OASIS-Central

The new OASIS-C includes new data elements that measure an agency’s process for responding to heart failure issues that are included in the cardiac status section.

These two new items, M1500 Symptoms in Heart Failure Patients, and M1510 Heart Failure Follow-up, are completed on transfer and discharge. They appear individually within a new section labeled cardiac status, rather than with synopsis boxes M2250 and M2400. M1500 targets if a patient with a heart failure diagnosis had symptoms since the last assessment, and M1510 targets the actions an agency takes, from no action to actively obtaining orders for changes in the care plan.

Guidelines for administrators

Within their agencies, administrators should support the implementation, education, and monitoring of compliance with clinical processes to decrease active symptoms in heart failure patients, provide a structured plan for care (such as a clinical pathway), and support EBP. This will include an assessment of current standards (or lack of standards) for number of visits, education provided to patients, and early intervention for symptoms of heart failure. When standards are determined, agency-wide education must occur to ensure that all clinicians are familiar with these standards and provide opportunity for feedback. Once the education is provided and standards are implemented, ongoing auditing for compliance will be vital to ensure the best practice standards are maintained.

Best practice guidelines for administrators

Front loading, the second most common strategy utilized by top agencies (according to the 2005 National Quality Improvement/Hospitalization Reduction Study), is defined as “a strategy whereby the agency increases the visit frequency or services at the beginning of care in order to reduce the potential for unplanned hospitalizations” (Briggs® 2005).

Data analysis is an important practice allowing the administrator to review statistics and trends within the agency-specific patient populations. It will be difficult for the administrator of the future to function without effective decision-support software that provides data aggregation and analysis opportunities for daily operational management. OASIS-C, with its newly designed data elements, will be most effectively monitored and analyzed through use of decision-support software.

Software data elements provide information on specific patient populations for trending and analysis include:

• Hospitalization rates
• Visit patterns and scheduling
• Disciplines utilized with episode
• Average length of stay during episode
• Therapy utilization for energy conservation training

In addition to software needed to monitor heart failure outcomes through OASIS-C data, enhanced heart failure education will be important as the agency plans its staff education calendar. It will be essential that the agency assess skilled staff competency regarding heart failure symptoms. The agency must also evaluate staff on an ongoing basis through performance appraisals and evaluations designed to assess heart failure competency.

This post was adapted 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.