State is coming and I'm a wreck..

Specialties Geriatric

Published

This would be my first state survey eversince I became an RN and got employed. Anyways, I am a foreign trained nurse and had no experience how the state does their surveys. And to make matters worse, I'm one of the nurses behind the med cart when they come in. I have a few questions to all nurses out there who had experienced state surveys and the DO's and DONT's that I have to know when they come in and follow me around.

-Is the 1hr before and after window during medpass universal or does that depend per facility's policy?

-Is wearing gloves when handling meds necessary during medpass? If yes, do I have to remove gloves everytime I open their cart?

-Should I take my medcart inside patient's room or may leave outside patient's room but locked?

-Is checking the room number and ID bracelet the only thing I have to secure before giving meds?

-Should I sanitize my hands before and after medication administration? Or handwashing is a must? (I sanitize my hands after giving meds and leaving the room.)

-Glucometer: When to clean it?

-Pill Crusher: When to clean it? After crushing pills?

If you have any suggestions, feel free to let me know. Comments are highly appreciated. Badly wanna do this the right way. I've been in this position for only 4months and I'm not really that confident when people of higher authority are following me. And me being a perfectionist doesn't make me feel better either. Thanks in advance

Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.
Really? If I sit down and wait for a neb tx to be done for 10-15 minutes is absolutely ridiculous. I'll be way too late for my medpass. No wonder a lot of nurses hate when the state comes in, it wrecks individual medpass system..

At our facility we have to get an MD order stating the resident is "ok to self administer NEBS after nursing set up", if we are to leave them unattended while it finishes up.

Specializes in Med/Surg, Geriatric, Hospice.
found out today that you need TWO tissues for eye drops, one for each eye!

We have to wash our hands BETWEEN each eye's drop. If you're giving hypotears one drop to each eye QD, you enter room, wash hands, set up 3 clean barrier tissues on table, (eye drops are in one tissue for transport into room, give the drop to right eye, use another tissue, place drops back on table on a clean barrier tissue on table, go wash hands for 15-20 seconds and dry them, reglove, then do the left eye, use another tissue, put drops on clean barrier tissue for transport out of room, throw trash away, and wash hands again.

Seriously. All that for SALINE EYE DROPS!! lol.

Specializes in M/S, Travel Nursing, Pulmonary.
At our facility we have to get an MD order stating the resident is "ok to self administer NEBS after nursing set up" if we are to leave them unattended while it finishes up.[/quote']

We have RT at my facility and they don't walk away. There are pods of 4 pts. (2 on one side of the hall, 2 across from them) and they stay in that small pod, give all the neb trt., wait, then move onto the next. If they have a pod with only 1 or 2 pts getting SA Trt, they use that time to document or something else on their computer on wheels.

We have to wash our hands BETWEEN each eye's drop. If you're giving hypotears one drop to each eye QD, you enter room, wash hands, set up 3 clean barrier tissues on table, (eye drops are in one tissue for transport into room, give the drop to right eye, use another tissue, place drops back on table on a clean barrier tissue on table, go wash hands for 15-20 seconds and dry them, reglove, then do the left eye, use another tissue, put drops on clean barrier tissue for transport out of room, throw trash away, and wash hands again.

Seriously. All that for SALINE EYE DROPS!! lol.

Now, that is absolutely assinine!

Specializes in home health, dialysis, others.

Years ago, I used a double-cup method for crushing meds. Put pill/s in a small paper pill cup. Put another cup on top of the first, so the pills are 'sandwiched' betweeen the cups. Now crush. You may need to look at the pills and crush them 2-3 times. Check the bottom of the upper cup for large residue. No pill residue gets on the crusher.

Just a thought.

Specializes in LTC.
We have to wash our hands BETWEEN each eye's drop. If you're giving hypotears one drop to each eye QD, you enter room, wash hands, set up 3 clean barrier tissues on table, (eye drops are in one tissue for transport into room, give the drop to right eye, use another tissue, place drops back on table on a clean barrier tissue on table, go wash hands for 15-20 seconds and dry them, reglove, then do the left eye, use another tissue, put drops on clean barrier tissue for transport out of room, throw trash away, and wash hands again.

Seriously. All that for SALINE EYE DROPS!! lol.

No I beg you not to be compliant with this. This is just wasting freaking time!

I do not wear gloves while giving eyedrops unless the resident has conjunctivitis. But even if you do put gloves on. In those 3 seconds from moving your hand from one eye to the other... there is no possible way you are going to contaminate the other eye.

The resident will give herself her eye drops by the time you do all this.

Who the hell thinks of stupid policies like this???

Specializes in OB, Peds, Med Surg and Geriatric Nsg.
No I beg you not to be compliant with this. This is just wasting freaking time!

I do not wear gloves while giving eyedrops unless the resident has conjunctivitis. But even if you do put gloves on. In those 3 seconds from moving your hand from one eye to the other... there is no possible way you are going to contaminate the other eye.

The resident will give herself her eye drops by the time you do all this.

Who the hell thinks of stupid policies like this???

LOL! I agree with you! This is totally absurd. Anyways, is it ok to do FS st 1530 instead of 1600? We only have 1 glucometer for the whole wing which has 2 halls. The other hall has only 4-5 patients that are on fingersticks while the other hall has 8. And usually, we wait for the nurse to be done with the glucometer before we could use it on the other hall. And I don't know if this is true but were not allowed to bring the accucheck machine inside the resident's room, instead we only leave the machine at the nurses station and take the glucometer with a test strip on it in the respective rooms. So what we do is come back and forth to discard strips and so on and so forth which consumes a lot of time.

Specializes in LTC.
LOL! I agree with you! This is totally absurd. Anyways, is it ok to do FS st 1530 instead of 1600? We only have 1 glucometer for the whole wing which has 2 halls. The other hall has only 4-5 patients that are on fingersticks while the other hall has 8. And usually, we wait for the nurse to be done with the glucometer before we could use it on the other hall. And I don't know if this is true but were not allowed to bring the accucheck machine inside the resident's room, instead we only leave the machine at the nurses station and take the glucometer with a test strip on it in the respective rooms. So what we do is come back and forth to discard strips and so on and so forth which consumes a lot of time.

I bring the glucometer in the room. I am non-compliant with wiping it down with a bleach wipe after each use. I tried it. Too time consuming. I have to keep moving or else I will be very behind. Dinner is at 5. The diabetics are the first ones in there. lol

Regarding the nebs we were cited a couple years ago. State views nebs as medication (which as we all know can not be left at bedside unless the RS is able to self-medicate. We assessed all RS who received nebs to determine if they are able to "self-med theirself" (only a few are able). If they did not "pass" the nurse must stay with them the entire time. "State" okayed us and we passed the re-survey.

Regarding the nebs we were cited a couple years ago. State views nebs as medication (which as we all know can not be left at bedside unless the RS is able to self-medicate. We assessed all RS who received nebs to determine if they are able to "self-med theirself" (only a few are able). If they did not "pass" the nurse must stay with them the entire time. "State" okayed us and we passed the re-survey.

then all the nebs need to be changed to MDIs with spacers......

Specializes in Gerontology, Med surg, Home Health.

Worrying is not just for the managers. I HAVE to worry about some dumb nurse doing something stupid or writing something stupid in a chart. My philosophy on surveys: do the job right every day and you won't be that nervous when DPH comes in. As soon as I know the state is in the building, I make it a point to see as many staff people as I can to let them know and to remind them it's only a few days out of our year....just a few visitors who like to watch what we do since they certainly couldn't do what they expect us to do.

Wash or use gel in between every resident. Our pill crusher uses little plastic bags so there is no mess to clean. We clean our glucometers after each use.

That whole business about eye drops is preposterous. Don't touch the tip to their eye and keep a tissue at hand.

Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

The only time you should be concerned about wearing gloves when giving eye drops is if the drops are an antibiotic because of an infection, otherwise good handwashing is the rule. One tissue for each eye is also the best rule.

Never leave your medication cart unlocked nor medications on the top of the cart. As long as your cart is locked and all meds are secured you can leave the cart unattended. It is not the best practice to take that cart into a room, think infection control....

Also make sure that all MARS or other patient/resident identifying information is covered when you leave the cart-confidentality and privacy.

You should not leave a resident with the nebulizer treatment on unattended- yes it is a PITA but the nebs are also an administration of a medication. Would you leave a cup of medications on the bedside stand for the resident to finish at his/her leisure? It is the same principle.

The federal regulations are the same for all states, however facility policies are different. The facility policy should incorporate what is expected in regards to the federal regulations. Now state regulations may be different- I don't know what other states do in terms of their licensure regulations- but in my state they are very vague.

I watched a med pass in which the nurse never once washed her hands- not once- not no time...ugh.

Medications are supposed to be given an hour before to an hour after the scheduled time, but think about what you are giving and is it a daily med? If it is daily then it would be hard to hold you to a time. I do not know what other state surveyors do, but we are not allowed to cite a deficiency just because the facility did not follow their policy. There has to be a potential for an outcome or an outcome for the resident. Giving a medication at 10:30 that was ordered at 9:00 once daily never killed anyone that I knoiw of.

Be aware of "technique"- not only handwashing, but crushing,administration of inhalers (rinsing mouth-waiting between puffs) cleaning stechescope between residents, and what you are mixing meds with, or how much fluid should be administered with certain medications.

Do not leave any meds at bedside, even TUMS or eye drops, or anything unless you have a physicians order and the resident has been assessed and care planned to self administer.

And if you are administering Fosamax- make sure that the resident remains upright for 30 minutes, and if they can't do that, then why are they even getting it?

Unfortunately surveyors are diffrerent and have different personalites and some may have not worked in long term care and have difficulty accepting what it is like in the real world, instead of just what they "think" is right. Just because they think it is right does not make it right- it has to be in the regulations or a standard of accepted practice.

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