Long-Term Care Survey Alert

Anyone who has been on the survey front lines for long has war stories about unexpected events that can put a facility on the fast track to decertification.

You can, however, head off serious citations by thinking through how to avoid the following and other worst-case scenarios.

Or surveyors find a resident who is supposed to smoke only with staff supervision puffing away alone in the bathroom. One way to avoid that type of scenario is to enforce the facility's smoking policy on an ongoing basis, advises Marty Pachciarz, RN, RAC-CT, a consultant with the Polaris Group in Tampa, Fla. And keep all smoking materials under lock and key in a fireproof box at the nursing station, adds Cheryl Boldt, RN, a consultant with Maun Lemke in Omaha, Neb. She suggests doing so for all residents, regardless of their ability to smoke safely without supervision.

Scenario No. 2: Frontline staff endanger a resident by not implementing basic safety directives on the care plan. One case involved a resident who had at one point been found eating her Polident tablets, requiring a trip to the emergency department, reports Joy Jordan, MSN, RN, SMQT, RAC-CT, clinical operations consultant for Boyer & Associates in Brookfield, Wis. And even though the care plan directed staff to keep the Polident tablets out of the resident's room, Jordan found the tablets in the resident's room.

Use a working care plan tool: Do routine checks to make sure caregivers are consistently implementing the care plan. Have CNAs use a working care plan tool that includes basic care directives, including ADL assistance, repositioning, diet, and safety measures, such as a fall mat.

Scenario No. 3: The facility has a glaring safety hazard that no one has addressed. Jordan reports being in one facility in California that had a "huge laundry chute with an unlocked door." Looking at it, Jordan realized a resident could fall headfirst down the chute. In another case, she found a construction worker had left a door to the roof propped open that residents with dementia could easily access.

Develop a safety watch mentality: "You have to develop the mindset of promoting safety for people with [the functional age of toddlers] in some cases," Jordan emphasizes. Conduct rounds on a regular basis to identify safety hazards. Reward staff for identifying, correcting, and reporting potential safety hazards 24/7.

Scenario No. 4: The team fixed an individual patient safety problem but missed the bigger picture. In the case of the resident who had eaten her Polident tablets, Jordan encouraged the facility to think through the implications of that incident.

Protect all residents: The facility also has to anticipate that other residents with dementia might eat their Polident or lotion or drink flavored mouthwash, Jordan adds. "The facility thus devised a policy/procedure where staff locked up all those kinds of things, labeling it, and handing it out under supervision."