By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

It is getting close to Halloween! Halloween is one of my favorite holidays, so lets have some fun with the serious subject of long-term care facility state surveys, which can occur regardless of the holidays...

BOO! That is what most of us say during the frantic state surveys. Today, more than ever, those working in long-term care facilities feel like they would rather mysteriously vanish than be working the day of the State Survey process. Facilities must be prepared to demonstrate compliance with federal regulations at all times to minimize any risk of citation. Facilities can be closed, and administrators and directors of nursing are in jeopardy of losing their jobs if the results are poor during survey. No Hocus Pocus can get them out of it. Inspector witches typically work for state agencies paid by Medicare. If they find brewing deficiencies, they rank them on an evil scale of A to L, the most severe. The vast majority is labeled D or E. Deficiencies are posted on the creaky front door and made public on the Internet. This can increase frightening negligence cases for lawyers. Beware of citations and F-Tags.

It should be your expectation to do the right thing every day, but menacing surveys need to be managed. With all the opportunities for potential deficiencies, it makes sense to make sure that the systems you have in place stay in place during the survey. It is natural for staff to panic and make mistakes. Surveyors, like slithering snakes, can distract your staff from normal everyday duties.

Ongoing education with candy corn to all staff, and staying current with new standards is critical in assuring a cobweb and citation free survey evaluation. Scheduling a superstitious mock survey is an opportunity to identify potential survey risk areas.

Be polite and offer the staff's candy corn to surveyors. If a surveyor makes you aware of an issue and asks you to confirm the deficient practice, do not confirm it. Simply say, "Thank you for letting me know. I will fix the problem immediately," and then fly away on your broom. Make the DON/Administrator aware of the surveyor’s questions and comments, and advise them to hide in the graveyard…

Wound Care Nurse Survey Preparation

1. List of Residents on Hospice, Dialysis, TPN, and NPWT
2. In-service education signed sheets
3. Standing orders (preventative care)
4. Weekly wound report (pressure and non-pressure)

Audit Documentation Weekly

1. Risk assessment complete – Admission, re-admission, weekly, X four weeks, quarterly, and annually. Change of condition
2. Nursing assistant care cards/sheets match plan of care
3. Skin sweeps weekly on every resident
4. Consents for treatments/procedures, if applicable
5. Physician orders/Telephone orders written correctly and signed
6. Wound assessment every 7 days
7. Depth on all pressure ulcer measurements
8. Family and Physician notifications
9. MDS 3.0 – accurate CAA
10. Care plans
11. Treatment Administration Records (TAR)
12. Security of treatment cart

A Parting Poem

It's Halloween! It's Halloween!
The wounds are glowing bright red,
Pressure, Arterial, Venous and Diabetic Ulcers,
Grinning wound margins fighting erythema,
Biofilms rising from their tombs,
Devitalized tissue on their magic brooms,
In isolation gowns we haunt the street,
Tonight we are the wound warriors,
For oh tonight it's Trick or Treat!
-Cheryl Carver

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.