A home health assessment of the post-operative status of a patient with hip replacement surgery focuses on the following five elements:
1. surgical wound healing, including assessing for signs of site infection
2. pain control
3. bed-chair transferring ability
4. transferring ability to and from toilet or commode
5. ambulation/locomotion ability
View Hip Replacement Recovery: 2020 PDGM Utilization Guidelines.
These items are well-covered by the related questions on the OASIS assessment: M1342 surgical wound, M1242 pain, M1850 transferring, M1840 toilet transferring and M1860 ambulation/locomotion. Include teaching on anti embolism stockings.
Assessing any wound includes evaluating for tissue loss, clinical appearance of the wound bed and stage of healing, wound dimensions, condition of the wound edge, presence of drainage or exudate, presence of a fever.
M1342 is an 'outcome measure', the HHA's statistics on improvement published by Medicare on Home Health COMPARE. The purpose of the OASIS question "(M1342) Status of Most Problematic (Observable) Surgical Wound" is to identify, track, and quantify the level of healing for any observable surgical wound. the available answers are:
0 Newly epithelialized
1 Fully granulating
2 Early/partial granulation
3 Not healing
KEEP IN MIND...one common mistake made with this particular question is that a fresh wound without any observable complications (e.g., a very recent knee replacement wound) is considered to be in a healing stage, however, since we are determining a baseline at the start of care to track the wound, “3 Not healing” is actually the correct response. We want to establish a baseline at the start of care and then track its progress from that point forward throughout that patient’s care period.
2. Pain Assessment M1242
M1242 is another 'outcome measure'. The available answers for M1242: Frequency of Pain Interfering with patient's activity or movement are
0 Patient has no pain
1 Patient has pain that does not interfere with activity or movement
2 Less often than daily
3 Daily, but not constantly
4 All of the time
KEEP IN MIND...assess the patient's pain level - using the above metrics - when the patient IS COMPLIANT WITH CURRENT PAIN INTERVENTION (medications and non-medical pain management techniques). The clinician's pain assessment must include ability to perform ADLs and IADLs can provide additional information about such pain.
M1850 Transferring is another 'outcome measure'. Physical therapy typically assesses all different manners of transfer: wheelchair, bed-chair, slide-board, pivot, chair-commode, scoot.
KEEP IN MIND...To the home health agency, most important, however, the ability to perform a SAFE transfer from bed to chair, or if bedbound, the ability to position self in bed.
Available OASIS answers:
0 Able to independently transfer.
1 Able to transfer with minimal human assistance or with use of an assistive device.
2 Able to bear weight and pivot during the transfer process but unable to transfer self.
3 Unable to transfer self and is unable to bear weight or pivot when transferred by another person.
4 Bedfast, unable to transfer but is able to turn and position self in bed.
5 Bedfast, unable to transfer and is unable to turn and position self.
From the OASIS Guidance Manual:
• In order for the assistance to be considered minimal, it would mean the individual assisting the patient is contributing less than 25% of the total effort required to perform the transfer.
• If the patient transfers either with minimal human assistance (but not device), or with the use of a device (but no human assistance), enter Response 1. If the patient requires both minimal human assistance and an assistive device to transfer safely, enter Response 2.
• If the patient can bear weight and pivot, but requires more than minimal human assist, enter Response 2.
• The patient must be able to both bear weight and pivot for Response 2 to apply. If the patient is unable to do one or the other and is not bedfast, enter Response 3.
• If the patient is bedfast, enter Response 4 or 5, depending on the patient’s ability to turn and position self in bed. Bedfast refers to being confined to the bed, either per physician restriction or due to a patient’s inability to tolerate being out of the bed.
4. Toilet Transferring
M1840 is the next functional assessment with treatment addressed by the physical therapist.
0 Able to get to and from the toilet and transfer independently with or without a device.
1 When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.
2 Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).
3 Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.
4 Is totally dependent in toileting.
5. M1860 Ambulation/Locomotion
M1860 is another outcome measure. Physical therapy typically assesses the patient's gait on level and non-level surfaces, stairs and steps. This assessment coincides with the OASIS M1860 question. Available answers are:
0 Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (specifically: needs no human assistance or assistive device).
1 With the use of a one-handed device (for example, cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.
2 Requires use of a two-handed device (for example, walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.
3 Able to walk only with the supervision or assistance of another person at all times.
4 Chairfast, unable to ambulate but is able to wheel self independently.
5 Chairfast, unable to ambulate and is unable to wheel self.
6 Bedfast, unable to ambulate or be up in a chair.