State Survey...Advice Please

  1. HI,

    I am a recent LPN graduate working on a temporary license at a local nursing home. I have been there about a month. Anyway, I just completed my orientation and got placed on a med cart alone 2 days ago. I was off today and I was called and told that state had walked in to do the survey and that they would be there tomorrow also, (which I work).. frankly I am terrified, I do not know what to expect and cannot get anyone I work with to tell me much either. The only thing I was told was that an RN would go with me to do invasive procedures to follow the legalities of my temp license. I really do not know what is and is not acceptable to the state as far as med pass because I have had a really shotty orientation. The only thing I have been told is to be sure I was through with med pass in the one hour time frame, which is impossible for me because I have 74 residents and patient safety seems more important to me.. anyway, I am sorry this was soo long but I desparately need some advice!!!



    Thanks!!

    Leelee
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  2. 26 Comments

  3. by   Nascar nurse
    1st step: Take a BIG deep breath and RELAX

    I can't help you with any info on a temp license as in my state, everyone has to be licensed to work at all. I have been thru many state surveys in this state tho and they are very stressful. I find it most helpful to remember tho that they are not "God" (although some of them think they are - but others have also been quite nice). Just remember, they are people to with a job to do - just as you have a job to do. when passing meds remember your 5 rights and double/triple check those meds. You really have to pass to all 70 something residents in an hour? Several years ago we divided our unit of 50 ... scheduled 25 residents to have an 8a-12N-4P-8p pass and the other 25 to have a 9a-1p-5p-9p pass. That gives you an extra hour to get done and stay legal. You can't fix this now - but you may want to suggest this later. If they ask you a question and you don't know the answer - tell them "I'm not sure of that, let me get right back to you." Go find the answer and go running back to them with it. Most of all, remember.. all you can do, is all you can do. Remember to relax and breath. good luck.
  4. by   gentlespirit
    Bless your heart... you must be terrified. I realize you feel like you are not prepared, but you are capable of more than you give yourself credit for. You need to start promptly, follow the five rights, don't give medications or treatments in a public area unless the resident requests it (I know that is not typical...but it's a regulation), be sure to use hand cleanser between each resident's med pass, double check the meds against the MAR carefully.

    That's pretty much it. It will be nerve-wracking but you will do your best and that is all you can do. I would ask in the am if the RN who will check you on the invasive procedures would be available to assist you on med pass. It would be perfectly acceptable if you could arrange it.

    Prayer helps too. God bless you.
  5. by   annabrooke93
    Thank you for the info. Yes, the patient nurse ratio is ridiculous and we will probably be written up for poor staffing if nothing else. I am just planning to try to be confidient and follow all the rule I learned in school.. Thanks for your advice!!!

    LeAnn
  6. by   Bird2
    Quote from annabrooke93
    Thank you for the info. Yes, the patient nurse ratio is ridiculous and we will probably be written up for poor staffing if nothing else. I am just planning to try to be confidient and follow all the rule I learned in school.. Thanks for your advice!!!

    LeAnn
    Try not to be nervous. Pass meds like you were in school. Never leave the med cart unlocked unless you are in front of it. Was you hands when ever you have any pt contact or use hand sanitizer. When asked a question by an inspector do not answer a question unless you are sure of an answer. Just say I will need to check the records. Then check the proper place such as a careplan and keep the DON informed. You will do great. Let us know how you did. Good luck
  7. by   Hellllllo Nurse
    When I was GPN (I'm an RN now) state came in my 3rd day on the floor, and yes, I was passing meds alone to 30 pts on a rehab unit.

    All they did was ask me about a couple meds I passed: What were they for and what are some side effects?

    The meds were easy ones: Colace and Lasix, so luckily I asnered their questions. My experience is that for the most part, state takes charts into the conference room and audits them. I wish they would have paid more attention to the conditions on the floor, but they didn't.

    Mgmt are the ones who need to be nervous when state is around, not the staff, in my experience.
  8. by   Bird2
    Quote from Hellllllo Nurse
    When I was GPN (I'm an RN now) state came in my 3rd day on the floor, and yes, I was passing meds alone to 30 pts on a rehab unit.

    All they did was ask me about a couple meds I passed: What were they for and what are some side effects?

    The meds were easy ones: Colace and Lasix, so luckily I asnered their questions. My experience is that for the most part, state takes charts into the conference room and audits them. I wish they would have paid more attention to the conditions on the floor, but they didn't.

    Mgmt are the ones who need to be nervous when state is around, not the staff, in my experience.
    I have to diagree with the last statement. I think that how the facility fairs during survey time or any time for that matter reflects on all staff not just management. We are all responsible for good quality care not just the managers. Hope you and your facility did well during your survey.
  9. by   CoffeeRTC
    Not to scare anyone, but the surveryors are spending more time on the floor in our areas.

    I think I would be almost as nervous as the OP. Its been years since I've been thru a survey. (working 3-11 and weekends I tend to miss the fun:wink2: )

    Deep breaths.
    Admit if you don't know the answer, but tell them you will look it up.
    Double check your P&P for tube feeds.
    Remember privacy for eye meds, injections, etc.
  10. by   Hellllllo Nurse
    I have been through several surveys at awful facilites, where I hoped the surveyers would force mgmt to address problems that staff had been bringing up, but that mgmt had ignored.

    To my surprise, we got a zero deficiency rating at all of these terrible facilities.
  11. by   annabrooke93
    Thanks to you all for the replies.. it is FINALLY over.. It was not as bad as I had expected it to be. They only went into one residents room with me and stayed all day with two of my co-workers. I don't know if that is good or bad but it helped my stress level. I was stopped several times in the hallways and asked questions, mostly common sense ones. While they were there they were mostly on charts, MARS & so forth. So glad it is over!!!

    Thanks

    LeAnn
  12. by   sharlynn
    Surveys are a necessary evil. In my opinion, if you are doing your job correctly all the time, you have nothing to worry about!
  13. by   califgal930
    Hi, as a former state surveyor I can tell you a few things. The med pass is divided into a couple of shifts if possible. They will initially look at 20-25 medications. They will check to see if you are following the 5 rights. They try to look at different administration routes. GT, flushing before and after, eye gtts, waiting at least a minute between gtts. Making sure alternate nostels are used with nasal sprays, if ordered that way. They check what they have seen against the MAR and then against the physician orders. They will see how you interact with each resident, proper sanitation practices ect. If any errors are found in the first 20 or 25 then they have to expand the sample to another 20 residents. Try to relax and just remember to double check your orders. Hope this helps.
  14. by   CapeCodMermaid
    Management needs to worry and not the staff nurses?!?!?
    You're right. I need to worry that the staff nurses have screwed something up royally...something that they should have learned in school but are too lazy or too stupid to do right.
    I do my job...I'm not worried about MY work causing a problem or getting the facility an F or G tag. I can not check every chart for every nurse's note or every missed med. Staff nurses need to take responsibility for their actions or lack of actions.
    Last year after survey I had to spend 6 eight hour days doing the plan of correction and you know what...NONE of the mistakes were mine.
    We have the surveyors in the building now and once again, it's not management making the mistakes.

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