OASIS-D just went into effect on January 1, and 28 M items were deleted. M2020 will continue to be included in this new version of OASIS. M2020 identifies the patient’s current ability to prepare and take all oral medications (always excludes injectable and IV meds) reliably and safely at all times. This includes administration of the correct dosage at the appropriate times/intervals.
Note that item M2020 refers to the patient’s ability to safely take oral medications, not the patient’s compliance or willingness. This ability can be temporarily or permanently limited by several factors, such as physical impairments (i.e. limited manual dexterity), emotional/cognitive/behavioral impairments (i.e. memory deficits, impaired judgment, and/or fear), sensory impairments relating to vision and/or pain, and environmental barriers such as stairs, and narrow doorways.In order to accurately assess and score the OASIS, it is key to view the patient from a holistic perspective. This will also assist in improving the patient’s outcome in this medication management item.
- Response 0
Enter Response 0, if the patient can set up her/his own “planner device” for medications, and consequently takes the correct medication in the correct dosage at the correct time.The following should be included in the assessment of the patient’s ability:
- Obtain the medication from where it is routinely stored,
- Read the label (or otherwise identify the medication correctly),
- Open the container,
- Select the pill/tablet or milliliters of liquid, and
- Orally ingest it at the correct times.
- Response 2
Enter Response 2, if daily reminders to take medications are necessary, regardless of whether the patient is independent or needs assistance in preparing individual doses (for example, setting up a “pill planner”). If a medication is ordered PRN and the medication is needed by the patient on the day of assessment, AND the patient needed a reminder to take this PRN medication on the day of assessment, then Response 2 should be entered.
- Response 3
Enter Response 3, if the patient does not have the physical or cognitive ability on the day of assessment to take all medications correctly (correct medication, correct dose, and correct time) as ordered and it has not been established (the clinician cannot assume) that set up, diary, or reminders have already been successful. The clinician should return to assess if the interventions, such as reminders or a med planner, were adequate assistance for the patient to take all medications safely!
Even if a patient resides in an assisted living facility where the facility holds and administers medications, item M2020 should still be used to continue to report the patient’s ability to take the correct oral medication(s) and proper dosage(s) at the correct times. Clinicians should report the ability based on assessment of the patient’s vision, strength, and manual dexterity in the patient’s hands and fingers, as well as cognitive ability, despite the facility’s requirement.
Ways to Improve Medications
There are many ways to improve medications. It should start with the staff requesting that the patient gather all drugs, prescription and OTC, at SOC. This will allow assessment of the physical ability and safety to get to the meds. Next, assess if the patient knows what the drugs are for and what to report. It is critical that all high-risk meds are taught at SOC/ROC visits. These drugs should be documented by name in the clinical note. If the patient’s med box is present, check that it is accurately filled for the times meds are due. Finally, always compare to discharge med list and call on any medication issues at SOC. This includes duplicate drugs and medication interactions.
Proper Assessment and Scoring of M2020
As with any OASIS item, it is key to be well informed to ensure proper coding. 5 Star’s coders are HCS-D coding and OASIS certified Registered Nurses.If your home health agency needs OASIS review and diagnosis coding, or OASIS D education, our RNs would like to help you! To learn more about our consulting services, please contact us at [email protected] or 866-428-4040.