Long-Term Care Survey Alert

Know What Surveyors Expect to See in a Skin Program

Question: What kind of pressure ulcer prevention/management systems and documentation do we need in place to have a chance of convincing surveyors that a residents pressure ulcer was unavoidable?

Michigan subscriber
 
Answer: Surveyors expect the following to be in place to show facility is doing everything possible to prevent pressure sores: A skin risk assessment on admission, quarterly and when the residents status changes. The assessment must be documented and accurate. They also expect to see an assessment of the residents skin at admission and weekly. Care planning should address the risk for skin breakdown on the day that staff identifies the risk.
 
Surveyors are not going to be happy if the facility identifies a resident at risk for skin breakdown on admission, yet does not provide the pressure-relieving devices until four days after admission. Surveyors will observe to see if caregiving staff is carrying out the preventive approaches consistently as planned and indicated for individual residents.
 
Expert advice provided by nurse B.J. Collard in Denver.

Exercise Your Rights and Obligations to Restrict Visitors

Question: Does a facility have much leeway to restrict a residents visitors, or will surveyors view that in most cases as a residents rights violation? When should we take the upper hand and refuse to allow someone to visit a resident?

Georgia subscriber
 
Answer: The rules of participation do provide for visitation rights in general. But they do not provide any specific person the unfettered right to visit anyone else in a facility. The facility always has the obligation to protect individual residents, as well as all of its residents and staff, from a visitor who poses any sort of danger. Documented or suspected abuse is one obvious example. But clinical issues may also arise for example, a visitor who insists on feeding a resident who is at risk for choking; or someone who tries to change the residents dressings or feeding tubes or doesnt observe infection precautions. Or perhaps a visitor invades residents privacy.
 
The facilitys response should be tailored to the issue at hand. For example, the facility might restrict the visitor to certain areas or allow visitation under supervision or get the visitor to agree not to touch tubing, etc. In some cases, the facility might give someone a written warning not to visit, and call the police if the person then tries to visit anyway.
 
Facilities can be cited when they knew or should have known of a problem, and did nothing. A typical citation would be under the abuse policy but the tag could be for failure to safeguard from accidents.

  Expert advice provided by attorney Joseph Bianculli in Arlington, VA.