State Surveys And Wound Care

Salisburysteak, BSN, RN · May 19, 2012

State surveyors look at everything in your facility. I went through my first survey last year and it was something! With wound care state looks at everything Nursing. They will watch a med pass; they look to make sure you are correctly giving the meds and doing it the appropriate way i.e. if it it a resident is a tube feeder you are giving the med(s) properly through the tube also they will look at the MARs to make sure all orders are correct. For example, if a resident is on Digoxin and you do not check the residents pulse, you are liable to get a tag. State will look through charts to make sure all information is in the chart like care plan, MDS info, therapy notes, dietary notes, nurses notes, and even a proper face sheet. For wound care, a surveyor may go with the tx nurse and watch them do txs, they will look at all the skin assessments, wound care documentation, and even check to see if wounds are in-house and preventable or if a resident came in with a wound(s). A tag can be given for an in-house wound if it could have been preventable. Documentation is very important! Surveyors also will watch the CNAs do their ADL care. even not closing the curtain all the way can be something they can give a tag for! Surveyors will watch a tray pass to make sure it is being done properly and staff is interacting with the residents ( had a CNA tell a resident she could not get water during a meal, and we got a tag! I could have strangled that aide!). They also look at housekeeping, maintenance, therapy, HR, social services and any other thing they see.

I clocked 70 hours that week state was in the facility I worked. They were there for four days! In my state(GA) they changed the way survey was done (all electronically) and the surveyors had an area where they interviewed residents form everything to the food, noise, care, and activities. Surveyors will also ask why you are doing something like why are you giving resident X Valproic Acid, or why does Resident X have a Foley.

It is a stressful time, but you will get through it. Use it as a learning experience and Good luck! :nurse:

DO NOT FORGET TO WASH YOUR HANDS!! Especially during med pass and tray pass! Pull the curtain during any cares. Make sure ALL documentation is up to date especially weights, I & O's, restorative, skilled nurses notes! Pretty much everything!

CompleteUnknown · May 20, 2012

I would add that when the assessors are in the facility, while they may not actually stand next to someone and observe every medication round that happens during the survey period, they DO have eyes in the backs of their heads and will notice errors in procedure or poor practice from seemingly the other end of the facility. You think they are safely reviewing falls documentation but they will still hear and see everything unless you are able to somehow lock them in a soundproof windowless room! They will also suddenly appear around corners and have the magic ability to overhear exactly the conversation you desperately don't want them to hear.

I'm not trying to scare you, just saying follow all your procedures and don't try to get away with cutting any corners when they are in the facility. :)

jenornwccdwc · May 21, 2012

Hi,

I have worked in long term care for 13 years and the last 6 of them I have been the Wound Care Certified nurse (WCC). I have been through many surveys and many skin related deficiencies as well, until I became certified in wound care once I became certified I was able to re-write our skin policy and update our practices to meet the current standards of care, since then we have been deficiency free.:w00t:

As far as the survey process goes, the surveyors will us F-Tag 314 as their guideline - you really should review it prior to survey. They will be looking for things such as your risk assessment tool (for accuracy and timeliness), for interventions for those patients at risk (reviewing care plans and patients bed / seating), they will want to be sure you have daily skin checks in place for your high risk residents, that there are COMPREHENSIVE wound assessments at a minimum weekly (this is where certification comes in handy for your facility - having an expert in wound care doing the assessments and documentation really saves you), they will watch you do dressing changes and make sure that your procedures are following the standards of care and your treatment selection is valid and also using the latest standard of care. They will monitor your infection control practice in regards to wound care as well. That you have made referrals when needed. They will focus more on pressure ulcers, but if someone has an open area related to moisture or incontinence they will want to be sure you are not coding it as a pressure ulcer and that you have documentation supporting. They will look at the staging, and measuring of your pressure ulcers for accuracy. They will look at Arterial, Diabetic and venous ulcers too. They will look at how the order was written and how it was transcribed into the treatment book for accuracy, they will check the treatment book to be sure if the order says every three days that the dressing was changed every three days. They will look at all aspects of documentation - team notes- MD, Dietician, social work, nursing etc. They will watch the aides do bedside care and question them about any interventions that are in place, like turning schedules etc. They also compare bedside notes to the MDS.

, Good luck! :)

classicdame, MSN, EdD · May 21, 2012

if you know and are following hospital policy you should not have to worry. Amazingly enough, the most frequent mistakes are the "simple" ones, like not washing hands before/after entering a room, checking for two id's----