Case managers collect OASIS data

Positions created to combat productivity decline

Participation in an Outcome and Assessment Information Set (OASIS) demonstration project prompted Community Nursing Service (CNS) of Oak Park, IL, to reorganize its nursing care delivery format to keep staff productivity high while using the lengthy documentation form.

CNS began participating as part of the control group in Phase II of the Prospective Pay ment System Demonstration Project in January, 1996.

Initially, all nurses administered the OASIS as part of their regular duties, but they found that it was difficult and time-consuming, adding about 15 minutes to a patient visit, says Pam Steinbach, RN, MS, executive director.

The agency administers the OASIS at admission, at discharge, and at 120-day intervals.

To increase staff productivity, improve coordination of care, and improve continuity of care, the agency has created four nurse case manager positions with a reduced daily caseload. They are responsible for administering the OASIS, as well as assessment, all documentation, plan of care, and change orders. Each case manager oversees care for 60 to 65 patients and carries a caseload of four patients a day.

Under the new delivery format, the productivity expectation of visiting nurses was raised from six visits a day to seven visits a day.

"It’s too soon to tell what effect this new model will have, but we are hoping that it will improve productivity," Steinbach says.

Agency eliminated duplication in tools

Before implementing the OASIS, CNS revised its assessment tools, simplifying them as much as possible and eliminating any items that duplicate the OASIS questions. Then the agency held an orientation session for its staff, explaining the tool and why they were using it.

By participating in the demonstration project, CNS is able to take the OASIS data and use them any way it chooses. The agency has begun an outcomes-based quality improvement project that tracks outcomes for two large groups of patients: rehabilitation patients and cardiac patients. It selected 10 items for each group from the OASIS scale and is analyzing them on paper.

A year into the project, CNS is just beginning to collect data on enough patients to be able to look for trends or variables, Steinbach says. Data on at least 100 patients per disease state are needed to be statistically valid, she says.

But preliminary examination of the outcomes data already has helped CNS make some minor improvements, Steinbach adds. For instance, initial scores in management of oral medication were low. In response, the agency developed a tool to monitor medication and compliance.

The OASIS tool assesses how independent the patient is in taking medication. The CNS form documents whether patients know when to take the medicine, knowledge of dosage and frequency, and knowledge of any possible adverse reactions.

There are three copies of the document: one for the patient record, one for the patient, and one for the primary nurse.

"The treatment team has been able to use this tool to guide them in terms of where the patients are falling short," Steinbach says.

CNS' treatment teams include full-time registered nurses, physical therapists, social workers, and home health aides. The agency subcontracts for occupational therapists and speech therapists.

The teams communicate through a written monthly summary form that is in the patients’ homes. Each discipline compiles its report, which is sent back to the case manager, who compiles the multidisciplinary report. The agency holds monthly team meetings where all disciplines come together to discuss treatment plans and patient progress.

The case manager uses the monthly summaries to revise the care plan, to report back to the physician, and to fill out part of the OASIS form at discharge.