Home Health Survey Success.
In our previous post we provided a checklist of items to have handy if your home health agency is being surveyed by a state surveyor. But in addition to the documentation listed there are a number of things you can do with your managers and staff prior to a survey to ensure your survey is a success.
3-6 months prior to your survey, I would begin working these items.
- Focus audits on all wound care patients (especially those in close proximity to your office)- make sure interventions and notes mirror actual md orders, check wound vac orders, make sure nurse is using correct supplies, cg/ patient education is noted and understanding verbalized and cg/ patient are doing wound care on days SN not scheduled.
- Look for Pressure Ulcer teaching on patients with potential skin breakdown. Make sure Oasis questions are answered correctly for wounds and that teaching in place for intervention.
- Look at Diabetic foot ulcer teaching – if this is a therapy only patient, then it should also be taught on all oasis points by that Physical Therapist.
Focus audit all IV and TPN Patients – make sure the orders are correct, medications are listed correctly, flushes are on the med profile, PICC and Groshong measurements in place, arm circumference measured for PICC patients, CG and patient education in in place with understanding verbalized and possibly return demo if patient or cg doing care.
- Review all patient charts that have foley or superpubic catheter, and especially if they are bedbound with Aide in home. Typically a surveyor would pick one of these patients for an onsite visit. Make sure the orders are correct, aide care plan reviewed, teach all foley patients / CG irrigation of foley with orders from physician and make sure CG verbalized understanding. With superpubic cath patients make sure that CG or Patient is aware to call on call personnel immediately and that this documented in the chart.
- Review your previous survey and address all issues that you previously had and make sure you are now in compliance.
Make sure all filing is up to date.
- Proactively pick out a few patients that are close to the office that might be appropriate for IV or wound visits and get those charts ready for survey review.
Make sure all of your admission paperwork is correct and in place.
- Make sure that your staff is utilizing the HHABN’s, BIPPA, etc and that they are on the charts.
- Check your refrigerators in the office, make sure they are clean and defrosted, and thermometer setting is logged daily.
- Do a bimonthly fire drill and document it.
- Have your Professional advisory meeting and sign in sheets ready for review.
- Have any performance improvement and QA efforts ready for review. Create a QA project for wounds or IV’s, and use your “clean up” to get ready for survey as part of this QA effort.
- Clean the supply room and make sure the MSDS books are updated.
- Update all personnel records.
- Make sure your business license, clia, delegation of authority, and PT therapy license on the wall and in clear sight.
- Make a fun game and prep the staff with questions so that they know how to answer surveyor questions and teach the patients about appropriate hot line numbers, how to contact on call clinician, etc.
There are several G tags / defeciencies that surveyors always start out the survey process looking for. Once they find a few of these items they will move on to other deficiency tags and extend the survey. I wanted to make sure to list the most common G tag deficiency items that you should be aware of:
G107 – Investigate & document complaints & resolutions (under patient rights)
G109 – Particpate in planning of care & treatment (under patient rights)
G123 – Identifiable line of authority (under organization, services, and administration)
G133 – Organizes & directs the agency’s functions (administrator- under the organization, Services, and administration)
G143 – Maintain liaison & support plan of care objectives (under coordination of patient care)
G144 – Documentation shows effective care coordination (under coordination of patient care)
G157 – All patient’s needs adequately met in residence (acceptance of patients, plan of care, And medical supervision)
G158 – Care follows written plan/ reviewed by physician (medical supervision)
G159 – Plan of care covers all pertinent diagnosis (plan of care)
G164 – Alert physician of changes in condition (plan of care)
G165 – Administer drugs/ treatments ordered by physician (conformance with MD orders)
G166 – Verbal orders put in writing / signed/ dated
G170 – In accordance with the plan of care (skilled nursing service)
G172 – Regularly re-evaluates the patient’s nursing needs (skilled nursing service)
G173 – Initiates the plan of care and necessary revisions (skilled nursing service)
G174 – Services requiring specialized nursing skill (skilled nursing service)
G185 – Services that are performed by qualified therapist (therapy services)
G186 – Assists physicians in evaluation/ developing plan of care (therapy services)
G187 – Prepares clinical and progress notes (therapy services)
G188 – Advises / consults with family and personnel (therapy services)
G224 – Written instructions by the RN or Therapist (home health aide services)
G236 – Maintain in accordance with professional standards (clinical records)
G331 – RN nurse must conduct an initial assessment visit (initial assessment visit)
G332 – Initial assessment within 48 hours or upon start of care date (initial assessment visit)
G337 – Comprehensive assessment must include review of all meds the patient is currently Taking (drug regimen review)
G338 – Comprehensive assessment must be updated and revised
G340 – Within 48 hrs of the patient return home after 24 hrs or more hospital stay other than Diagnostic tests (update of comprehensive assessment)
Take a deep breath! You will survive the survey process. And remember it is the surveyor’s job to try to find something wrong with the agency you work for, so don’t take it personal. Be honest and truthful, but never offer any more information than what they ask for. Be the most prepared that you can be using these key points. If you found this article helpful please let us know and we can prepare other survey updates for you in the future! Keep up the good work.