State Surveyors

aortas · May 23, 2014

State came in a couple weeks ago when I had the pleasure of being the charge nurse. When the surveyors showed up at 830a I was busy attending to a patient who was in respiratory distress. 911 and MICU had just showed up and I was giving report to them when another nurse motioned at the door that the state was there! Greet timing!! I handled my patient, sent him out to the ED and then gave a walk through of my subacute unit and the facility. I personally was never med passed, they didn't watch me do any treatments...essentially left alone which was a relief. I guess I made a good first impression :) the state left in 2 1/2 days and we had a perfect survey with no deficiences!

wtf4527 · Apr 3, 2015

But what if the survey staff are extremely hostile towards facility staff?? The team we get every year is horrible. Even family members and residents become very upset with them. One family member became very tearful and ripped them a new one!! Do they have to report that?? Or should the facility?? How do you make a complaint about a state surveyor?? This same team seems to make violations up. We follow what they want us to do but then tag us for it anyway. Have you ever heard of a tag for "prohibiting the resident's right to fall"?? We made interventions that were approved by the resident and her family due to her frequently falling but still received this tag?? Also received a tag for med errors but state surveyors could not provide us with statistical info. They told our Medical Director that "it just seems like a lot". And gave us an IJ tag. Awesome.

CapeCodMermaid, RN · Apr 3, 2015

In Massachusetts there is a process by which you can complain about a surveyor or a whole bunch of them. You call their boss. We complained about a complaint surveyor who said something about a "G_d damned crucifix" and asked if a resident's grandson was gay because he knew what belongings she had in her room. They are NOT the Gestapo and cannot make things up.

There is also the IDR process. Call your state's DPH chief and find out how to resolve this.

twinsmom788 · Apr 3, 2015

But what if the survey staff are extremely hostile towards facility staff?? The team we get every year is horrible. Even family members and residents become very upset with them. One family member became very tearful and ripped them a new one!! Do they have to report that?? Or should the facility?? How do you make a complaint about a state surveyor?? This same team seems to make violations up. We follow what they want us to do but then tag us for it anyway. Have you ever heard of a tag for "prohibiting the resident's right to fall"?? We made interventions that were approved by the resident and her family due to her frequently falling but still received this tag?? Also received a tag for med errors but state surveyors could not provide us with statistical info. They told our Medical Director that "it just seems like a lot". And gave us an IJ tag. Awesome.

Big sigh... Surveyors should not be hostile toward staff/family members/or residents. Surveyors in my state have been fired for that. We had surveyor evaluation forms to be filed out by the facility and sent to our boss's boss. Unfortunately, I have heard of a resident's right to fall which I totally disagree with. in the regulations there is a formula for citing medication errors. Ask the surveyors for specifics which should be in the 2567.

NurseQT · Apr 5, 2015

We just went through a particularly gruesome annual survey with surveyors who seemed to really be nitpicking. We were cited with a dignity tag for one, their examples given were "staff member remained standing while feeding a resident" and "staff member was heard saying to a resident 'keep eating'". Seems like they were reaching... Our big one was an IJ for pain, the tag was based on two VERY confused patients. One who will yell while cares and repositioning is being done. As soon as no one is touching her she instantly stops. There are never any other indicators of pain. She rarely will take any PO meds and has a son who is VERY involved with her care. He has made it clear that he does not want his mom over medicated to the point where she does nothing but sleep. When state was in house they demanded that this resident be given an APAP supp for her "pain". Her son was livid as was her MD who has said he may present this case to the state himself.

The other resident is one who has a daily drsg change and yes he has pain but he also has a lot of anxiety and dementia. He'd yell "in pain" before the dressing was even removed but made no complaints when the actual wound was cleansed and no sooner was the drg change complete and he'd be smiling and would say he was "doing great!". He was one that we were actively monitoring and his provider had been playing with his meds trying to find the "happy medium". When the surveyors observed his wound care they decided that three of them needed to be in the room! He was even more agitated because there were three strangers standing there staring at him! They said we needed to increase his scheduled pain meds, which the provider wrote new orders for. Two days later they had the audacity to say we were over medicating him! It was a lose:lose situation for us.

lumbarpain, ADN, RN · Apr 6, 2015

I have the pleasure of working 3-11, although the surveyors came down to our unit with their little clipboards, watching and observing, I didn't feel threatened by them...I however was very nervous if one of them would approach me..but I kept reviewing in my head all the important things to do....don't walk away from the cart without locking it...the right patient, right dose, right time, right medication and right route... privacy, pulling curtains....proper med administration with GT tubes/and flushes. Checking Patient ID bands before giving meds and calling out their name if they are able to answer you. Delegating to CNA to answer those callbells within 5 minutes..or I would answer it. making sure wandering patients DONT wander into anyone elses rooms....many things....I was rehashing this over and over in my brain. Plus making sure I washed my hands before entering the room and after. the State left our facility earlier than expected....but we did get cited...but my opinion is...why do they wait until the last minute to polish up the facility and staff...its very stressful.

twinsmom788 · Apr 7, 2015

Most of the tasks you are reviewing in your head are basics I hope you are doing all the time whether the state is watching with their little clipboards or not. Please don't stop when the state leaves... Sigh

twinsmom788 · Apr 7, 2015

State surveyors are there to evaluate the care you and others provide to the residents. They are not in position to "demand" any thing. If there was a problem with pain control that should be cited and left to the facility to correct the issue.

twinsmom788 · Apr 7, 2015

Where was the survey team leader. Too many people in the room!

wtf4527 · Apr 7, 2015

They have been extremely brutal this year. They extended our survey and tomorrow will be day number 8 with them. We have an IJ tag for med errors that were all resolved and nothing bad happened as a result of them. No actual harm came to a resident as the IJ tag states. Our poor DON and Administrator have both put in like 80+ hours in the past week. Also the DON has to face the board of nursing and is very fearful of losing her license right now. We follow all our policies and protocols at all times. These med errors were just human errors and not on any controls or "major" meds. It just feels like sometimes their goal is to get us shut down. We are a small, privately owned facility and the fines will be devastating. We follow their guidelines and algorithms but are told that it is all "open to interpretation" and get tagged anyways. When we ask them for help the say "well follow your facility policies". Okay--but that is never good enough!!

busybee22 · Apr 16, 2015

I relatively new to LTC and have only been a nurse for 9 months. I am very anxious over the thought of the survey!!! Is there somewhere I can go to read all these in-depth rules such as "wash your hands with soap/water after q3 med passes" and "don't serve milk in a carton" etc.? I asked my DON for the guidelines but they were very generic and not very helpful. I practice in Kentucky.

CapeCodMermaid, RN · Apr 16, 2015

Does the Kentucky Department of Public Health have a web site? If so you can review regulations there....just be ready for your head to explode! Your pharmacy should be able to help you out with any regulations in regard to the med pass.