Staff solve OASIS data collection problem
SunPlus Home Health in San Diego was concerned about urinary tract infections (UTIs) and wound care after the staff read the agency’s first Outcome and Assessment Information Set (OASIS) report two years ago.
The report compared the agency to other agencies involved in the National Medicare Quality Assurance and Improvement Demonstration project conducted by the Center for Health Services and Policy Research (CHSPR) in Denver.
Based on the report’s findings, the agency decided to improve its UTI and wound care outcomes by forming a plan of action and increasing staff education, says Estelle Wolf, RN, former director of professional services for the agency.
The QI process has resulted in improvement in statistics for UTI and wound care patients, and these were reflected in the agency’s second OASIS report a year later, Wolf said. (See SunPlus’ plan of action, p. 177.)
Here’s how the agency assessed the problem and made improvements:
1. Form staff committee to assess report.
"I believe in staff participation because I think it leads to more buy-in and acceptance," Wolf says. "When a new process is introduced I feel it is much easier to have the involvement of the supervisors, management, and field staff who are going to be using the new process."
When the agency received its first OASIS report, Wolf formed two staff teams, one for each office. The teams included a supervisor from each office; a representative from each discipline: a nurse, a therapist, an aide, and a social worker.
Wolf gave the team members OASIS data and asked them to do a comparison of how the agency fared against the national average. "They came back with 10 categories, and what we needed to do was sit down and evaluate what we were doing well, what was average and what might be areas of concern," Wolf explains.
Each office chose one area of concern, with one selecting UTIs and the other selecting wound care.
2. Check to see if information is valid.
The committees first checked the validity of the information. The staff submitted the original OASIS data, so committee members checked the original charts.
"We went back and did a two-fold exam," Wolf says. "We looked at the chart information and the information sheet that was submitted to the center that collected the data to see whether the information given to the center was in fact valid information."
Why was the patient admitted?
They discovered that nurses sometimes failed to identify a patient’s diagnosis correctly at the time a patient was admitted to the hospital. The nurses might simply write down the patient’s primary diagnosis, even if that diagnosis had nothing to do with the reason for the patient’s return to the hospital.
Patients who were admitted to the hospital for an acute episode of congestive heart failure may have been identified only as wound care patients. This would result in skewed statistics, perhaps showing worse outcomes for wound care patients than what actually occurred.
"A few of the charts that came out deficient actually were not because the information sheet used by the staff was done incorrectly," Wolf says. "We would have fallen within the national norms if the initial information given to the data center was correct," he adds.
3. Decide how to solve the problem.
Next, team members analyzed the care provided to the wound care and UTI patients, and they analyzed all documentation to see how they could prevent nurses from documenting the incorrect diagnosis.
The committees also analyzed patient incidence reports, commonalities, causal factors, and whether the standard practice was followed.
"After we retrieved all this data, the next part was to take all this information and decide how to educate the staff," Wolf says.
One solution, team members decided, was to educate the staff on how to use the statistical data sheet.
"I had committee members decide what needed to be taught, and helped them gather the tools, write lesson plans, and make a presentation to the staff," she adds.