Home Health News

by Julianne Haydel, RN

Agencies often ask their consultant, “What do we have to do in order to pass survey?” Frankly, a complete answer would be so lengthy it is easier to ask how to flunk one. I can answer that one authoritatively because I have firsthand knowledge on how to completely bomb a survey. Follow the instructions below and it is almost guaranteed that you will find yourself in survey hell shortly after the state comes knocking on your door.

1. Hire anyone who is available. Do not waste your time checking references or verifying licensure. Supervise staff only when convenient. Play ignorant when you learn that the DON does not have the required experience to hold that position.
2. Honesty may be the best policy but not if you want to bomb survey. Give a surveyor just a hint that you might be fudging on the facts and your survey will go south in a heartbeat.
3. Show your creative side by manufacturing notes and documents as they are requested from the surveyor.
4. Explain to the surveyors that your referring physicians are too busy to address patient problems so you have not actually contacted any of them when blood sugars fall or blood pressures rise.
5. Write your therapy frequencies after the visits are made to ensure they are accurate.
6. Admit numerous patients from physicians who are not licensed to practice. This strategy works best if you can produce documentation that you tried to verify their license but were unable to find their name in the Medical Board’s database.
7. If you are the Director or an owner of an agency, distance yourself from the staff by calling them stupid. It will make you look brilliant and undoubtedly cause questions about agency leadership ensuring poor survey results.
8. Explain that your hospitalization rate is higher than state average because your on call nurse drinks most weekends and you have no choice but to send your patients to the hospital.
9. Refuse to let the surveyors in the door. I’ve only seen this once (not our client by the way) but thus far, this technique has a 100 percent success rate when it comes to having a license revoked.
10. And obviously the easiest and surest way to bomb survey is to forge signatures.

If you refuse to follow these guidelines, it is entirely possible that you will pass you survey regardless of how many honest mistakes you have made. When it comes time for survey, agencies that tend to their patients’ needs, pay close attention to documentation and are open and honest with surveyors usually pass. Deficiency-free surveys are bragging rights but an honest survey with one or two tags unrelated to patient care is a huge success.

My best advice to anyone seeking to pass a survey is “just breathe.” It will be fine. Bombing a survey really does require some effort, provided you take good care of your patients and your documentation matches what you do.

Keep in mind, however, if you are among those agencies who choose to put in the effort to deceive, you ought not seek out a consultant to help you. Most, like my own agency, will not enter into business relationships with agencies who intend to run afoul of the rules.

Dealing with honest mistakes

If you are like most agencies, your policy is to remain in compliance but, from time to time, you unintentionally stumble. That is understandable and forgiveable. There are a number of tags that I see repeatedly at agencies that should never happen.

The first, and easiest, is to write orders and then not follow them. For example, “weigh patient q visit and report weight gain of x pounds.” My first issue with tags related to these orders is that many of them need not be written at all. But if you do write them, you must follow them.

There are two ways to deal with these types of orders. The first is to write a blanket order for every patient and verify that weights are on each and every note. This, of course, requires a new agency process. Keep in mind that, generally speaking, it takes about three months for a new process to be implemented and followed consistently.

The second way to deal with these types of tags is to think twice about writing unnecessary orders and, if you do, monitor those patients’ charts weekly. Either way, it is a given that some patients must be weighed in order to deliver appropriate care. Your processes must protect these patients.

Another tag that is very common and should never be seen relates to medications. It is not at all unusual for a nurse to state on a visit note that a patient’s pain is relieved by Tylenol, Advil or some other pain medication and yet not list any of them on the patient’s medication profile.

This is a serious tag. On a grand scale, giving a patient medications that are not ordered puts your patients at much greater risk than weighing a patient who does not need to be weighed at every visit. Consider that Tylenol may cause liver damage and, since home health patients are typically on numerous medications that are metabolized by the liver, it is critical to consider even seemingly benign medications in the context of an entire medication profile. Additionally, some narcotic pain meds such as Darvocet and Percocet already have Tylenol as a primary ingredient. Therefore, an overdose situation may occur if the patient takes OTC Tylenol for breakthrough pain.

Finally, one of the most frequent tags I encounter is related to coordination of care. This is largely a documentation error but can become a serious one. If important changes to the plan of care or the patient response to treatment are not documented, circumstances can cause care to be compromised. Though your own staff may be well aware of such changes most of the time, that only protects you and your patients when circumstances are normal. Should an emergency occur, any available clinician may be confronted with your patient and must rely on whatever written information is available. As someone who has lived through numerous hurricanes in the past few years, I can assure you that every piece of documentation counts when a patient is separated from his or her regular caregiving staff and family.

Action steps

If you spend most days in the field, make your life easier by weighing patients if you are uncertain of the orders. If you encounter an order for a patient who cannot weigh, document why and send a change order to the physician so the order can be discontinued. When anything at all happens to a patient that is not captured on a visit note, document it.

When you encounter complaints about having to do too much documentation, take it with a grain of salt. Suggest to the clinician she is welcome to turn in her license now rather than wait for the state to demand it later. It is less important to accommodate someone who complains to you about too much documentation simply out of a desire to enjoy an easier day than it is to pass your next survey. Accurate and timely documentation trumps your requirement to listen to such complaints.

Julianne Haydel is the owner and principal consulting with Haydel Consulting in Baton Rouge, LA. She can be reached at Haydelconsulting@bellsouth.net Or, readers are welcome to comment on this article below.