Include the following best practice (Medicare) guidelines for completing OASIS M1400 Shortness of Breath:
(M1400) When is the patient dyspneic or noticeably Short of Breath?
Identifies the level of exertion/activity that results in a patient’s dyspnea or shortness of breath.
- 0 - Patient is not short of breath
- 1 - When walking more than 20 feet, climbing stairs
- 2 - With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)
- 3 - With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation
- 4 - At rest (during day or night)
A 'better' way to ask the M1400 question...
Instead of asking...'When is the patient dyspneic or noticeably Short of Breath?', a better way to determine the patient's dyspnea level with the correct intent, M1400 OASIS guidance recommends
'When is the patient short of breath? (assess SOB when using O2 if used continuously or without O2 if not used continuously)'
Best Practice Assessment Strategies for M1400
- If the patient uses oxygen continuously, select the response based on assessment of the patient’s shortness of breath while using oxygen.
- If the patient uses oxygen intermittently, mark the response based on the patient’s shortness of breath WITHOUT the use of oxygen.
- The response is based on the patient’s actual use of oxygen in the home, not on the physician’s oxygen order.
- The responses represent increasing severity of shortness of breath.
- For a chairfast or bedbound patient, evaluate the level of exertion required to produce shortness of breath.
- The chairfast patient can be assessed for level of dyspnea while performing ADLs or at rest. Response 0 would apply if the patient has not been short of breath during the day of assessment. Response 1 would be appropriate if demanding bed-mobility activities produce dyspnea in the bedbound patient (or physically demanding transfer activities produce dyspnea in the chairfast patient). See Responses 2, 3, and 4 for assessment examples for these patients as well as ambulatory patients. copd