OASIS skills critical for data integrity

Agency targets three areas for improvement

Donaldson Home Health of Lebanon, TN, has made this the year of improving quality and compliance with the Outcome and Assessment Information Set (OASIS).

The agency collects data on 20 indicators from the OASIS tool, including the five deemed necessary for the ORYX initiative by the Joint Commission on Accreditation of Healthcare Organi- zations of Oakbrook Terrace, IL. The indicators include OASIS data on pain, dyspnea, ambulation, management of oral medications, and discharges to an inpatient facility.

"This gives us a well-rounded picture of outcomes and a sense of what’s going on with medications," says Liz Lovvorn, RN, CPHQ, quality improvement (QI) nurse for the agency, which is part of the University Medical Center of Lebanon, TN. However, in order to obtain the best data for QI comparisons, the agency needed to make sure the staff knew how to interpret OASIS questions and collect the most accurate data.

"Last year, we realized we were concerned about the data collection processes," Lovvorn says. "We decided we needed to divide the QI project into three components, and these 20 indicators are a part of that."

Here are the three parts of the QI project:

- Education: Employees took a pretest on OASIS, which helped Lovvorn identify problem areas. "We gave them examples and definitions, and the way clinicians responded to that, we realized we absolutely had a problem," she says. "We . . . developed a pretest for data entry folks as well, picking out specific indicators from OASIS and the basic principles."

The test fit on one page, and employees were allowed to take it home, with instructions to return it within a few weeks. Lovvorn estimates the test should have taken them no more than 10 to 15 minutes to complete.

Here are some test question examples:

• We have __ days to complete the OASIS discharge assessment. (The answer is two.)

• The data we are collecting and entering into the state’s database will be used for:

A. partially driving the prospective payment system

B. Joint Commission vendor for ORYX

C. part of the state survey

D. part of the accreditation survey for the Joint Commission

E. A and B only

F. B and C only

G. A, B, C, and D (The answer is G.)

• Is it OK to enter an OASIS assessment completed by a physical therapy assistant? (The answer is no.)

After reviewing the test results, Lovvorn identified the problem areas, which included the third question above, and sent the staff educational self-study sheets on those areas. The sheets gave the staff the OASIS question, the OASIS definition, and some examples of how to apply that definition to the question.

Lovvorn also educated staff at weekly case conferences and by putting information on the agency’s bulletin board. "But it was pretty much all self-study because inservices are so hard for us to do now," she adds. When she felt confident that the staff had been educated about the correct ways to interpret and complete OASIS questions, she gave them a post-test. The staff showed they better understood OASIS data collection by their higher scores on the post-test. "It’s a great way to make sure they actually understood what they read, and then they have an opportunity to come back to me with questions," Lovvorn says.

- Data integrity: The quality improvement committee reviewed the OASIS tool, evaluating it for what was working and what wasn’t, and expanded the indicators that the agency was collecting. The tool was revised twice and now is in its third edition.

The team also audits 10 charts a month and then meets monthly or every other month to discuss changes to the tool and problems that might arise. For example, in May, the QI team realized that staff mostly understood how to complete the tool accurately, but they were having problems with timeliness. So the agency implemented a 100% timeliness log entry that keeps track of exactly when the assessment is logged in.

A data entry employee checks to make sure the tool is complete, without any blank questions, and then it’s logged in. Lovvorn reviews the log sheet, looking for timeliness and other problems. When she finds a problem, she shows the employee who made the mistake in an effort to correct it immediately.

That process has worked well. "We showed a pretty significant decrease immediately," she says. "Our percentage of overall problems in May was 31%, and a month later, it was 24%."

One-on-one interviews with the staff and ongoing education are the keys to the agency’s success in improving data integrity, Lovvorn adds. "People are beginning to understand what’s a good indicator, and it’s starting to click with them."

- Program compliance: Administrators and QI staff met to develop and implement an internal tracking process. One person now receives the nurses’ daily visit notes and checks them off as they arrive. If a nurse turns in a discharge note, then the clerical person looks for an OASIS discharge assessment to accompany that note.

Lovvorn and the agency’s director of clinical services work at making sure all of the documentation is obtained in time for the weekly case conferences. So if a nurse turns in a Medicare 485 worksheet, Lovvorn will hold it until the OASIS assessment is completed and turned in. Then the physician is notified.

"Now we have an internal process to make sure the physician remains in the loop," she adds.

Liz Lovvorn, RN, CPHQ, Quality Improvement Nurse, Donaldson Home Health, University Medical Center, 500 Park Ave., Lebanon, TN 37087. Telephone: (615) 449-0045.