- 0Apr 22, '11 by txdonJust curious as to what facilities are getting tagged for this year. I heard that they are cracking down on glucometer cleaning.
- 0Apr 23, '11 by CapeCodMermaid, RNI think it varies by region. Last year I had heard that infection control was a huge issue including cleaning the glucometer between uses. My pharmacy is telling me that proper use, documentation, and disposal of medications that come in patch form is a bigger deal than in previous years. Resident dignity is always an issue here in Massachusetts...care plans are being looked at more closely, too.
I am due for survey any minute....when they're done, I'll let you know what we got tagged on.
- 1Apr 23, '11 by PammyRN,CENWe are also due for survey any day now. I am ready for them on Monday! They did go to a sister facility recently and they were looking for siderails assessments, orders and careplans. We have a lax med pass policy that is resident centered... am meds must be completed by 1000. They were reviewing dialysis patients, agreements P&P and careplans. Thats as much as I know at this time.
I will post after survey, my building is facing a G due to falls with fx. If anyone has anything to share I'd also appreciate it.
- 2Apr 23, '11 by CapeCodMermaid, RNA fall with a fracture doesn't necessarily mean you'll get a G tag. Did you assess the falls risk? Were there interventions in place to prevent a fall? If you assess, plan, and revise as necessary, you should be okay. But sometimes it all depends on the particular surveyor which is why the system is so horrid.
- 0Apr 23, '11 by achot chaviALl these issues are important, you never really know what they are going to zero in on, the important thing is not to open any doors you dont want them to go through- give short, to the point answers. They always check charts of new admits, pressure ulcers etc.
Yes, You have to revise care plans after every fall as if that will really prevent a fall- but we do the best we can.
If definitely depends on the surveyor. Best to be professional and not chummy.
How do you prove glucometer cleanings? Do the nurses have to sign after every use like we do for the EKG machine?
- 2Apr 23, '11 by marthyellenHow do you prove glucometer cleanings? Do the nurses have to sign after every use like we do for the EKG machine?
Skills check list for glucometer usage and cleaning. Surveyors will watch glucose checks to verify proper usage and cleaning. Make sure the check list includes manufactures recommendations for cleaning.
- 0Apr 24, '11 by debRN0417A fall with a fracture will not automatically get you a "G" citation. It only is harm (G) if the facility was remiss in ensuring the interventions were in place and updated. If your resident was assessed as a fall risk, you care planned it and put interventions in place, made sure the interventions were appropriate and if other falls occurred, revised your interventions and care plan, then you did everything you should have to prevent injury. Harm occurs if the facility was aware the resident was high risk for falls and did not do everything (revise interventions)they could to prevent injury. Sometimes no matter what you do though, an injury can happen, especially when you have older, osteoporotic individuals. If you have numerous falls with fractures, then that certainly is suspect and will be looked into very thoroughly.
With no QI's to assist in sample selection and target concerns, the survey team will most likey be doing a great deal of observation, especially on initial tour and your sample selection will be based on those observations as well as any facility reported incidents or complaints. They will also focus on residents who meet certain criteria, such as those with weight loss, pressure ulcers, feeding tubes and infections.
Medicare Demand Billing is not something that nursing has to worry about. It is related to the Advanced Beneficiary Notification and residents rights. To me, that is more administrative and business office stuff. It is when a resident has been decertified by the facility with skilled days remaining (the facility has determined that the resident no longer meets skilled criteria) and the resident has been given notification that they have the right to appeal this decision by the facility.
Glucometers are going to be looked at because I hear there is some other mumblings going on about the concern that they cannot be cleaned thoroughly, but I have not heard anythind definite yet. Just make sure you have a cleaning schedule log and that you are cleaning them per the facility policy, especially between residents.
Documentation is always an issue, as well as making sure that any issues are followed up and documented, as well as proper notification.
- 1Apr 27, '11 by justus501I assume you are talking about federal tags, not state tags, as state tags vary from state to state.
-They are looking at all incident reports...reporting and investigations events..with citations at F225
-Falls are always a big one...with citations at F323
-Pain is always big...with citations at F309
-Pressure ulcers..with citations at F314
-Care planning on residents...with citations at F279
-Sanitation in kitchen..with citations at F371
-Infection control, especially with glucometers and cleansing between residents with appropriate wipes (ones that actually kill things such as C-diff).... with citations at F441.
Those are the big ones I am seeing. Also seeing some nutrition issues. Food temp with last tray pass, and pureed food stuff.