OASIS-E Spotlight: Signs of Delirium

August 7, 2023

Making sense of CMS guidelines is more challenging than ever after the launch of OASIS-E and the abundance of changes that go along with it. KanTime’s OASIS Spotlight series will spotlight specific OASIS items to simplify the ruling and help clinicians significantly improve their understanding of OASIS so they can move forward with accuracy.

C1310 Signs and Symptoms of Delirium

C1310 is used to identify any signs and symptoms of acute mental status changes from the patient’s baseline status.

Per the OASIS Guidance Manual, delirium is defined as: A mental disturbance characterized by new or acutely worsening confusion, disordered expression of thoughts, change in level of consciousness or hallucinations. It is associated with:

    • increased mortality,
    • functional decline,
    • development or worsening of incontinence,
    • behavior problems,
    • withdrawal from activities,
    • rehospitalizations and increased length of home health stay.

It is important to distinguish between delirium and dementia. Acute changes likely indicate delirium, and may be reversible if detected and treated in a timely manner.

Time points:

    • Start of Care
    • Resumption of Care
    • Discharge from agency

C1310 Signs and Symptoms of Delirium (from CAM©)

Code after completing Brief Interview for Mental Status and reviewing medical record

    1. Acute Onset of Mental Status Change Is there evidence of an acute change in mental status from the patient’s baseline?

      Code 0,
      No, if there is no evidence of acute mental status change from the patient’s baseline.

      Code 1,
      Yes, if patient has an alteration in mental status observed or reported or identified that represents an acute change from baseline.

      Dash
      is a valid response for this item.
    2. Inattention – Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was said?

      Code 0,
      Behavior not present, if the patient remains focused during the assessment and all other sources agree that the patient was attentive during other activities.

      Code 1,
      Behavior continuously present, does not fluctuate, if the patient had difficulty focusing attention, was easily distracted, or had difficulty keeping track of what was said AND the inattention did not vary. All sources must agree that inattention was consistently present to select this code.

      Code 2,
      Behavior present, fluctuates (comes and goes, changes in severity), if inattention is noted during the assessment or any source reports the that patient had difficulty focusing attention, was easily distracted, or had difficulty keeping track of what was said AND the inattention varied or if information sources disagree in assessing level of attention.

      Dash
      is a valid response for this item.
    3. Disorganized thinking – was the patient’s thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?

      Code 0,
      Behavior not present, if all sources agree that the patient’s thinking was organized and coherent, even if answers were inaccurate or wrong.

      Code 1,
      Behavior continuously present, does not fluctuate, if, during the assessment and according to other sources, the patient’s responses were consistently disorganized or incoherent, conversation was rambling or irrelevant, ideas were unclear or flowed illogically, or the patient unpredictably switched from subject to subject.

      Code 2,
      Behavior present, fluctuates if, during the assessment or according to other data sources, the patient’s responses fluctuated between disorganized/incoherent and organized/clear. Also code as fluctuating if information sources disagree.

      Dash
      is a valid response for this item.
    4. Altered level of consciousness – Did the patient have altered level of consciousness, as indicated by any of the following criteria?
      • vigilant – startled easily to any sound or touch
      • lethargic – repeatedly dozed off when asked questions, but responded to voice or touch
      • stuporous – very difficult to arouse and keep aroused for the interview
      • comatose – could not be aroused

      Code 0, Behavior not present, if all sources agree that the patient was alert and maintained wakefulness during conversation, interview(s), and activities.

      Code 1,
      Behavior continuously present, does not fluctuate, if, during the assessment and according to other sources, the patient was consistently lethargic, stuporous, vigilant, or comatose.

      Code 2,
      Behavior present, fluctuates if, during the assessment or according to other sources, the patient’s level of consciousness varied. For example, the patient was at times alert and responsive, while at other times the patient was lethargic, stuporous, or vigilant. Code as fluctuating if information sources disagree.

      Dash
      is a valid response for this item.

Adapted from: Inouye SK, et al. Ann Intern Med 1990; 113: 941-948. Confusion Assessment Method. Copyright 2003, Hospital Elder Life Program, LLC. Mot to be reproduced without permission.

The indication of delirium by the CAM requires:

Item A = 1
OR
Item B, C or D = 2
AND
Item B = 1 OR 2
AND EITHER
Item C = 1 OR 2
AND
Item D = 1 OR 2

Stay tuned for next Monday’s spotlight so your practice can continue to stay ahead of the curve and provide elite patient care through the Oasis E changes.

We provide clinicians that are part of the Kantime enterprise system with links to the guidance from CMS for each individual OASIS item. If you would like to learn more about how better happens, contact us at sales@kanrad.com to schedule a demo.

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