State Tags

noc4senuf · Apr 29, 2011

I do not have P&P for anything unless the regs state you need to have one. I do have "guidelines", which at the front of that binder is a statement that they are only guidelines and the nurses may deviate from them as they see fit.

CapeCodMermaid, RN · Apr 29, 2011

I worked in a building which lacked many P&Ps. The survey team came in and demanded to see one for whatever it was. The DON told them it was on my computer and I'd print them off a copy. Then she told me to hurry up and write a policy to give them! Thank goodness I can type at 50+ wpm

noc4senuf · Apr 29, 2011

They always asks for P&P..... then will site you for not following them. That's why I don't use them........... they can't site me for guidelines.

CompleteUnknown · Apr 29, 2011

They always asks for P&P..... then will site you for not following them. That's why I don't use them........... they can't site me for guidelines.

Hi there noc4senuf, can you expand on this a little? Sounds like a great idea, just wondering what sorts of things you cover in your guidelines? Have you ever been asked how you monitor deviations from the guidelines or anything like that?

noc4senuf · Apr 30, 2011

For example... pressure ulcers. We have a formularyas to what the nurse should do for a particular wound but, the nurse can decide what type of dressing is used. we had taken the P&P book and completely revamped it. No longer does the words policy or procedure show up in it.... it a guideline. No need to monitor a guideline.

CompleteUnknown · Apr 30, 2011

Thanks for replying noc4senuf. :)

I see what you're saying, perhaps our policies aren't as rigid as some as many of them leave room for nursing judgement. I'm keen to have a look at the policy manual again now, if only to help stave off that 'I see your policy states abc and yet I note here, and here, that abc didn't happen. Are you able to explain to me why that is?' Arrrggggh. Lol.

CapeCodMermaid, RN · Apr 30, 2011

We had an issue during survey with PICC line documentation. The DON told me to go 'talk to the surveyors and explain why we did what we did.' OK, but I wasn't even working at the building when this happened. I showed the policy to the surveyor. He said, "Good try, but the STANDARD of PRACTICE says........" We got a tag.

CompleteUnknown · Apr 30, 2011

We had an issue during survey with PICC line documentation. The DON told me to go 'talk to the surveyors and explain why we did what we did.' OK, but I wasn't even working at the building when this happened. I showed the policy to the surveyor. He said, "Good try, but the STANDARD of PRACTICE says........" We got a tag.

Yes.... sorta what I'm thinking might happen.....

ssmandile · May 1, 2011

I worked in a building which lacked many P&Ps. The survey team came in and demanded to see one for whatever it was. The DON told them it was on my computer and I'd print them off a copy. Then she told me to hurry up and write a policy to give them! Thank goodness I can type at 50+ wpm[/quote
When I was surveying we actually saw this a great deal, and we knew that policies were being written when requested, but guidelines, policy whatever your facility uses, is not really the point, anything can be written up to support an action. Evidence based practice is really what is being looked at now and the documentation from a surveyor, regarding a breech in clinical practice, that goes into the reports generally have to have an evidence based source for validity. Another thing being looked at is consistency of practice, do all nurses on all shifts have a consistency in practice for the same type of problem, like pressure ulcers, does a facility have "guidelines" in place which inform the nurse on the floor as to the appropriate action to take,for example, when a non-blanchable erythema develops in a suspect area. Sounds simple, but you would be surprised at some of the goofy things that go on. Some of the most efficient facilities I have been in used decision aids or critical thinking trees for decision-making, can be computer based or paper based, as a support for nursing decisions. I work as an ADON right now, and I get so frustrated at the lack of consistency in approach, and it seems to be the little things that trip us up every time.
Surveyors only are focused on negative outcome, whether potential or actual, to patients. If they can connect the dots they will.

cheleb61 · May 4, 2011

I know glucometer cleaning is an issue. Make sure you are following the manufacturer's guidelines and using the proper cleaning product. Also make sure that the barrier is used and the glucometer is allowed to dry for at least 2 minutes before bing used again. A facility in my area just got a tag for not completing a dental assessment. There's always a potential for tags related to falls. Be sure that your fall risk assessments are correct and that your interventions are in place. Unnecessary meds is one that quite a few facilities have gotten hit on. Be sure that there is proper documentation about using PRN meds and their effectiveness after being given. If you feel you have a problem in a certain area include it in your QA/PI. Sometimes that helps to avoid a tag or decrease the level of the tag. It shows that you are aware of the problem and are doing something about it.

NurseGuyBri · May 5, 2011

The rules I've been hearing are major Dignity issues and infeciton control. but then again, you know they'll page through everything, find a small flag, and then run with it.

debRN0417 · May 7, 2011

They always asks for P&P..... then will site you for not following them. That's why I don't use them........... they can't site me for guidelines.

In our state the surveyors cannot cite for PP alone. There must be evidence of deficient practice. Just saying that you did not follow your PP is not enough. However, you must have PP...the state regulations require it. (In my state). Review your state licensure regulations. There are also Federal regulations that call for the facility to have policies and procedures...like the abuse tags...