when state comes to visit

[mrsbiggy]

i would appreciate any advice you all can give or important lessons learned when state has visited your facility.

for example a few nurses at my facility have been sited for not noting in mar amount of min. for an aresol treatment, ie. ) you initial and underneath intials you put 5 for the amount of min. it took to give treatment.

paper towel under your bs reader, aresol equipment supplied in a bag at the bedside ( after you have rinsed and dried it)

so please any tidbits on those little things we seem to forget when the stress of state has been there. even if it's just something you know of - you don't have to personally expierence it ourself. i am just trying to have a checklist in my mind.

thanks in advance for any advice

[madwife2002, BSN, RN]

Red rules are something that should be upmost in your minds.

Dont leave any meds unattended anywhere.

Indroduce your self to pt and read name band

Nothing in site which could cause HIPPA violations

[catlynLPN]

date the insulin bottle was opened...they're said to be good for 28 days after opened

cover the MAR with something if you leave the cart, so passersby can't read it

use gloves when giving eye gtts and sanitize hands before and after putting on the gloves

don't leave meds at the bedside unless it's ordered the patient can self medicate

That's the few that come to my mind. There are zillions more.

[mudd68]

:thnkg:If it says 'give with food'...give with food, even if it's a cracker! If it says mix with 8oz of fluid...mix with 8 oz of fluid. Change gloves/wash hands when doing dressings, before you start, after removing the old dressing, and after putting on the new. At my facility, the last time state was here, they counted how long nurses were washing their hands:spbox:...the nurse was cited if it was less than 10 seconds. Keep a drug book near by. They may ask you about drugs you're giving and why. It's okay if you don't know. Just say "I will look it up". Pull curtains, lock med carts, close books, identify yourself and your patients. Know fire (RACE) protocol :flmngmd:. Know when and who to report abuse to. Most of all, Breathe. You have the right to have your manager/supervisor present for any/all state inspections. You also have the right to refer to your manager at the time of audit to answer questions :confused:for you. Don't hide or try to avoid the auditors, :sofahiderI think they can sense nervousness. Relax:tbsk: and... Good Luck.

[htrn]

We just found out that our crash carts have to be lock with more than just red tags (i.e. combination lock). All needles and syringes have to be locked. They are apparently hitting documentation hard - esp. in the ER around here.

We have a whole list at work - I will refer to it and post again.

[jnrsmommy]

Advair, once removed from the foil pouch, is only good for 30 days, does not matter how many doses are left in it.

Xopenex is only good for a couple of weeks once the foil pouch has been opened (still looking for the exact amount of time).

Never, ever, ever leave meds unattended. Even if you are experiencing difficulties giving said med(s) and need to get help.

Document, document, document. No matter how small a matter might seem. If it takes time out of your schedule to take care of it, it needs to be documented.

[evilolive, BSN, RN]

Thanks to the OP for starting this thread. I am in my first year at a LTC facility and could use some assistance. I work nights, so I don't think I should run into surveyors too often, but I have learned a few things. For instance, I was told the way to do narcotic count when the state is here from a nurse who was per diem. Apparently you read the drug name/dosage/patient name from the book, and the counter compares the number of the drug to the number written in the narc. book.

I haven't been through a survey before, so I would be completely lost as to the right way to do things if they came in before 7am!

Any info helps, thanks :)

[Vito Andolini]

Rule #1: Take a vacation day. The hypocrisy of it all is just so aggravating.

[ktwlpn, LPN]

You and your co-workers should be in the habit of doing things the right way all of time then it won't be so stressful when the state arrives...They will show up on off shifts so everyone should be well prepared. Most tips others have mentioned here are things we do routinely.Mudd68 has some great advice-they can smell fear.Don't try to hide because they'll seek you out. Our facility is changing-we are starting to view the dept. of health as part of the caregiving team instead of adversaries. The DON has called on them numerous times for input into challenging situations involving both residents and their s/o's... Good Luck

[mrsbiggy]

Thanks, these are all really good keep posting I sm gonna write these in my note book. Some are no brainers and for the most part I try not to develop bad habits but state catches people on the craziest things. One thing I know we are told about was on a tube feed after you rinse the piston syringe you put in back in the bag in 2 pieces (rather than the plunger inside the syringe) because bacteria breeds when it's stored together. It makes sense however I was not taught this in school. It was something I was taught at work. So keep listing. I think it could only help us. : )

[whipping girl in 07, RN]

When inspectors come they have to check in and be accompanied by hospital staff, like QRD or management. They can't just wander up to the floor without the hospital staff.

Is the interdisciplinary plan of care up to date? Is it truly interdisciplinary or just filled in by nursing? Nutrition, for instance, should be filling in their part if they are following the patient. Same with PT, OT, ST, RT, etc.

Document time out before invasive procedures.

You must follow your policies. If the state standard for meal tray temperature is 135 and your policy is 140, you will be cited if it's not 140. You have to make sure your policies/standards are in line with the states. Probably not smart to go above.

Where do you find your policies and procedures?

Two identifiers for patient. Confidentiality. Hand hygiene.

We just had state in a month or so ago. They watched me place a feeding tube. I was kind of nervous but everyone said I did just fine.

The inspectors are people too. I was nice and friendly and made sure to not take any short cuts.

[1776patriot]

You and your co-workers should be in the habit of doing things the right way all of time then it won't be so stressful when the state arrives...They will show up on off shifts so everyone should be well prepared. Most tips others have mentioned here are things we do routinely.Mudd68 has some great advice-they can smell fear.Don't try to hide because they'll seek you out. Our facility is changing-we are starting to view the dept. of health as part of the caregiving team instead of adversaries. The DON has called on them numerous times for input into challenging situations involving both residents and their s/o's... Good Luck

I agree to a point about doing things the right way but some of the things the state surveyors require are getting down right stupid. You're better off not working that day or two when they visit. My advice: If they must watch a med pass cherry pick one of your easy residents that will take them nicely and only has a couple of pills. If you keep your hand sanitizer in a drawer make sure to make a production while putting it on. Wear gloves when opening capsules for people that have crushed meds. Make sure your resident is available to take the meds before you set them up.