OASIS Alert

Outcomes:

5-STEP PLAN REDUCES YOUR ACUTE CARE HOSPITALIZATIONS AND IMPROVES TEAMWORK

Don't keep OASIS a secret.

Improve outcomes by recruiting the patient and family as part of your team:

1. Talk with patients early. If you have access to a hospitalized patient before discharge, talk with the patient and family about home care, what the agency can do and what the patient and family will be responsible for, advises consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT. If that isn't possible, have this discussion at the first visit, she says.

2. Use phone calls between visits. Phone the patient/caregiver to be sure they understood your instructions or to remind them of something they are supposed to do between visits. This simple, inexpensive act can extend the effect of your visits and improve outcomes, says occupational therapist Carol Siebert with the University of North Carolina in Chapel Hill.
 
3. Provide progress reports. On each visit, report to the patient on progress made, plans for future visits and approximate discharge date, McNamara suggests. Also, talk with the patient and caregiver about how they will arrange post-discharge care, she adds.

Tip: Sharing OASIS documentation with the patient/caregiver may help de-mystify the plan of care and show them what their roles will be, McNamara says.

4. Emphasize teamwork. From the very beginning, choose words that show shared responsibility between the agency and the patient, advises occupational therapist and consultant Karen Vance with Springfield, MO-based BKD. Then at each visit reinforce the patient's involvement on the team, McNamara says.

Smart idea: Ask the patient to keep a journal to record items such as weight, blood sugar, symptoms that occur between visits and questions to remember. This keeps the patient connected to the agency, reinforces the care plan and emphasizes the patient's self-care role, she notes.

5. Tell the patient who to call. Using an emergency care plan (see OASIS Alert, Vol. 7, No. 4 for sample) encourages the patient to contact the agency for any problems that arise, allowing early intervention and fewer hospitalizations, experts agree.

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