I'm in the process of being survey for initial licensure by Texas Department of Aging & Disability. I've been through several JCAHO hospital surveys as both a staff nurse and manager but I feel lost as what to expect for a home care survey.
I was hoping those of you that have been through this process could share some tips, words of wisdom or encouragement.
What is the day of survey like, how long, what to do and not do, do I need to "prep" the patients, etc. I've heard of horror stories when it comes to home care survey, therefore I'm extremely anxious, nervous, and stressed.
Specializes in Functional Medicine, Holistic Nutrition.
HealthyNurse,
Thank you for reinforcing the important of documentation.
You are correct about difficulty of tracking down physicians. I recently had a situatio where I repeated called the physician(s) involved on the case, RN working alongside one of the physicians and it takes a day or so to get a reply.
In the hospital setting, one can usually go up the ladder if no response but how is that handled in the home care setting.
Any suggestions?
PS- Are you a surveyor?
Having worked on the other side of home care, I realize that it is very challenging to contact some physicians. From the survey side, it's not the surveyor's concern how challenging it was to get in touch with the doctor. It's not to be callous or indifferent to the challenges you are facing in home health, but the surveyor hears a lot of excuses and it is impossible to separate out which ones may be legitimate. If you are unable to reach the doctor regarding a patient concern, you should document your (hopefully) multiple attempts, exactly who you spoke with at the office, what the conversation entailed, etc. If you are a field nurse, you should also speak with your manager about the patient concern and the actions you need to take and then document your conversation. As another poster mentioned, you can also try alternative methods of communication, as long as there is documented evidence of it. Depending on the situation and how serious the patient concern is, you may want to consider bypassing the physician and sending the patient to the hospital, contacting another of the patient's physicians, or even the referral source (depending on how soon it is after the patient's discharge).
as an RN in home health care for 18 years i have been involved with numerous JACHO and DOH surveys...they surveyors look for basics..if youhave orders for services..where they placed..if not why..d/c orders medlists inthe home match the 485? if not why..are treatments ie wound care foleys wound vacs o2 etc being done correctly as per md oders? documentaion of abnormal clinical findings addressed and md contacted? outcomes of md converstaions documented? change of orders sentin timely fashion?? coordination of care between all services documented?are goals being met? its actually relatively simple although such a high level of stress. they interview the patients and families do they know how to reach the agency? when to contact agency? i always tell my patients if you dont know the answer an acceptableone is its in the folder!(our soc packet)of course basic bag technique hand washing and infection control..was pain addressed ? meds reconciled?just your basic everyday practices..unfortunately what seems so simple can be so difficult when due to our caseload documentation isnt always up to par..just relax deep breathe have someone review the chart prepare patients for things to expect be yourself and be careful where u put down your bag...We are expecting both DOH and JCAHO in next two weeks GOOD LUCK YOU WILL DO JUST FINE ..
I think what surveyors focus on varies region to region, depending on what the prevalence of issues/citations are for that area. Our last survey here they focused on Human Resources, documentation related to case management communication and always always always, are your nurses following the plan of care. Therpay communication and timeliness of 13/19th visit evals I'm sure will be assessed as well.
As far as the tag with the highest frequency of being cited on survey, I couldn't say for sure. I can tell you that the biggest issues that I see are related to documentation and communication. An agency may be providing wonderful care, but if it's not documented, it didn't happen as far as I'm concerned. This is Nursing 101, but you would be surprised how many agencies forget this. And communication is also a challenge in any setting. In home health care, clinicians often tend to think that because a physician is not on site, they are hard to get a hold of, or are challenging to work with, that they just don't need to make the effort and document accordingly. Or there is no collaboration within the home care team.
I can't tell you how often or how many times I tell my nurses this, but they just don't comprehend. There really is no difference between what a nurse should do or how they should perform their job in either setting. As you said, it is taught the first day of nursing school....if it's not documented, you didn't do it!
I am a DON of an agency in the state of Texas and recently went through our triennial state survey. I know I have heard that the big ticket items are Coordination of Care and Plan of Care. They love to look for instances where clinicians fail to communicate with either the physician and/or their supervising nurse. Their newest bone of contention is management of the CHF patient, which is what I was dinged on, which involves a little of Coordination of Care and a little of Plan of Care. Pretty much, the best advice I can give is make sure your nurses document, document, document and communicate, communicate, and communicate and oh, document that communication! As previous posters mentioned, stay calm, be cooperative and provide the surveyor what they need to get in and out as fast as possible. I can't even begin to imagine how an initial survey is like. You will do fine! Keep the faith!
HealthyNurse
143 Posts
Having worked on the other side of home care, I realize that it is very challenging to contact some physicians. From the survey side, it's not the surveyor's concern how challenging it was to get in touch with the doctor. It's not to be callous or indifferent to the challenges you are facing in home health, but the surveyor hears a lot of excuses and it is impossible to separate out which ones may be legitimate. If you are unable to reach the doctor regarding a patient concern, you should document your (hopefully) multiple attempts, exactly who you spoke with at the office, what the conversation entailed, etc. If you are a field nurse, you should also speak with your manager about the patient concern and the actions you need to take and then document your conversation. As another poster mentioned, you can also try alternative methods of communication, as long as there is documented evidence of it. Depending on the situation and how serious the patient concern is, you may want to consider bypassing the physician and sending the patient to the hospital, contacting another of the patient's physicians, or even the referral source (depending on how soon it is after the patient's discharge).