[txspadequeen921]

I know that you are a DON and after reading this and comparing it to my place of employment ...I am surprised we are not shut down. I think that in light of the missing stuff we really care about our residents and try to give good care but there are some sloppy nurses. It drives me crazy that no one charts their PRN's. Of course you know if they compare the narc sheet and the PRN sheet and the documentation is not in place your in deep doo doo. Nothing is dated when opened or when replaced (neb mask or humidified air bottles).

Oh and the charting..oh my goodness the awful charting...

Let me give you and example of charting on a patient that fell and had to be sent to the hospital..This is no exaggeration either

Pt fell sent to ER , Wife and DON notified.

Well when I got this patient back he had multiple open oozing wounds in need of dressings , multiple bruises a gash in his head.....He had seven wounds that I had to measure and document on. I cant even imagine if state would get a hold of that....

I guess I just needed to vent.. To the OP make sure you are not guilty of sloppy nursing....CYA

Originally Posted by CapeCodMermaid

You should be commended for being proactive and trying to clean up before survey.
A few items to look at in addition to what everyone else said:
PICC lines...neasure the length of exposed catheter on admission and weekly thereafter with measurements of the arm above and below the insertion site with documentation of the condition of the skin
Care plans..everything must match
Falls...make sure you have a documented intervention with each new fall
MD orders and progress notes...all have to be signed per regulation
GTubes...verify placement BEFORE giving meds...with air (no joke..a nurse at a place I used to work verified the placement with water!!kind of defeats the whole purpose)
Med pass...no APs or fingersticks in the hallways. Make sure your order and MAR matches exactly...don't give a multivitamin if the MAR reads multivitamin with minerals...alcohol gel cleaner between patients and washing after every 3-4
Wound care-daily documentation of the wound and periwound with weekly measurements
Name tags...don't laugh...you can get cited for this
Nebs...02..all tubing needs to be dated and if not being used in a plastic bag..not on the floor
If you have someone in a gerichair and the legs are up, make sure it's not a restraint or make sure it's well documented with an order, a consent and a care plan
Psychotropics---consents, and GDRs
The list is endless and every year they seem to focus on something else.
In my state the surveyors are going to start using digital cameras to 'document' what they see.....yikes!
Don't forget your CNAs. There is a great little book on survey prep for CNAs. Good ones will be worth their weight in platinum if the surveyors ask them questions and they give the right answers!

[CapeCodMermaid]

Don't get me started on sloppy charting. We had a patient fall..I was on the floor at the time and saw every assessment and intervention the nurse did (of course I was there helping and not just watching). The patient was stabilized and sent to the ER. I came back a few hours later and the note read "Pt found on floor, sent to ER, MD and wife notified." I found the nurse and asked her to review all she had done for the patient. She told me and then I showed her the note. Take credit for what you did.

[mercy1975]

I know several of you have seen this info, but I thought it would be helpful.
Survey Preparation
permalink

• Here's some items that should be inserviced before your upcoming survey. These are alot of the areas the surveyors will be reviewing.
  
  
• All staff to wear name tags
• Greet and smile at surveyors as appropriate. They are guests in the facility and should be treated as guests. Offer water and coffee after breakfast is done.
• Call residents by their names only
• Nembulizers-include cleaning procedure
• Inhalers-include cleaning procedure. Remind staff to shake the inhaler in-between puffs and offer water for resident to rinse mouth out.
• Accucheck machine-clean after every use!!
• Eye Drops-if giving multiple eye drops, know how long to go in-between giving them
• Injections
• Peri-care--try to have two staff go together. They can coach each other. Keep residents appropriately covered during intimate procedures.
• Emptying of Foley bags
• Tube medications-Do each med separately and flush between each med
• Med pass- remind staff to use hand gel every time after giving a resident’s meds. Wash hands with soap and water after every 4th resident.
• Policy and Procedure for Cleaning Razors
• Positioning of residents
• All residents to receive appropriate cueing and assistance during meals.
• Keep all hazardous items locked up
• All residents to be appropriate dressed
• Man shaved by 10am
• If wheeling a resident in a w/c their leg extensions must be on and feet appropriately placed.
• All O2 tubing should be in a plastic bag and not laying on the floor.
• Keep clean and dirty items separated by three feet minimum.
• All staff to know where the care plans are located.

#2
Dec 15, 2007, 10:50 AM
mercy1975 (Female)
Member

Nursing Specialty: LTC surveyor, DON of LTC
Years Exp: 35 years
Join Date: Aug 2007
Location: Fontanelle, Iowa
Age: 54
Posts: 39
Country: united states
Received 12 "Thank You" From 11 Posts


Re: Survey Preparation
permalink

Following is a listing of what should be included in a Survey Entrance Manual.

This is the information the surveyors will request upon entering into your facility.This will make the entrance go very well. This also will give the DON more time to be with the nursing staff instead of rushing to get the nursing information. This will save the surveyors time also which keeps them happy.Surveyors have been very impressed when this information is readily available.

1. Resident Roster with room numbers
2. Blank 24 hour report sheet with residents names (one for each surveyor)
3. List of key personnel, including the Pharmacy consultant and QA person
4. Copy of facility layout-(one for each surveyor)
5. Resident’s Advocate Committee names
6. HCFA Form 672
7. Work schedule for RN/LPN (day of entrance)
8. HCFA 802-up to date
Under “Wt.” Indicate with an arrow if weight is up or down
Under “UTI/ inf control/antibiotic”-note UTIs
Under “Interview able: Indiv/Fam” ,note With an “I” if the resident is
interview able. A list would be also be acceptable.
Under “Psychoactive Meds” note :“P” for psychoactive, “A” for
anti-anxiety, and “H” for hypnotic.
9. Policy /procedure for monitoring accidents/incidents and system to
prevent/minimize
10. Immunization practices (flu and pneumococcal)
11. List of employees since last survey (list position and hire date)
12. Admissions (past 30 days)
13. List of discharges (during last three months)
14. Medicare residents requesting demand billing (during past 6 months)
15. Resident age 55 and younger
16. Meal times (of all dining rooms)
17. Dining room seating chart- (one for each surveyor)
18. Copy of menus (including therapeutic menus for duration of the survey)
19. List of residents on therapeutic and mechanically altered diets
20. Work schedule for LPN/RN (Day of entrance)
21. Medication pass times for inhalers, eye drops, injections, g-tube
medications, and nembulizers.
22. Emergency water supply policy and procedure (5 gallons per resident per day)
23. CLIA wavier certificate
24. Copy of Surety Bond
25. Resident Rights
26. Admission agreement
27. Policies /procedures to prohibit /investigate abuse
28. Activity calendar (last three months)
29. Resident Advocate Members
30. Resident council meeting minutes-(last three months)

Last edited by NRSKarenRN : Dec 15, 2007 at 11:49 AM.

[proud2b1]

The obvious,and then anything else that arrises!They are big on follow-up cahrting,pt.care,labs md notifications.They are very big on activities,postioning,and dietary.Seems each year they hit hard on any certain area.BEHAVIORS are a real biggie.Always make big issues out of any contact kind of behaviors.

[proud2b1]

Thanks for all this!We are in our window now,where I work.This is nice to go by,to hit on hot spots and the basics,that sometimes we forget!!!

[LVNwannaBE2007]

thanks for all the help..... i am a new LVN in charcge of about 48 people a day on average..... our window just opened in march and state walked into a neighboring facility 2 nights ago on 10-6 shift. anything else you all can add to this. even when we just ahve 1 or 2 state people come in like DADS i freak out and almost cry i cant help it lol...... i get so nervous and have never been through this before and am so nervous

[cotjockey]

Some quirky things facilities in our corporation have been dinged for...
"Shred" containers being too big...unless you shred documents on site (which they don't like either), the container needs to be less than 32 gallons. Big trash cans are not a good idea.

Leaving oxygen concentrators when the resident is not using them...fire hazard.

Things on care plans like "Encourage fluids." If you offer fluids and the resident declines, you need to offer again and tell them how important fluids. Use verbage that is less likely to fail...like OFFER fluids.

Make sure that resident quirks are care planned...like sleeping in clothes or wearing clothes that don't match or wearing too much makeup or having a nickname like "Ugly" or "Topsy" or "Doodie."

See if someone can give you a copy of CMS 802 and CMS 672...it shows you who the surveyors are going to look at before they even walk in the door.

The most important thing is to just have your ducks in a row all of the time...always do everything by the book and you should be good to go when the survey team shows up.

[sunny261]

We just had the state in our LTC and they focused on pressure sores, documentation, weight loss and enviromental(had nothing to do with nursing)....

[cotjockey]

Originally Posted by sunny261

We just had the state in our LTC and they focused on pressure sores, documentation, weight loss and enviromental(had nothing to do with nursing)....

That is what we are hearing in this area too...we are really lucky that we don't have any pressure sores...we keep pretty on top of weight loss...our housekeeping and maintenance staff are really on the ball...our documentation needs work, but we have a plan for improvement. I wish the would just show up and get it over with.

[sunny261]

cotjockey:
I so understand where you are coming from. We don't have many pressure sores either-most are admitted with them. Documentation seems to be a hard area for nurses to grasp. you have to document residents reaction to changes in meds, behaviors on and on. I find that it seems like it really comes down to communication. For example I had a recent readmit for the hospital to my unit. They came back with a foley. I had several reasons not to d/c it but it seems no-one discusses with me to ask or talk to me about it. They had been admitted with renal failure and dehydration and they had alot of dependent edema on their return. So why would I want a foley to remain in for the first couple of days??? I think when I freaked a tad in the facility wide morning report they got the message. or finding out from the state that one of my residents had an incident with another resident and had the potential to be a victim. Not mentioned in report at all or put on the 24 hour report sheet. How can you document on anything if you don't know...