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We actually did fairly well except for an IJ because of a resident for whom we could not get psychiatric help. State thought he should have had it. So did we. Rural and underserved, after a YEAR we contracted with a psychiatrist and a psych NP.
And no one is ever under distant supervision. You'd better know where they were if they make it out the doors!
We just finished our annual survey! It was my first year as MDS. We faired pretty well. But it's so stressful when they are here. Our nurses did awesome with cbg's, med pass, and treatments. Our infection control went well but our restraint policy did not pass their standards. We had admitted a little lady with fx femur in a leg immobilizer and she would turn it like it was nothing plus she kept pulling out her f/c, even though we had her in a low bed managed to crawl out of it with immobilizer and all and she barely weighed but 88lbs! Anyway, the night nurse called md and family and agreed on mittens, the night before THEY showed up. Needless to say we got dinged on not having a proper pre-assessment for restraints in place. Our restraint nurse has a follow up and reduction form that she uses but they want one for pre assessing the resident? Does any one have something similar to that? We had our documentation in place but it was not enough. Other than that sliding scale was looked at very closely. Oh and before I forget, like I said they look into every cranny-our toilet seats in resident's rooms need updating apparantly our housekeepers have over cleaned them. This was part of the infection control. But I was very happy to see them leave.
I don't know what other states do, but we do not have a particular focus at any time. The survey just is what it is. I mean they don't tell us to focus on one thing or another we just go in and do what we do. We are getting ready to have our MDS 3 training and that will change the survey for a while because once the MDS starts to be used, then there will be no QM/QI's for a while and the survey will be more like it used to be in the "old days". There are some surveyors who themselves focus on particular things, because maybe that's their "area". I just let be what it will be. Observation and clinical record review- mostly observation because observation and the quality of care is the most important thing, I think. I mean, if you observe a resident who needs assistance to eat and is not provided this assistance and you look in the chart and there are blood pressures that are not documented (and the resident has been on the meds forever) what is most important? That's the way I look at it. Not to say that documentation is not an issue, but there are things that are way more important than holes in the MARS....