Tips for preparing for surveyors @ work

You don't have to know the answer to every question they ask. It is sometimes appropriate to say, "I don't know the exact answer but I do know where our policy and procedure books are and can look it up."

Wash your hands A LOT.

Six Rights of Medication Adminstration

1 right patient

2 right time

3 right route

#1 Do not be afraid of them, be confident and look them in the eye...if you shy away or hide they will harrass the hell out of you. They are looking for mistakes and they know those who get flustered will make them.

#2 Do not answer hypotheticals, you will never win in the world of "what if."

#3 You do not have to answer a question you do not know, if you do not know the answer then it is perfectly acceptable to go to your manager in front of the surveyor and ask or look it up.

#4 Scrap #2 and #3 and simply do not answer anything, most states do not have a law or written policy that says you the individual nurse must anwser a question alone on the floor. If they need to know something you can direct them to your manager or at least go and get your manager to be with you.

#5 Forget the careplans, no matter what you do your facility will ALWAYS be cited for careplans. Careplans are subjective and you cannot plan for everything so no matter what they will find a problem with one of them.

sorry accidentally hit enter

4 right does

5 right medication

6 right documentation.

hand washing / infection control, expired meds, insulins, eye gtts, etc. on med carts,

During med pass, make sure you check the mar, pull the med, give the med, then sign the MAR.

holes in the MARS,

If you crush their meds, make sure you have an order to do so,

Staying with Res during HHN tx, unless ordered that they can self administer,

Identifying Residents, calling them by name other then "honey or Sweety"

knocking on doors, privacy pulling curtains, don't do things in hallways

Cleaning the glucometer, gloves during finger sticks

Call lights answered promptly

This is just a sample of the simple slip ups that they watch for,

Just do your job, you will be fine

While this is your first survey and your first nursing job know that it is natural for you to feel nervous. Take a deep breath. This can work to your favor as many surveyors will go to another nurse that has worked there long enough to know policy and procedures. If they do choose to ask you a question, answer only if you are absolutely sure of the answer. If you don't know, you can say that BUT always follow up with another answer of "I will look in the chart and let you know." or "I will ask my manager and come back and tell you." Then make sure that you do that or they will assume that you not only you don't know but that you don't even know who to ask or where to go to find the information that you need. Surveyors know that you can't know everything at all times.

Make sure that you can easily find the Policy and Procedure Manuals, and emergency procedures. Brush up on Infection Control policies and follow them. As for the general nursing duties, calm down and don't let them rattle you. Do what you were taught to do and know to do. They will observe that you are following patient rights as listed above, that you give privacy to your clients, that you give the meds in the appropriate times. If they ask to follow you on a med pass and say that they will come back remember, they are human too. You do not have to wait for them if it will cause your patient distress simply let them know that your patent needed you so you had to get started. I always try to do the hardest ones ie trachs/GT's/nebs without them so they are the ones that I will do first before they come. Often, they will ask that you do this in front of them and say that they will come back tomorrow to watch you do this. Don't worry or get nervous. But do prepare. Take a few minutes at the end of your day to review P&P for this med pass as we sometimes take shortcuts that could get the facility in trouble. And always f/u with your nurse manager to let her know everything that a surveyor asks you or says to you as they can prepare a possible answer/defense before the end of the day when the surveyors sit down and present their concerns.

Best of luck to you and let us know how it went when it's over.

IF you are in LTC there are a few other threads over in that section.

Remember to deep breath.

Don't let them push you around or intimidate you.

Remember that you are there first for the patient/ resident.

Go over your P and P for G Tube meds, and eye gtts and inhalers.

Keep all meds off of your med card.

Lock your med cart when you are not there or it is out of your reach.

Keep refrigerated meds refrigerated.

Check the exp dates on your injectables, eye gtts.

make sure your OTCs are labeled.

O2 masks and neb masks should be bagged and dated when not in use.

Wow..thank you guys so much for all the great information! I will keep everything in mind and try and to prepare myself for it. One of my concerns is that I work night shift and if they do ask a question that I don't know the answer to who do I ask because we don't have a manager at night. And also the time frame for passing out meds, is the rule of thumb that you can start early as one hr before and one hr after? And if insulin needs to be givin at 630am can i start as early as 6? And do they also watch you as you write your nurses notes?

Thanks again everyone for your help!

First of all you don't say what kind of surveyors they are. TJC, Magnet, Board of Health, etc. I have been a nurse for almost 20 years and have never know a survey to be conducted at night. We've had breakfast meetings for night staff.

Stand up straight and be confident. Answer the questions directly, no "I think", "I believe" etc. When asked a question in a group setting, raise your hand high.

Know where to access answers if you happen not to know, i.e., policy/procedures, resource manuals, standards of care, etc.

Relax, surveyors are not usually there in an adversarial positions.

I've had pharmacy reps follow me and my coworkers (not state surveyors), and there were a few things that they flagged that may not seem like biggies, but were important to them:

Make sure all spoons on the cart have their handles up;

don't use the gloves on the med cart; use the ones in the patient's rooms

for eye drops, each eye gets one tissue

don't crush meds unless the MAR specifically says you can

potassium has to be given with a meal, so the food tray should be there when you give it

no blood pressures in the hallway

A survey is a federal process not state so any state laws or lack of would not apply. Your facility (like most LTCs) would be a voluntary participant in the Medicare program and therefore subject to survey/inspection and answering any questions that arise.

Good luck

@kayern really? You havnt seen them come during nightshift even once? Is this a common thing? I also hurd that they are even cuttin down on the visits they make because the state can't afford it (I live in ca) would anyone know the truth to this?

Hello,

I just went through my first survey in August as my first year as an LVN (yikes!). I was very very nervous and I was hoping that I was off when they showed up. To my luck, the surveyor wanted to follow me for my med pass! I had been followed already by our pharmacy consultant so I had been practicing, although I was very nervous I just had to remember mainly the 6 Medication rights. They usually ask to follow a Gtube, and PO meds. I had a 100%! If you happen to make a small error or notice something not right, you must correct it immediately. I was always going up to my supervisor and asking her questions. Make sure you identify the pt, we have a couple of pts that do not keep their ID band so we have to have a 2nd nurse confirm the name, always lock your med cart, wash your hands before and after for about 15 sec, don't forget to knock, carry a steth, check gt placement and residual, etc

we passed btw! and i'm glad that i'm over the fear of being followed by a surveyor:yeah: