What to do when state comes in?

Try to be off that day :chuckle In all honesty, just do things right.

Just be yourself, do things the way they are supposed to be done, watch the times on your meds, make sure you flush g-tubes with the right amount, check and double check your policies, if you have a pharmacy consultant that can come in and give you tips, that would be great. If you are asked a question, just answer the question, don't elaborate or add anything. Try not to be nervous. Surveyers usually do a lot of writing while following anyone around, don't let it get to you, it doesn't mean you are doing anything wrong. Make sure the call lights are within reach, water pitchers, etc. No 02 tubing on floor, we are to keep our tubing in plastic bags with dates on them. Make sure you have the correct liquid for your pt. eg: honey thickened, nectar thickened, reg. Make sure your med cart is locked when you leave it. WASH YOUR HANDS in between pt. The usual stuff that you do every day. You just tend to get a little anxious when you know someone from state is watching you. We get to pick the pt. that they go around with us to watch. They will tell you what it is they need to observe, such as crushing meds, feeding tube, eye gtts, neb tx. that type of stuff. Always pick your most cooperative pt. if you can. This is funny, if we get nervous or unsure about something, we have a cheat sheet stuck on the inside of the bathroom door, we can tell the surveyer we have to go to the bathroom before doing a procedure and review if need be. But, really, it's just common sense stuff that you already know and do. No holes on the MAR or TAR. Know your fire and disaster policy, elopement policy. Even if you can't quote these by heart, know where the policies are located so you can look them up in a heart beat if need be. You want to be able to walk up and grab the policy book and show them what they are looking for so they will know that you are aware of what to do. Know your protocol for abuse, the chain of command etc. These are some of the things that come to mind at the moment. I'm sure others on the board will have some great suggestions for you. Just keep your cool, remember, they have a job to do too. I've never had a surveyer really intimidate me, it's just the thought that they are watching and it makes you feel like they are waiting and watching for you to make a mistake. Our med carts have two locked sides, last year during survey, I got busted for leaving one side unlocked. I knew better, it was just one of those crazy things that happen sometimes.Took me almost a year to live that one down, everybody in the building would walk by and ask me if my med cart was locked!!! Even though it is a serious offense, I learned from it and got to the point where it was funny every time someone would walk up to my cart and check it!! Sure wasn't at the time. But, the world kept spinning. So, even if you make a mistake, it isn't the end of the world.

Try not to say "I don't know" and leave it at that. It's okay to say something about being nervous and while you can't recall the exact answer, you know how to find out and then show them. Most surveyors know they can make us mere mortals nervous and space out on an instant response to some far-fetched policy questions and just want to see you know how to find the answer. Of course some things, like washing your hands and equipment between patients will not be viewed with any sympathy.

Also make sure that your staff has their name tags, transfer belts, etc... on them if your facility uses that kind of thing. And make sure that they know the correct mode of transferring the resident ie: mechanical lift, 2 person, one person, SBA or whatever. If the transfer is not done as to how it is stated in the care plan, then that can be a deficiancy.

Also make sure that the care plans are UP TO DATE!!!!!!!! Make sure to change them if anything changes with the resident.

Just relax and realize that they are not out to get you! Don't be afraid to tell them that you're nervous or haven't done something for awhile. I started at a facility as a charge nurse after being out of nursing for awhile and was nailed by State. I just told the surveyor that I hadn't done a procedure for awhile, and she just said to relax, take my time and do it how I normally would. These people are made out to be mean and nasty, but remember, they are human and they have done this before!

Hello, I am a new nurse, passed boards in October 2005 and have worked in LTC since then, state will be coming in sometime within the next three months, any advice on how to act, what to be on look out and how to not totally look like a fool when they are there? Thanks.

Hide!!!

In all honesty, just do your job, be yourself and NEVER LET THEM SEE YOU SWEAT. If you can get beyond them being "surveyors" and remember that they as well as you have jobs to do ~ you will be fine. Make sure you follow all your medication rights, make sure you know which inhaler to give first, take a pulse prior to giving digoxin, etc... All the stuff you would normally do........

If you do not know an answer to the question, say, I will find the answer and get right back to you - then make sure that you do. BY THE WAY - WASH YOUR HANDS ALOT - EVEN IF YOU DO NOT HAVE TO. Especially between patients - some surveyors do not like the alcohol gel so WASH WASH WASH..... Make sure you know why you are giving the meds you are giving.........

Educate your staff on answering the question the surveyor asks them but not to elaborate or give their personal opinions. During survey is not the time for staff to have a gripe session.Stress to them the importance of being professional.

I'm a new nurse too. We finished our state inspection yesterday. On Monday I was working 3-11 and they came in to announce their visit around 6p. They didn't talk to me but all administrators had to come back in. Our unit manager had to give them a room by room run down on every resident. They only followed 7-3 shift on a med pass, yay! so I was safe.

1. Hide when you see one of the surveyors coming your way!:roll
   
2. Call in sick. We know they are in the building because in Ohio they post a notice on all the doors of the building stating that they are present and doing a survey.
   
3. Tell all your aides to keep an eye out for the surveyor and to let you know right away when they see any of them around (gives you time to hide).
   
4. Get rid of any pre-poured meds anywhere in your med cart. Make sure your orals are separated from any rectal meds. Do a quick check for outdated eye drops and topicals and get rid of them. No treatment medications should be in the medication cart. Today you have to do everything by the book, so sign out meds as you give them.
   
5. Keep your med cart locked at all times. Same with the treatment cart.
   
6. Hide the communication book that sits on the nurses station--it's illegal to have one.
   
7. Make sure you can cite the steps to take in case of fire, tornado, earthquake or hurricane (depending on where you are in the country)

Seriously, these surveyors were once nursing instructors or DONs themselves. They know they are intimidating and that people are scared to death of them. Just smile and be pleasant. Mostly, they want you to continue doing your job. My experience has been that they will usually tell you or ask you if they are going to or can they tag along with you. We have been told that they have agendas and specific things they are looking for and asking the nursing staffs when they come into facilities (at least here in Ohio). I was once asked if I knew where the care plans were kept. I was also asked if the surveyor could come and watch me do a dressing change on a resident. She was very nice and even discussed with us the previous treatment that had been done to get the patient's wound healed just as if she were any other nurse. One of our aides was asked what she would do if the fire alarm went off right at that moment. We also had a surveyor who went into patient rooms interviewing patients and ringing call lights to see how fast they got answered. One time a surveyor stood at the nurses station with a couple of the nurses just shooting the breeze about nursing. Most of the time they were with the DON and the medical records people going through charts and other kinds of paperwork.

State walked in at 8am this morning:o There goes the rest of the week I had planned at the pool:o

To sum things up, just be perfect and you'll be fine!!:) It helps me to remember that essentially, the surveyors work for us. Our tax dollar pays their salary. They're there to do a job and for the most part, they're decent people. Once in awhile you'll get one who needs to prove themselves. That happened in a facility that I worked at. She had been an employee there & came in looking for blood. We had a perfect survey the year before with many of the same staff members & ended up with 9 deficiencies that year. When they (a different team) came to re-survey, they said, 1) We should have asked for another team leader (she was the team leader), & 2) We should have challenged all but one of the deficiencies. Live & learn. Remember, this too, shall pass...

i always walk up to them introduce myself, let them know i am the floor nurse. i tell them i have such and such treatment to do and i invite them to go with me. many times they will just ask me a few questions and they are through with me. only on a few occasions have they said yes i would like to go with durning the treatment.

if they ask a question that i am not able to answer i will say, "give a few minutes and i will have that answer." i always make it a point to get back with them with their answer.