State is coming and I'm a wreck..

brownbook · Jul 28, 2010

You sound like a great nurse. Unfortunately I don't know any specific answers. Your facility policy and procedure manual should give you some answers. You can make copies of any specific procedures that apply to your questions. That way you can re-read them at your leisure and understand them better. Unfortunately policy and procedures manuals are often a little vague while you have very specific questions.

I float to two different sites owned by the same company. At one site we clean the glucometer after every use, at the other they are ok with a cleaning at the end of shift! Try not to drive yourself crazy!

The best thing to remember with inspections is it is ok to say "I don't know, BUT, the policy and procedure manual is at the nurses station," (or wherever you keep it) "I can look that up". No inspectors expect any nurse to have the whole manual memorized.

nyteshade, BSN · Jul 28, 2010

does your facility have a "cheat sheet" for med pass? if not, check in the huge policy books. i know no one enjoys looking through them, but if something ever came up, you can always direct the surveyor to the policy books.

blessedmomma247 · Jul 28, 2010

State is also at my LTC...here is my tips:

1) Remember the RIGHT of MEDICATION ADMINSTRATION ( right pt, right time, right dose, right route, right documentation, right medication)

2) Wash/Santatize hands frequently.

3) I have never worn gloves while pulling or giving meds; only if its insulin, topical or eye drops.

4) After each glucoscan, clean the meter with Santi wipes. I also clean the pill crusher frequently.

5) Follow your normal routine. I have 28 pts and its physically impossible to pass my 8am med pass in the time allotted. Some pts are not up until after 9am...Just do the best you can.

6) If they ask you a question, think about it as an open book test...you have the chart, the MAR, the TAR at your finger tips...use them. Just say, " Oh, sure, give me a minute to look that up." They usually ask who has a foley and why, are they on a supplement (like med pass) if a pt has had a fall in the last 30 days...stuff like that. If you are not able to answer..just say, "You know, I am not sure of that answer, but let me get someone who can you." And then find someone.

7) RELAX!! YOU WILL BE FINE!!

Hope this helps!!!

SuesquatchRN, BSN, RN · Jul 28, 2010

State is also at my LTC...here is my tips:
6) If they ask you a question, think about it as an open book test...you have the chart, the MAR, the TAR at your finger tips...use them. Just say, " Oh, sure, give me a minute to look that up." They usually ask who has a foley and why, are they on a supplement (like med pass) if a pt has had a fall in the last 30 days...stuff like that. If you are not able to answer..just say, "You know, I am not sure of that answer, but let me get someone who can you." And then find someone.

This, especially. "I'm not sure. Perhaps the DON (or unit manager, etc.) knows." Do not be led into discussions about what you "thought" about x, y or z.

JB2007, ASN, RN · Jul 28, 2010

1st of all calm down, take a deep breath you will be fine. Do not leave your med or tx cart unlocked when you walk away from it ever. I have always just checked the name bracelet and the picture when giving a resident their meds and state has not had a problem with it yet. I do not clean the pill crusher until my med pass is done unless some of the crushed meds come out of the cups and onto the crusher. I sanitize my hands before giving the med and after I give the med. Clean the glucometer between each use or according to your facilities policy.

Use the basic safety precautions that you learned in school and you will be fine. Word to the wise, do not leave a resident on a NEB tx and leave the room. State does not like that at all.

eriksoln, BSN, RN · Jul 28, 2010

Just a quick post for my input:

I've been on the unit at the time of a survey a few times. I think a lot of managers would do themselves a favor by not whipping everyone up into an anxiety driven frenzy with these surveys.

TBH, it was not the survey people or anything that was said in any survey that bothered me. It was the managers and admin. running around trying to tie up loose ends they should have taken care of months ago. They stressed everyone out, were unprofessional at times (I had to get mean with one manager who kept interrupting a D/C to tell me things that I did not care to be bothered with "Don't forget, if they ask this question the answer is...............blah blah".

The survey people in my experience are not there to slam the nurses unless they find GRAVE reasons to do so. I had one talk to me and ask me a few questions about how I dispose of biohazards. Another simply said "hello" to me and asked me how I crush pills.

Don't stress to the point of getting an ulcer over this stuff. That's for management.

misschiatia · Jul 28, 2010

Try to remember that the state surveyors are there to make sure we maintain reasonable standards of care. They really are not there to put good nursing homes out to pasture. It's the bad ones their looking for. You would know it by now if your employer was providing sub standard care, so if you work for a home that you can be reasonably proud of. You should be OK.

About your questions...

I work in the state of Missouri. Regulations vary from state to state, not so much from home to home. So the 1 hour before and after is accurate(at least in my state). Please remember, all of these pointers are relevant ONLY to the state of Missouri, and the state is the best place to ask SPECIFIC questions. These pointers are in general only.

You do not have to wear gloves while handling the medication, but your bare hands should also never touch the pill. Nor must the pill lie on the counter, med cart, or other possible source of contamination. Our community uses bubble pop. In theory, on a good day, you should be able to pop the pill from the card to the pill cup without ever touching it. When state is in the building, of course it will fall, spill, or otherwise manage not to land in the cup. In which case you discard the pill and pop a fresh one. Remember to get another nurse to destroy if its a narc.

In my state, you do not have to wash your hands between every patient. A good squirt of hand sanitizer is absolutely appropriate. I believe that there is a cutoff though. You can use hand sanitizer if your hands are not visibly soiled,but if you have visibly soiled hands they MUST be washed. Also, I think you can only use the hand sanitizer so many times. The number of times escape me, but I think you have to wash your hands every 3 hand sanitizer applications or something like that. Check on that stat with your DON.

Glucometers must be cleaned between each resident use. We use a special type of wipe that the state(they have a list in MO. ) approves between pts.

Taking the med cart in the resident room is a NO-NO where I work. Instead I recommend park it at the doorway facing you. As long as you are within sight of that cart, I believe you are allowed to walk away from it without locking it. I wouldn't walk far. But from the doorway of that small room to the bedside is OK. From the top of the hall to the end of the hall to answer a call light is altogether too much distance.

Gloves are required for eyedrops. Remember to take a tissue.

I wish you all the luck, but just be the excellent nurse you are every day, and youll be fine.

morte, LPN, LVN · Jul 28, 2010

found out today that you need TWO tissues for eye drops, one for each eye!

BittyBabyGrower, MSN, RN · Jul 29, 2010

-Is the 1hr before and after window during medpass universal or does that depend per facility's policy? I believe this depends on the state...ours is half and hour...got dinged by CMS on that one.

-Is wearing gloves when handling meds necessary during medpass? If yes, do I have to remove gloves everytime I open their cart? we wear gloves when drawing up IV meds

-Should I take my medcart inside patient's room or may leave outside patient's room but locked? we have a central med area, sorry

-Is checking the room number and ID bracelet the only thing I have to secure before giving meds? The 5 R's, and make sure you look at the ID band. They may ask you what how you ID your patient...last name, DOB, MR number

-Should I sanitize my hands before and after medication administration? Or handwashing is a must? (I sanitize my hands after giving meds and leaving the room.) Wash/sanitize before med pass, and upon leaving room

-Glucometer: When to clean it? Ours is once a day unless soiled

cebuana_nurse · Jul 29, 2010

1st of all calm down, take a deep breath you will be fine. Do not leave your med or tx cart unlocked when you walk away from it ever. I have always just checked the name bracelet and the picture when giving a resident their meds and state has not had a problem with it yet. I do not clean the pill crusher until my med pass is done unless some of the crushed meds come out of the cups and onto the crusher. I sanitize my hands before giving the med and after I give the med. Clean the glucometer between each use or according to your facilities policy.
Use the basic safety precautions that you learned in school and you will be fine. Word to the wise, do not leave a resident on a NEB tx and leave the room. State does not like that at all.

Really? If I sit down and wait for a neb tx to be done for 10-15 minutes is absolutely ridiculous. I'll be way too late for my medpass. No wonder a lot of nurses hate when the state comes in, it wrecks individual medpass system..

cebuana_nurse · Jul 29, 2010

Try to remember that the state surveyors are there to make sure we maintain reasonable standards of care. They really are not there to put good nursing homes out to pasture. It's the bad ones their looking for. You would know it by now if your employer was providing sub standard care, so if you work for a home that you can be reasonably proud of. You should be OK.
About your questions...
I work in the state of Missouri. Regulations vary from state to state, not so much from home to home. So the 1 hour before and after is accurate(at least in my state). Please remember, all of these pointers are relevant ONLY to the state of Missouri, and the state is the best place to ask SPECIFIC questions. These pointers are in general only.
You do not have to wear gloves while handling the medication, but your bare hands should also never touch the pill. Nor must the pill lie on the counter, med cart, or other possible source of contamination. Our community uses bubble pop. In theory, on a good day, you should be able to pop the pill from the card to the pill cup without ever touching it. When state is in the building, of course it will fall, spill, or otherwise manage not to land in the cup. In which case you discard the pill and pop a fresh one. Remember to get another nurse to destroy if its a narc.
In my state, you do not have to wash your hands between every patient. A good squirt of hand sanitizer is absolutely appropriate. I believe that there is a cutoff though. You can use hand sanitizer if your hands are not visibly soiled,but if you have visibly soiled hands they MUST be washed. Also, I think you can only use the hand sanitizer so many times. The number of times escape me, but I think you have to wash your hands every 3 hand sanitizer applications or something like that. Check on that stat with your DON.
Glucometers must be cleaned between each resident use. We use a special type of wipe that the state(they have a list in MO. ) approves between pts.
Taking the med cart in the resident room is a NO-NO where I work. Instead I recommend park it at the doorway facing you. As long as you are within sight of that cart, I believe you are allowed to walk away from it without locking it. I wouldn't walk far. But from the doorway of that small room to the bedside is OK. From the top of the hall to the end of the hall to answer a call light is altogether too much distance.
Gloves are required for eyedrops. Remember to take a tissue.
I wish you all the luck, but just be the excellent nurse you are every day, and youll be fine.

In the state of PA, I know there is a 1hour window before and after medpass, but I'm not sure if this also applies to FS. Say if the resident gets a FS at 1600, can I do it at 1530?