Long-Term Care Survey Alert

Use a QA Approach to protect residents from common hazards.

Time is not on your side when addressing maintenance issues, which means your facility needs a plan to stay one step ahead of patient safety and survey disasters waiting to happen.

Common example: If someone puts in a work order to repair a wobbly toilet--and two weeks later, a resident topples off that wobbly toilet and hurts himself--the facility is definitely looking at an F tag, says attorney Jay Adams in Tallahassee, FL.

Proactive strategy: Involve your charge nurses and maintenance and housekeeping staff in quality improvement projects identifying areas that require root-cause analysis and new systems, suggests Patricia Callen, RN, BSHCA, CLNC, a medical legal consultant and president of Callen & Associates in Ashland, MA. "For example, the facility could measure how quickly nursing or other staff identifies hazards or broken equipment--and how quickly and effectively maintenance and housekeeping respond," she suggests.

Nail Down Your Routines

Use your QA process to develop a set routine to do maintenance. Safety experts suggest everyone make an effort to look for these common hazards:

• Chips in bath tiles
• Loose grab bars and broken bed rails
• Cracked or torn vinyl chairs which can cause skin tears
• The condition of outdoor areas, including furniture. "If residents go on patios, for example, look for cracks in the patio surface that could cause someone who's unstable on his feet to fall," advises Stephen Trosty, JD, MHA, HRM, a risk management consultant in East Lansing, MI.

Stay on Top of Your Logs

Catalog all of the facility's medical equipment and the maintenance for it according to the manufacturer's instructions, advises Eleanor Alvarez, president of LeaderStat LLC in Columbus, OH. Then assign someone to make the maintenance checks and calibrations and document they did. "In the past, glucometers and oxygen concentrators have been a survey focus," Alvarez notes. "Automatic scales are also an issue in terms of their accuracy. Staff should follow the manufacturer's instructions to calibrate the scales correctly."

Prevent burns: Pay special attention to the facility's water temperature logs, emphasizes Kathy Hurst, RN, JD, director of operations and human resources for Anaheim-based TSW Management Group, which manages nursing facilities in California. The TSW-managed facilities keep water temp logs daily. "How would the facility know the water isn't too hot if they don't do them at least daily?"

Remember the old survey saw: If you didn't document it, you didn't do it. If state or federal inspectors find your facility has a problem with its HVAC, water temperature or equipment on survey day, they will investigate to see if the problem is an anomaly--or a recurring issue, cautions Trosty. And in that regard, incomplete logs can translate into survey headaches.