State Tags

CapeCodMermaid, RN · Apr 23, 2011

I think it varies by region. Last year I had heard that infection control was a huge issue including cleaning the glucometer between uses. My pharmacy is telling me that proper use, documentation, and disposal of medications that come in patch form is a bigger deal than in previous years. Resident dignity is always an issue here in Massachusetts...care plans are being looked at more closely, too.

I am due for survey any minute....when they're done, I'll let you know what we got tagged on.

PammyRN,CEN · Apr 23, 2011

We are also due for survey any day now. I am ready for them on Monday! They did go to a sister facility recently and they were looking for siderails assessments, orders and careplans. We have a lax med pass policy that is resident centered... am meds must be completed by 1000. They were reviewing dialysis patients, agreements P&P and careplans. Thats as much as I know at this time.

I will post after survey, my building is facing a G due to falls with fx. If anyone has anything to share I'd also appreciate it.

CapeCodMermaid, RN · Apr 23, 2011

A fall with a fracture doesn't necessarily mean you'll get a G tag. Did you assess the falls risk? Were there interventions in place to prevent a fall? If you assess, plan, and revise as necessary, you should be okay. But sometimes it all depends on the particular surveyor which is why the system is so horrid.

achot chavi · Apr 23, 2011

ALl these issues are important, you never really know what they are going to zero in on, the important thing is not to open any doors you dont want them to go through- give short, to the point answers. They always check charts of new admits, pressure ulcers etc.

Yes, You have to revise care plans after every fall as if that will really prevent a fall- but we do the best we can.

If definitely depends on the surveyor. Best to be professional and not chummy.

How do you prove glucometer cleanings? Do the nurses have to sign after every use like we do for the EKG machine?

Ruas61, BSN, RN · Apr 24, 2011

They looked at dental, medicare denial letters- particularly demand bills, reference checks.

marthyellen · Apr 24, 2011

How do you prove glucometer cleanings? Do the nurses have to sign after every use like we do for the EKG machine?

Skills check list for glucometer usage and cleaning. Surveyors will watch glucose checks to verify proper usage and cleaning. Make sure the check list includes manufactures recommendations for cleaning.

debRN0417 · Apr 24, 2011

A fall with a fracture will not automatically get you a "G" citation. It only is harm (G) if the facility was remiss in ensuring the interventions were in place and updated. If your resident was assessed as a fall risk, you care planned it and put interventions in place, made sure the interventions were appropriate and if other falls occurred, revised your interventions and care plan, then you did everything you should have to prevent injury. Harm occurs if the facility was aware the resident was high risk for falls and did not do everything (revise interventions)they could to prevent injury. Sometimes no matter what you do though, an injury can happen, especially when you have older, osteoporotic individuals. If you have numerous falls with fractures, then that certainly is suspect and will be looked into very thoroughly.

With no QI's to assist in sample selection and target concerns, the survey team will most likey be doing a great deal of observation, especially on initial tour and your sample selection will be based on those observations as well as any facility reported incidents or complaints. They will also focus on residents who meet certain criteria, such as those with weight loss, pressure ulcers, feeding tubes and infections.

Medicare Demand Billing is not something that nursing has to worry about. It is related to the Advanced Beneficiary Notification and residents rights. To me, that is more administrative and business office stuff. It is when a resident has been decertified by the facility with skilled days remaining (the facility has determined that the resident no longer meets skilled criteria) and the resident has been given notification that they have the right to appeal this decision by the facility.

Glucometers are going to be looked at because I hear there is some other mumblings going on about the concern that they cannot be cleaned thoroughly, but I have not heard anythind definite yet. Just make sure you have a cleaning schedule log and that you are cleaning them per the facility policy, especially between residents.

Documentation is always an issue, as well as making sure that any issues are followed up and documented, as well as proper notification.

noc4senuf · Apr 26, 2011

The glucometer cleaning was last year in our area. Each year they have a new focus. Keep in touch with other facilities in your area and find out what they are looking at.

justus501 · Apr 27, 2011

I assume you are talking about federal tags, not state tags, as state tags vary from state to state.

-They are looking at all incident reports...reporting and investigations events..with citations at F225

-Falls are always a big one...with citations at F323

-Pain is always big...with citations at F309

-Pressure ulcers..with citations at F314

-Care planning on residents...with citations at F279

-Sanitation in kitchen..with citations at F371

-Infection control, especially with glucometers and cleansing between residents with appropriate wipes (ones that actually kill things such as C-diff).... with citations at F441.

Those are the big ones I am seeing. Also seeing some nutrition issues. Food temp with last tray pass, and pureed food stuff.

pdle1e · Apr 29, 2011

Pammy, I too am a Pammie RN CEN, I thought it was funny we have the same name and credentials! If you would, could you expand a little on your lax med pass policy? I have attended a conference recently that talked about culture change and no med pass times at all, all resident centered.

Thank You

ssmandile · Apr 29, 2011

I am new to this site but I have to agree with your statement that the focus of each year depends on the facility and their past history, I was a surveyor for a while and I can tell you the focus for each facility is determined more on the past five years of history of deficiencies and trends, you would be surprised that facilities continue to make the same mistakes over and over again, and the QI/QM reports. As far as the glucometer cleaning documentation, there is no federal requirement per se ,other than maintaining professional standards of practice, infection control and such however ,they will probably want to look at your facility policy and procedure or the manufacturers recommendation for cleaning and would expect that your nurses clean the machine properly between patients while be observed during a med-pass. That is really it, pretty simple, don't give them more information than they ask for period, make them do their own investigations based on what they know, if they need more they will ask.