Ensure therapists are competent
Here are tips on testing assessment skills
Therapists and nurses need to excel in conducting the assessment thoroughly and competently and documenting their assessment findings on the Outcome and Assessment Information Set (OASIS) form.
"Competency in assessment skills and competency in documentation are two different tasks," says Linda Krulish, MHS, PT, president of Acworth, GA-based Home Therapy Services. "You may have clinicians who are good at assessments, but don’t document well enough to take advantage of all the data they’ve gathered."
Or the problem could be the clinician may be unskilled at patient interviewing, history taking, or observation, and the problem is that the clinician needs to be trained to perform better assessments.
Ways to screen
Quality managers can measure how competent staff are at conducting assessments through these methods:
• A self-assessment checklist: This method is an easy way to screen for training needs.
Here, a quality manager could ask clinicians to identify areas they feel competent in and areas they need additional training.
For example, the self-assessment checklist could ask, "Can you complete the drug regimen review?"
The drawback to this method is that it relies on the test-taker’s self-assessment of skills, and this has a potential bias. A therapist may want to look more competent and report assessment details that he or she doesn’t follow, or the therapist could desire to appear less competent in hopes of not being asked to perform any assessments.
• Verbal or written test: This is an objective test that relies on their knowledge, but not their performance. For example, ask the clinician what the process is for determining if a patient is eligible for a Medicare home health benefit. Instead of asking them if they know how to do it, ask what the benefit is and how do you determine if a patient is eligible, Krulish suggests.
• Patient/staff feedback: An informal way to assess competency is to listen to what patients and staff have to say about a particular clinician’s competency. For example, a patient might call to say that a therapist came to the patient’s home and didn’t know how to take a blood pressure reading, Krulish says.
"Or if two clinicians were in the home at the same time, one may observe that the other staff member was not competent in a certain skill," she adds. "This is more informal and cannot always be counted on, but it could be used to identify when there’s a potential need for training."
• A clinical record audit: An agency looks at the OASIS data responses and compares them to other documentation on the patient’s chart to see if they are consistent.
For example, a therapist or nurse might mark on an OASIS assessment that the patient did not have pain interfering with function. The chart auditor would review the clinical documentation of other care providers who saw the patient on or around the date of the OASIS assessment. If the documentation shows that the patient refused activities with the home health aide because of pain, then the auditor has identified a discrepancy which may be due to inaccurate assessment or documentation of OASIS data.
"What we’re trying to do is assess whether OASIS data is accurate," Krulish says. "So if someone turns in a comprehensive assessment form with all this information about Mrs. Brown, how do we know this is accurate?"
• A simulated setting: The agency could set up a lab with a pretend patient who has specific diagnoses and problems. Then the clinicians would go through the process of evaluating the pretend patient.
"It’s not as costly as having two people go out into the home for every clinician, but it’s also not as realistic," Krulish says.
• A clinical visit audit: Two clinicians conduct a joint visit, where one clinician conducts the comprehensive patient assessment and both document the OASIS responses. After the assessment visit, the responses are compared and the reason for any discrepancies is investigated.
"In my opinion, this clinical visit audit is the most valuable auditing method because you can identify competency in assessment skills and documentation skills in a real-life setting," Krulish says.