

1. Understand the time period under consideration for each item, report what is true the day of assessment unless a different time period has been indicated in the item or related guidance.  Day of assessment is defined as the 24 hours immediately preceding the home visit.
2. For OASIS purposes, a care episode must have a beginning , start of care (SOC) or resumption of care (ROC) and an end(transfer or discharge).
3. If a patient’s ability or status varies on the day of the assessment, report what the patient’s usual status or what is true greater than 50% of the assessment time frame, unless an item specifies differently.
4. Minimize the use of NA and unknown responses.
5. Responses to items documenting a patient’s current status should be based independent observation of the patient’s condition and ability at the time of the assessment without referring back to prior assessments.
6. Combine observation, interview and other relevant strategies to complete OASIS data items as needed.
7. When OASIS item refers to assistance, this means assistance from another person unless otherwise specified within the item.  Assistance is not limited to physical contact and includes both verbal cues and supervision.
8. Complete OASIS items accurately and comprehensively and adhere to skip patterns.
9. Understand what tasks are included and excluded in each item and score item based only on what is included.
10. Consider medical restrictions when determining ability.
11. Understand the definitions of words as used in OASIS.
12. Follow rules included in the item specific guidance.
13. Stay current with evolving CMS OASIS guidance updates.
14. Only one clinician takes responsibility for accurately completing a comprehensive assessment.
15. When the OASIS item includes language specifying one calendar day, this means until the end of the next calendar day.
16. The use of i.e., means “only in these circumstances” or “that is” and scoring of the item should be limited to the examples listed.  The use of e.g., means “for example” and the clinician may consider other relevant examples when scoring this item.

ADL/IADL item specific conventions

1. Report the patient’s ability, not actual performance or willingness, to perform a task.
2. The level of ability refers to the patient’s ability to safely complete the specified activities.
3. If a patient’s ability varies between the different tasks included in a multi-task item, report what is true in a majority of the included tasks, giving more weight to tasks that are more frequently performed.

Only when a clinician is educated regarding the OASIS conventions/rules can they begin to understand the OASIS assessment tool.  It is only the first step in education regarding OASIS and OASIS documentation.  Due to constant changes from Center for Medicare and Medicaid Services (CMS), home health clinicians must maintain ongoing awareness and a commitment to constantly keeping abreast of OASIS changes and CMS guidance.  A good way to do this is to regularly read the OASIS questions and answers (Q & As) that can be found on the CMS website at: http://www.cms.gov/ and by routinely accessing the quarterly provider updates located at http://www.cms.gov/.

[i] http://www.cms.gov/