Preparing for state survey nightmare

[Khaos RN]

so, the state surveyors are supposed to visit our long term care facility any day now. So, night shift has been assigned by the DON to clean the med carts. Throw out anything and everything that's dated 30 days or more, or not dated. Well, that pretty much means throw out every single OTC medication in the cart, all liquid medications and some eye drops, etc. Then go to the med room and replace all medications that were thrown out. This has been a nightmare going through a whole med cart, actually I have two to clean. The med cart has to be cleaned top to bottom.

I guess no other nurses on days or evenings use the med carts because only nights has been told to do the cleaning and then the next day the cart has more junk, more liquid medication messes because certain nurses don't know how to clean a sticky liquid off the bottle! I have 40+ residents at night and I guess the DON thinks I don't do anything on the night shift!

Anyone else see a facility go insane at State Survey time?

[Rose_Queen, BSN, MSN, RN]

Many facilities do. The hospital I work at rents 2 big tractor trailers, loads them up with all of the stuff that normally sits in the hallways because we don't have enough storage space, and then they park them somewhere during the survey. Of course, as soon as the survey is over, everything goes back to the status quo.

[bluegeegoo2, LPN]

I know that I'm urinating into the wind, but if everyone just cleaned up after themselves as they go, dated bottles as they opened them, restocked when the bottle is almost empty, etc...back to reality. I routinely have to clean up after the previous shift, (well, one nurse in particular) restock bottles as there is one whole acetaminophen left in the bottle and therefore "technically" not empty, clean the pro-stat bottle, etc. It's irritating, I know.

We have 2 med carts and 2 tx carts and it's divided between days and evenings to do cart checks to make sure those issues are addressed. Night shift is responsible for stocking/cleaning the med room. All shifts are responsible for the supply room. Most people do what they're supposed to, but there's still "those" people who don't.

Fortunately, my facility runs pretty close to survey ready at all times so there isn't a mad rush to get into compliance when our window opens. We managed to get away with 2 nursing tags this year, (one was a med bolus issue with a tube, the other infection control. Someone didn't wash/dry their hands properly.)

Your D.O.N. would be wise to implement the division of cleaning/compliance duties among all shifts year round to prevent burdening one shift to make up for the non-compliance of all over the last year. It's bad practice to allow such slack in practice then lay it all on one shift to correct, imo.

[Khaos RN]

The DON has decided she will have an in-service so that we will all know what to expect next time the surveyors come in. It should be an ongoing process, not a rush job to prepare the facility. Of course everything is dumped on night shift.

You are correct that every shift should be responsible for the med carts and treatment carts. I am constantly dumping trash from the treatment cart from the day and evening shift, restocking the med cart, and cleaning up someone else's mess. To me it's just common courtesy to clean up after yourself.

[slauren]

From my LTC it is under the impression that night shift doesn't do anything and has all the time in the world.

Sure, there are some nights that are great but when there is minimal staff in the building to help you it can be chaotic. My building tries to make night shift do most of the cleaning, organizing, and checking crash carts and accucheck machines. I work day shift now and it bugs me so much when I constantly hear "night shift should be doing this..."

There are a lot of people who don't clean up after themselves too.

[Medicarenurse1]

Yes. As a Regional Consultant, I do "Mock" Surveys, pulling all the quality reports, creating a resident sample and remotely reviewing electronic charts before I go to the building. The med carts are so easy to keep clean and well stocked that it is considered a "cheap tag" to get to cite someone on outdated meds, etc. In the last 6 months I have had to call two IJ's (Immediate Jeopardy) tags in med rooms. Of course the facilities would rather I find this, than the state, but I am amazed at how people do not understand the importance of the survey process. You should always keep your med cart clean and well stocked, not just when state is coming.

[Khaos RN]

I agree that we should all be keeping the med carts clean and not only when state is ready to walk in.

Now the emphasis has shifted from the med carts to a facility acquired pressure ulcer. The state surveyors are all over this pressure ulcer and rightfully so. There are so many other things more important than a med cart!

Sometimes I don't think our management see's the big picture.

[BuckyBadgerRN, ASN, RN]

I remember doing my computer training in an LTC I worked in for less than a year. The activities director ( I use that term loosely) literally burst through the door and said "State. Is. HERE!" and frantically started tossing undated/unlabed food from the freezer. All I could think was "Seriously? This isn't a surprise, why not label the Lean Cuisines or toss them when you see that they aren't labeled?" Yeah, I was gone by next survey time...

[ktwlpn, LPN]

They walked in today.A couple of our unit managers were running around looking panic stricken.One was barking and biting people's head's off and slamming stuff around,the other just ran like Chicken Little from one unit to the other...I'm thinking this does not make a favorable impression.And the residents feed off the bad energy and start to get agitated as well .....I did my best to speak in a low,soothing voice everywhere I went today,just hoping my Zen would rub off....Dreading Monday....I hate to see us get slammed for the same dumb stuff over and over and over.....