It does not matter now many surveys we go through and how well we are prepared, it is still such an emotional trauma to go through. We all get nervous, strung out, become easily agitated, intimidated, and sometimes physically ill. It's human nature. I like to call it the survey jitters!! Following are some survey tip reminders to help you put your best foot forward at time of survey and to make a good first impression with the surveyors.
- Curb Appeal: First impression is so important. Make sure the facility's grounds and parking area(s) are maintained. Planted/potted flowers make a nice addition to the entrance. Have the entrance to the facility checked daily for any debris.
- Announcing Surveyors' Presence: It is best not to announce a secret code to alert staff of surveyors being in the facility. This does set well with surveyors. Recommend that the facility administrator announce something to the effect of "Staff and residents our state regulatory surveyors are in the building. Please make them feel welcomed".
- Surveyors' Work Area: Welcome your surveyors by preparing a work area suitable for them. Do not provide area close to nurses' station. Usually there is a lot of activities going on around the station and staff are not always aware of what they say. Something overheard by a surveyor could cause an investigation resulting in a deficiency.
- Initial Tour: It's extremely important to making a good impression during the initial tour to prevent the surveyors from expanding their resident sample for review. Areas of target during the initial tour are:
- Survey Notebook: Having surveyors to wait to collect required documents can be an annoyance and lead to a bad impression of the facility's organizational skills. There are certain documents/information that has to be submitted within the first hour following the surveyors' entrance conference. Keep (what I call) a Survey Readiness Notebook that has all of the required documents/information. Update notebook monthly seven months from last survey and then weekly as you get closer to your expected survey.
1. Odor - Keep linen barrels emptied. Eliminate "spot" and general odors as soon as possible.
2. Call Lights - Keep call lights within reach of residents. Answer call lights timely.
3. Locked Doors - Surveyors will be checking every door as they walk by. If a door is found unlocked and hazardous chemicals are present, the facility will be cited.
4. Staff Communication - Speak respectfully to residents. Say "please" and "thank-you". Always knock and wait to be invited in, if applicable.
5. Resident Positioning - Make sure residents are not slumped over in their beds or wheelchairs. For tube fed residents the head of the bed is to be elevated as ordered or according to facility protocol.
6. Restraints - Make sure restraint in use is according to physician's order andis the least restrictive. If restraint reduction is considered not feasible state the reason(s) why. This is still a hot topic. If many restraints noted being used, it will send up a "red flag".
7. Infection Control - Be careful how clean and dirty linens are handled. Remove soiled gloves and wash hands prior to touching anything that is considered clean. Surveyors will be observing for cross contamination.
8. Resident Hygiene - Residents are well groomed (i.e., nails trimmed/clean, absence of facial hair for both male and female residents, mouth care provided if needed, clothes clean without stains/tears).
9. Housekeeping - Residents' rooms are clean, organized, and free of clutter.
10. Facility Upkeep - Facility needs to look good inside and out. Have a routine maintenance schedule for checking certain areas/equipment. Report any problem noted to maintenance and fix promptly.
11. Medical Equipment - Check to make sure they are in working order, installed correctly and used as ordered (i.e., oxygen, catheters, any assistive devices).
Suggest establishing a checklist to include the above areas and assign the checklist to appropriate department heads to check on a routine basis.
When surveyors take the initial tour have someone who knows the residents to accompany them. Suggest having staff members already designated and trained regarding the initial tour (i.e., questions that might be asked, what to say and not say).
Instruct your staff to keep you informed of what the surveyors are targeting during the initial tour (i.e., charts being pulled, questions asked by surveyors, names of employees surveyors engage in conversation).