OASIS-Central

As clinicians strive for accuracy in implementing OASIS-C, they must have access to resources that will help them complete these new data elements.

The following data resources will help in answering your OASIS-C questions:

• Review of the clinical record that would include physical assessment data, weight trends, and clinical tools and documentation of the heart failure patient
• Chapter 5 of the OASIS-C Guidance Manual provides standard clinical guidelines and list of heart failure symptoms
• Beacon Health Web site (www.beaconhealth.org) for additional direction on OASIS-C

Because caring for cardiac patients is a common role within a homecare nurse’s daily activities, the agency often depends on the assessing clinician’s expertise rather than establishing best practices or evidence-based guidelines for care. The terminology for this practice is “usual care,” primarily based on the clinician’s level of expertise where the agency should be focused on establishing a standard EBP guideline for skilled staff members. Assessing clinicians must be educated on the current evidence-based guidelines for heart failure and be compliant to these guidelines in the care of heart failure patients.

Best practices guidelines for clinicians

Sample best practice interventions based on standards for heart failure require patient education in the following areas:

• Recognition of fluid retention
• Weight monitoring and use of weight diary
• Understanding the importance of exercise and its role in helping to reduce heart disease
• Recognizing signs and symptoms of worsening condition and appropriate patient intervention
• Following low-fat diet and low-sodium guidelines
• Tobacco abstinence

Clinical staff competency must be evaluated at least once a year with a grading system provided. It is also recommended that the competencies be added into the clinician’s job description and evaluated, and documented and reviewed at performance appraisal time.

One of the primary skills that the homecare clinician must master is the cardiac assessment.

1. Identifies rales/crackles versus rhonchi/wheezes on lung auscultation with accuracy
2. Demonstrates how to accurately assess jugular venous distention and abdominal and peripheral swelling
3. Verbalizes general exercise recommendations for the heart failure patient
4. Supports weight management and recording compliance with heart failure patient on every visit

This is an excerpt from the book, OASIS-C Process Measures: A Program for Best Practices Implementation, by April Perry, RN, APN, MEd, Laurie Salmons, RN, BSN, and Bobi Rose, RN, BSN, CWCN, CCCN.