M1850: CMS OASIS Q&As

The need for assistance with gait may impact the M1850 - Transferring score if the closest sitting surface applicable to the patient's environment is not next to the bed. M1850 reports the patient's ability to move from the supine position in bed (or the current sleeping surface) to a sitting position at the bedside, then some type of standing, stand-pivot, or sliding board transfer to a sitting surface at the bedside. If there is no chair at the bedside, report the ability to transfer from the sleeping surface to whatever sitting surface is applicable to the patient's environment and need. If the sleeping surface is in the bedroom and the sitting surface is down the hall in the bathroom and the patient is independent moving from the supine to sitting position, sitting to standing, and then standing to sitting, but requires minimal human assistance or an assistive device to ambulate from the bed to the sitting surface, the appropriate M1850 score would be a "1". If the patient requires more than minimal assistance or requires both minimal human assistance and an assistive device to be safe, the appropriate score would be response 2.

CMS does not provide a definitive list of assistive devices to apply when determining relevant OASIS responses. Use your clinical judgment and examples of devices included in OASIS items and related Q&As in determining what are considered assistive devices when scoring OASIS items.

A patient who can tolerate being out of bed is not “bedfast.” If a patient is able to be transferred to a chair using a Hoyer lift, Response 3 is the option that most closely resembles the patient’s circumstance; the patient is unable to transfer and is unable to bear weight or pivot when transferred by another person. Because the patient is transferred to a chair, they would not be considered bedfast (“confined to the bed”) even though they cannot help with the transfer. Responses 4 and 5 do not apply for the patient who is not bedfast. The frequency of the transfers does not change the response, only the patient’s ability to be transferred and tolerate being out of bed.

If the patient is able to safely transfer with either minimal human assistance (but no device), or with the use of an assistive device (but no human assistance) then they should be reported as a 1 - Able to transfer with minimal human assistance or with use of an assistive device. If the assessing clinician determines the patient is not safe in transferring with either of the above circumstances, (e.g., they transfer with only an assistive device but not safely, minimal assistance only is not adequate for safe transferring, or they require both minimal human assistance and an assistive device to transfer safely), then the patient would be scored a 2 - Able to bear weight and pivot during the transfer process but unable to transfer self (assuming the patient could bear weight and pivot). Safety is integral to ability. If the patient is not safe when transferring with just minimal human assistance or with just an assistive device, they cannot be considered functioning at the level of Response 1. For the purposes of Response 1, minimal human assistance could include any combination of verbal cueing, environmental set-up, and/or actual hands-on assistance, where the level of assistance required from someone else is equal to or less than 25% of the total effort to transfer and the patient is able to provide >75% of the total effort to complete the task. Examples of environmental set-up as it relates to transferring would be a patient who requires someone else to position the wheelchair by the bed and apply the wheelchair locks in order to safely transfer from the bed to the chair, or a patient who requires someone else to place the elevated commode seat over the toilet before the patient is able to safely transfer onto the commode.

Safety is integral to ability, if the assessing clinician determines the patient requires more than minimal human assistance or they need minimal assistance and an assistive device to safely transfer, and can bear weight and pivot safely, Response 2 should be reported. If the assessing clinician determines the bearing weight and pivoting component of the transfer is not safe even with assistance, then the patient is not able to bear weight or pivot and the appropriate selection would be Response 3 – Unable to transfer self and is unable to bear weight or pivot when transferred by another person.

The term "bear weight and pivot" in M1850, Transferring, may include both a standing pivot transfer and multiple sitting pivot transfers, such as those utilized when performing a bedto-chair transfer with a sliding board. If the patient does not have use of the lower extremities and transfers with the use of a sliding board, but no human assistance, select Response 1 - Able to transfer with minimal human assistance or with use of an assistive device. If the patient requires both minimal human assistance and the sliding board to transfer safely, select Response 2 - Able to bear weight and pivot during the transfer process but unable to transfer self. If the patient can bear weight and pivot utilizing their upper extremities, but requires more than minimal human assist, Response 2 should be marked. 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, select Response 3 Unable to transfer self and is unable to bear weight or pivot when transferred by another person.

The bed to chair transfer includes the patient's ability to get from the bed to a chair and from the chair back into bed. For most patients, this will include transferring from a supine position in bed to a sitting position at the bedside, then some type of standing, stand-pivot, or sliding board transfer to a chair.

M1850 - Transferring, must be assessed for all patients requiring OASIS data collection. The item includes assessment of the bed to chair/chair to bed transfers. If your patient no longer sleeps in a bed (e.g., sleeps in a recliner or on a couch), you will assess the patient's ability to move from the supine position on their current sleeping surface to a sitting position and then transfer to another sitting surface, like a bedside commode, bench, or chair, and then back to their current sleeping surface.

In the situation described, the medical restriction against climbing stairs does not impact the patient's ability. The assessing clinician will report the patient's ability to move from the supine position on the current sleeping surface to a sitting position at the side of the sleeping surface, then some type of standing, stand-pivot, or sliding board transfer to a sitting surface, and then back to their current sleeping surface. Certain medical restrictions could impact ability, e.g., an order to maintain strict bed rest means the patient is scored as bedfast. Other medical restrictions that may prevent access to the usual sleeping surface DO NOT impact ability as M1850 – Transferring reports the patient's ability to move from the bed or current sleeping surface, e.g., an order not to climb stairs or an order to sleep in hospital bed.

M1850 - Transferring and M1860 - Ambulation/Locomotion report the patient's ability on the day of the assessment. Day of assessment is the 24 hours immediately preceding the visit and the time spent in the home. Ch. 3 of the current OASIS Guidance Manual in the M1850 Response-Specific Instructions defines bedfast. "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." If the patient can tolerate being out of bed, they are not bedfast unless they are medically restricted to the bed. The patient is not required to be out of bed for any specific length of time. The assessing clinician will have to use their judgment when determining whether or not a patient can tolerate being out of bed. For example, a severely deconditioned patient may only be able to sit in the chair for a few minutes and is not considered bedfast as they are able to tolerate being out of bed. A patient with Multiple System Atrophy becomes severely hypotensive within a minute of moving from the supine to sitting position and is considered bedfast due to the neurological condition which prevents them from tolerating the sitting position.