OASIS Training that Works!!
Does your quality assurance staff complain they make the same corrections to OASIS assessments over and over? Have you trained and re-trained your staff on OASIS with only temporary improvement?
As a home health DON, I remember making a point to mention “OASIS corrections” when interviewing prospective nurses. Most nurses who came from a hospital background were perplexed. “No one ever looked at my charting in the hospital?” Or worse, insulted, “I have been charting just fine without help for 20 years”. What nurses and agency owners often overlook is the connection between re-imbursement and the OASIS assessment. This connection does not exist with nursing documentation in the acute care setting.
I could talk a lot about how the OASIS is a very long and complex assessment tool, because it is. In fact, I often tell clinicians documenting the OASIS assessment is like being cross examined by an attorney. Instead let’s look at the two main reasons for its difficulty.
- It seems to be written in English; it really isn’t. Its written in what I call “Medicare speak”.
- Items interacting with each other are pages apart making it easy to accidently contradict yourself.
Clinicians who take the OASIS questions at face value, often, if not frequently, misunderstand the intent of the questions. This has been such a pervasive problem that most HHA’s perform quality assurance on every OASIS completed before locking and submitting it. Often this includes sending back pages of needed corrections to the clinicians. This long and circuitous process is made even worse if/when the field staff get into an adversarial relationship with the QA department.
At the end of the day, if acuity is missed, patients are the ones who lose. Because the agency is not reimbursed at the level they need for appropriate patient care- so patients may get less care than they need.
In short, OASIS training is just not enough for most clinicians. And let’s face it, the clinicians who have a great understanding of OASIS usually become part of your QA staff.
So documenting an accurate OASIS is hard, but why is training clinicians to document the OASIS such a problem for home health? I believe the four following reasons are the cause…
- Poor motivation from Clinicians (they would rather just take care of patients)
- Employee turn over
- Very slow feedback
- Negative/ multiple correction cycle
I don’t have to talk much about poor motivation or turn over- there are very few HHA's I have ever worked with who have not cited those two ongoing challenges. But slow feedback and negative correction cycles are two things most HHA’s don’t realize are causing them problems.
When researching the type of feedback that supports learning and changes behavior it becomes easy to see where most HHA’s correct and return approach has been falling short.
Here are some of the top must haves for an effective feedback loop- along with some commentary on how your HHA may be missing it! Effective feedback must be…
- User Friendly
Feed back is not valuable if you don’t understand it. I have reviewed corrections so long and technical that the clinician’s response was either a passive “do whatever you think” or a frustrated “it’s my license don’t change anything.”
- Actionable
Corrections are often written “consider reviewing XYZ”. Because reviewers are afraid of frustrating or overstepping, they often write vague suggestions leaving the clinician wondering exactly what they are supposed to do.
- Ongoing
This is a pitfall to many good HHAs. They have a strong educational event or correction process, but don’t stay with it and behaviors regress quickly back to the way we have always done it.
- Consistent
Often agencies have more than one QA nurse or they outsource QA to a large company. This can lead to conflicting or inconsistent corrections. Watch out for complaints like – “QA nurse A never gives me corrections, but QA nurse B always does”, or “I received corrections from two different QA nurses that contradicted each other”.
- Timely
Studies show that people who get immediate feedback have significantly better performance than those who don’t. Comprehension also improves. When clinicians wait days or weeks to receive OASIS corrections this delayed response decreases OASIS competence. Put simply, they don't connect the correction and OASIS so they can't learn from it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034228/
http://www.epsteineducation.com/home/articles/file/research/immediate_feedback.pdf
So what can you do to lessen clinician frustration, increase OASIS accuracy and take better care of your patients? OperaCare’s Quality Assurance system helps your agency provide real time, 100% consistent feedback for OASIS assessments. Our process is designed to give your agency a 24hr visit to OASIS/ plan of care completion. The happy side effect of your increased efficiency? (besides amazing cash flow)
Your clinicians finally learn OASIS!!!
