In LTC, and SNF’s the annual survey process can be a very stressful week. The survey window is usually a large variable of time, and surveyors come unannounced. In preparation for this unannounced visit, rounding should be done in an orderly fashion on a regular basis. A successful survey requires the cooperation and support of the entire staff, and everyone should be aware of state rules and regulations that need to be followed out daily in their particular departments.

CMS measures LTC and SNF’s performance. Surveyors select patient’s and follow the care the patient has received throughout their stay. They observe practices, documentation and the environment the patient has been in. They also interview staff and patients to collect data. They ask questions about the safety and the care each patient receives to ensure quality. If a facility receives a citation it could lead to financial penalties, Medicare and Medicaid fund stoppages, or even closing of the facility.

When preparing for the annual state survey many facilities tend to focus on the resident’s charts who already have wounds. However, many citations are actually triggered from residents without wounds. Surveyors go around patient’s rooms and monitor their incontinence care, turning and repositioning, and call light timeliness. One may observe a resident lying in a position longer than the plan of care that is in place for that resident indicates. Which in turn leaves them susceptible to a skin breakdown or even worse a pressure injury. When preparing for a survey it is important to focus on the whole picture which is wound prevention and management

Risk assessments (Should be current and accurate)

  • -Done on Admission/Re-Admission
  • -Done weekly x4 weeks
  • -Done with change of condition
  • -Done with MDS(Quarterly/Annually)

Care Plans

  • -All risk factors identified are listed on the skin integrity care plan
  • -Risk factors come from assessments, MDS, history, and chart reviews
  • -Appropriate interventions that help stabilize or decrease risk factors
  • -Staff are aware of interventions. They monitor the effectiveness and placement daily
  • -Weekly skin assessment preformed on all residents by licensed staff
  • -Wound assessment are done every 7 days. Including measurements and progress
  • -Resident information sheets (Care Cards) should coincide with the Care Plans in place
  • -Proper clean dressing change technique

Documentation

  • -Correct and accurate wound documentation: type, location, tissue composition, drainage amount, periwound, and appropriate treatment
  • -Notes provider, family and interdisciplinary team are all aware of status.
  • -Onset date, if no progress in 2 weeks, if there is a decline, if its healed
  • -Treatments written correctly and being carried out as ordered
  • -Co-morbidity’s, turning and repositioning, incontinence management, nutrition/hydration, test results i.e. labs, -Doppler studies, ABI’s
  • -Use of devices/equipment i.e. support surfaces, wheelchair cushions, heel boots. Ensure they are on and functioning properly
  • -Wound Care supplies- proper storage, expiration date, and meets infection control protocol

The Wound Nurse is the key player in this equation. Having a consistent nurse doing the weekly wound rounds will prevent any inconsistent documentation. That nurse inputting documentation and doing the would care plan’s will ensure accuracy. He/she then can audit all things wounds, and ensure devices, treatment orders ect. are in place the way it is ordered. The treatment nurse can also do education with floor staff on dressing changes, and their ability to asses’ wounds. They can also monitors equipment and dressing supplies related to wound care.

Education Department

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