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| No. 30 | 
May 26, 2009, 11:30 PM
 Re: Questions on State Visits
Congrats, you deserve it and worked hard, you gotta reward your team- take em out for brunch or something!
and how ridiculous is that - surveyors not nurses!!!
I guess the tax auditors lack a background in accounting as well- explains everything.
 | | Advertisement Sponsored Links | | | | No. 31 |
May 27, 2009, 04:21 PM
Re: Questions on State Visits
In Massachusetts not all surveyors are nurses. We usually get a nurse or two and a dietician or social worker. It's just the way it is. Congrats on your good survey.
| | No. 33 |
May 31, 2009, 04:32 AM
Re: Questions on State Visits Originally Posted by CapeCodMermaid  In Massachusetts not all surveyors are nurses. We usually get a nurse or two and a dietician or social worker. It's just the way it is. Congrats on your good survey.
Ok are you sitting down, we are a 180 bed SNF and 25 bed ALF ( soon to be 50 bed ALF) and the survey teams come separately- SNF and ALF, each a 13 member team -2 doctors, 2 nurses, 2 social workers, a dietitian, phys therapist, recreation therapist, occupational therapist, 2 for administration, 1 for bookkeeping (they check that the schedule is kept etc.)
If we are fighting for some equipment or changes to help the nurses, they usually help us- for example. on a newly built unit, the nsg station lacked a sink, we begged for one but was told it couldn't be done, the survey team wrote it up and presto - within a week we had our sink....its the small things....
Each discipline stays within the realm of their specialty. They can all ask questions of the nursing staff, but usually with the nurses from the survey team present.
The dietitian also checks the kitchen staff, getting under their skin by weighing and measuring portions (once found us short by a few ounces,...)
The doctors are the nicest and most understanding... the nurses are usually new each year, (lots of turn over) we usually get our license for 2 years but they get under our skin to achieve that
I have never had a dietitian ask me about the TSH, but I am sure she knows what that is, they are pretty knowledgeable.
| | No. 34 |
Jun 09, 2009, 05:41 PM
Re: Questions on State Visits Originally Posted by expltcrn Regarding pending State Visits:
If you are relatively new and actually had a little time to burn(so to speak). Go to this link: http://www.cms.hhs.gov/manuals/downl...endicestoc.pdf
and on page 2, download these: P
Survey Protocol for Long-Term Care Facilities
929 KB
PP
Interpretive Guidelines for Long-Term Care Facilities
1,440 KB You will be able to obtain insight on how surveyors are taught to interpret the regulations, and what questions to ask, how to probe, etc. If you understand where they are coming from, and the purpose behind their line of questioning (whatever it may be), it is easier to provide a straight answer. If your facility has provided limited training on Fed and State Regulations, it will be a huge eye opener for you. Survey prep should be a reoccurring activity with any facility. If your leaders have not spent any time going over basic standards and expectation (the state regulations, the federal guidelines - key areas) ask them for a series of inservices. Good luck! There isn't enough time and space for me at present to give you the many things I have learned and taught over time, but here is a few: ALWAYS, make it obvious that you are following good Hand Hygiene habits before and after patient contact - they will be watching! Sometimes they ask the patients if they saw you washing your hands! Always knock on the door and ask for permission before you enter a resident's room (if it is a non-verbal patient - knocking and announcing your entry would suffice). During any interview, do not add words which are unnecessary (small talk) - they write everything down - Date/Time, your name and what you said. If you are nervous or flustered, take a deep breath and admit you are nervous-it is okay. Ask them to clarify any questions you don't understand, or you are unsure of. For life safety information and policies, you do not necessarily have to memorize everything - but you have to know where to find the answer - i.e. where the manual is, who you can ask, etc. BUT you must know your codes for fire and disasters, the acronyms RACE and PASS - many facilities have them laminated and attached to the back of their badges, along with other tips. Know that if you are interviewed about abuse - your first action upon witnessing any situation which could be abuse, is to remove the patient from the unsafe situation, then immediately report to the supervisor or your Abuse Prevention Coordinator (usually it is the Administrator, DOn or Social Worker), fill out the required form, and the facility must follow the reporting guidelines to the regulatory bodies. If you happen to be the med pass pick - anticipate this. During survey, all carts must remain stocked with non-expired house supply - your supply person should assist with this. Have your cups, spoons, syringes, whatevers - stocked - it is not the time to be running around for supplies. Your pill crusher should be clean - pressure washing works or soaking in hot water and bleach or soap (whatever your approved method is). Your insulins and other vials should all be dated when opened and the date of expiry also placed - dated/initialed accordingly - usually night shift nurses help with this prep. YOur juices/apple sauce, etc. should be dated. Refrigerate again after your med pass if you will be using again. Best tip? Pick your easiest patients - avoid the ones who are usually problematic because once the surveyor reaches the quota, they will stop observation for a while, but may ask to specifically watch someone with a tube feeding. Brush up on your policy for med administration for a tube feeder. make sure you follow your patient identification procedure before you give any medications. Explain to the patient what you are giving them and what the meds are for - yes it is required. If a BP or Pulse is needed before you give a med, do not pour those meds until you have taken the measurements so you can follow the parameters. Sign immediately after administering - never before - and never until after the entire med pass for all the patients! Cover your med sheets or med book (can use a folder, a paper, etc.) when you leave the cart to administer the meds to a patient. Do not give injectables, eye gtts, etc. in a public area (or dining room) - it's a newer dignity issue. Unless a medication is ordered with food, do not interrupt a patient's meal by administering meds. More to follow later Good luck!
I can not thank you enough for all the above noted!!!!! This was a huge help for me and i have been searching for hours for this. Although this is what i already do, I just need to be touched up on this before state comes!!! Thank you again so so so much!!!!
| | No. 36 |
Jul 20, 2009, 01:23 AM
Re: Questions on State Visits
just tell the truth, don't try to cover up, specially if asked by the management. It is worse to be caught telling a lie.
| | No. 37 |
Jul 20, 2009, 01:24 AM
Re: Questions on State Visits
What us the role and duty of an admissions nurse in a nursing home?
| | No. 38 |
Sep 09, 2009, 01:02 PM
Re: Questions on State Visits Originally Posted by CapeCodMermaid The State assumes we as managers are supposed to know everything. "Have you told anyone" is not one of the things I've ever heard a surveyor ask. I HAVE heard them ask leading and misleading questions and I have seen them set a nurse up to fail. I've also read their reports with outrageous misquotes. Surveyors are there for one thing...to find fault. Some are reasonable, most are zealots.
There is certainly some truth here. On my first survey as an ADON, we were 'crucified' on day 1 with 15 possible tags (I had worked there just 3 months and had put into place Psych monitoring/reductions, Immunizations, a Fall Committee, and developed an education/in-service process where all staff were brought current on their annual in-services just in time). We had 7 surveyors. A new Admin, a new DON and myself.
At the end of day one, we all felt defeated but no one more than myself. I knew the hours of OT I put in just to get us to this point. Our Admin called all managers in for the final conferences. I looked at all of their faces slowly disolve into defeat. Then everyone got up to leave. I, however, HAD to turn around and asked "Isn't there anything good about our facility? Is it really that bad?" At this point, the room became completely silent...the lead surveyor sort of mumbled "Uh, oh..." Then nothing. They all looked at each other then one said "We are not here to tell you what you are doing right, but to identify your deficiencies." Wow!!!
Anyway, while that was rough I now view them as 'keeping us honest'. In the years since, many have used this time as an educational experience to which I welcome. Yes, they can be stubborn and particular and some can be very unreasonable but you just have to remember your P&P manual and follow it. If it is not in your policy even though they want something done, you don't have to do it. As DON/ADON you have to stick up for your staff and your policy and not 'change your mind' cuz you think it's what they want to hear.
That was good advice another poster gave to the floor RN, if you don't know the answer, it is absolutely ok to say that you don't know but that you can find out. Very often, when there is a question they are asking you, it is precisely for this reason...to see if you even know who to ask, or where to go to in order to find an answer to a question. They know that you ccan't possibly know the answer to every question.
Good luck to you, relax, do the best job that you can. Remember, it won't go on forever!
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