Long-Term Care Survey Alert

Sometimes it's the little things that can really ding your survey record.

One secret to doing an effective mock survey for med pass: Arrive early when you're not expected. That's the approach that mock surveyors at Presbyterian Health Services (PHS) of New Jersey use in observing medication pass and safety in the organization's nursing communities, according to a presentation by Judith Porter at the fall 2008 American Association of Homes & Services for the Aging annual meeting.

This "gives me ample opportunity to observe" not only oral med pass but inhaler techniques, medication patches, injections, etc., given during the morning, said Porter, a nurse and director of health services for PHS.

That's not all: Porter or whoever is doing the mock survey also looks at the cautionaries on the medications themselves.

For example, if the medication is to be given with food and it's been an hour since breakfast, what does the nurse offer to the resident in the way of food? "Apple sauce is not food," Porter cautioned. "It's considered water." Thus, she looks for puddings, crackers or milk supplies to help the medicine go down. And she makes sure the milk-based products are iced.

Beware: Medications in the extended release form should never be crushed, advises Rod Hicks, PhD, RN, FNP-BC, FAANP, a professor  at Texas Tech University inLubbock, Texas. "Pharmacists should label these drugs with 'do not crush' warnings to provide a visual prompt for nurses," he suggests.

Check out these additional highlights of the mock survey:

The mock surveyor makes sure the nurse did the pain assessment before giving a PRN pain medication and then checked back with the resident one to two hours later to see if the med relieved his pain. "If a resident is getting a pain medication, we do not want to see the word 'effective' used post-administration" because the state frowns on that. "We want the exact word" the resident used, said Porter. The surveyor also makes sure the MAR doesn't contain blanks for any medication.

• Assessments and orders for self-administered medications. If a resident is self-administering a cream or vitamin, the nurse doing the mock survey goes to the resident's chart to see if staff has completed an  assessment form that deemed he could safely give himself the medication. She also checks the physician order for the self-administered med.

box. The PHS mock surveyor looks to see if the box contains any expired medications.

Tip: Make sure staff members pay close attention to controlled substances in the emergency box. If you can't reconcile the count in the box, the pharmacy has to notify the Drug Enforcement Administration, says Albert Barber, PharmD, who oversees several nursing facilities in a chain based in Ft. Smith, Ark.

• Management of refrigerated medications. The surveyors check to see that staff members have been tracking the refrigerator temperatures and whether the fridge containing meds has any food in it.

Editor's note: For a look at leading- edge strategies to prevent adverse drug events, see the next Long-Term Care Survey Alert.