SHOW ME: Enhancing OASIS Functional Assessment

1 Vol. 27 no. 1 January 2009 Home Healthcare Nurse19 SHOW ME: Enhancing OASIS Functional AssessmentMARY CURRY NARAYAN, MSN, RN, HHCNS-BC, COS-C, JOISE SALGADO, OTRL, AND ANN VANVOORHIS, PT, HCS-DHave you ever felt that thesearch for Outcome and Assess-ment Information Set ( OASIS )accuracy is endless? In 2007,the administrators and clinicalmanagers at ProfessionalHealthcare Resources, Inc.(PHRI) looked at the agency sfunctional outcome indicators(improvement in bathing, trans-ferring, ambulation/locomotion,and management of medica-tions) and shook our again, the outcomes didnot seem to capture our intu-itive sense of the degree towhich our patients actually didfunctionally improve under ourcare.

2 Why were these outcomesnot better?Our home health agency has8 offices in the Maryland, Vir-ginia, and the metro DC week, our administratorsand clinical managers meet todiscuss quality issues via aconference call. As we re-viewed the most recent HomeHealth Compare outcomes foreach office, we considered pos-sible causes for outcome re-ports that did not match clini-cians reports of clinical managers ofPHRI review their teams pa-tient outcomes at patients do not improve,the managers frequently dis-cuss the outcomes with the cli-than a therapist would atadmission.

3 Nurses tend tooverestimate patients Functional abilities at ad-mission, whereas thera-pists seem to capture thepatient s Functional statusadequately at interrater variabilityleads to an erroneous noimprovement when pa-tients Functional abilitiesactually have improved identifying these prob-lems, PHRI selected a smallperformance improvementteam consisting of a nurse, aphysical therapist, and an oc-cupational therapist (the au-thors of this article) to developaperformance improvementplan.

4 This article describesSHOW ME, the 1-page tool andprocess we developed to ad-dress these problems. But first,let s frame our solution interms of why Medicare be-lieves Functional assessmentand outcomes are so crucial togood patient ofFunctional Assessmentand Care PlanningTo have a high quality of life athome, home health patientsneed to perform their ADLs andIADLs (Table 1). Functional inde-nicians involved in the care ofthose patients. Now theyvoiced their opinions aboutpossible reasons for inaccu-rate outcomes.

5 Comments in-cluded the following: Nurses are not skilled atperforming Functional as-sessments. They still relymore on interview than ob-servation despite beingtold they must ask the pa-tient to demonstrate his orher activities of daily living(ADLs) and instrumentalactivities of daily living(IADLs) before answeringOASIS M0640-M0810. Even therapists fail to per-forman adequate assess-ment in some functionalareas, especially neglectingto assess patients abilityto select and administeroral medications safely.

6 When admitting a patient,some therapists do not ad-equately assess patients ability to ambulate safelyon all surfaces they needto transverse in the homeand to transportation,which they do capture atdischarge. Nurses frequently admitpatients who are dis-charged by often score patients Functional status higher 20 Home Healthcare is associated withhealth and well-being (Graf,2006). Yet, many of home care spatients come to us with a re-cent decline in Functional one third of all hospi-talized patients older than 70years are discharged from thehospital with a decline in theirability to meet their ADL needs(Brown, Friedkin, & Inouye,2004).

7 Because of the limitedmobility imposed on patientsfor their illness/injury while inthe hospital, patients can be-come rapidly , a significant decondi-tioning (decrease in musclemass causing muscle weak-ness) can occur within 2 daysof a patient s hospitalization(Hirsch, Sommers, Olsen,Jullen, & Winograd, 1990, as re-ported in Graf, 2006).Home care nurses and thera-pists have a professional andethical responsibility to iden-tify Functional deficits accu-rately so they can appropri-ately develop careplans thatreturn patients to the highestfunctional level possible.

8 Toidentify Functional deficits,nurses and therapists mustperform an appropriate assess-ment of patients abilities sothey know what rehab servicesand exercise programs willhelp them reach their patients deserve goodassessments, which lead togood care planning and thus ul-timately to good outcomes. Al-though our agencies adminis-trators and performanceimprovement directors want usto achieve good outcomes, ourpatients are even more in-vested in the outcomes its recent series on bestpractice geriatric assessmenttools, the American Journal ofNursinghighlighted the value ofassessing the ADLs and IADLsof older patients.

9 When pa-tients show signs of functionaldecline, the authors suggestthat clinicians use the KatzIndex of Independence in Activ-ities of Daily Living and theLawton Instrumental Activitiesof Daily Living Scale to helpthem intervene appropriately(Graff, 2008; Wallace & Shelkey,2008). The OASIS Functional as-sessment incorporates the as-sessment parameters of thesebest practice ME Tool To resolve the inadequate func-tional assessments and theproblems with interrater relia-bility our managers identified,we developed SHOW ME (Fig-ure 1).

10 With the SHOW MEmnemonic, clinicians can eas-ily remember what they actu-ally must observe patients dobefore they answer the variousOASIS Functional Activities of Daily Living (ADLs)M0640 Grooming M0650 Dressing upper body M0660 Dressing lower body M0670 Bathing M0680 Toileting M0690 Transferring M0700 Ambulation/locomotionM0710 Eating/feedingOASIS Instrumental Activities of Daily Living (IADLs)M0720 Meal preparation M0730 TransportationM0740 Laundry M0750 HousekeepingM0760 ShoppingM0770 Telephone useM0780-800 Medication management M0810 Equipment management Functional Quality Indicators Exhibited on Home Health Compare Web Site M0670 Bathing M0690 Transferring M0700 Ambulation/locomotionM0780 Oral medication management Table 1.