Monthly Survey Spot Light January 2017

Over the next 12 months I am going to start a monthly survey spotlight. I will be discussing survey issues from experience, observation and current trends. I would love for people to share in these and make them a discussion on how to improve our survey outcomes across Ohio. I am tired of all of the negative press regarding nursing homes. I am seeing a huge jump in jeopardy level deficiencies and feel that this is one way to combat this. Please make comments and share your ideas and experiences.

Employee Records

The first area I am going to address is one that I have been seeing cited repeatedly in facilities and is very easy to correct. Inaccurate documentation in this are can be spread across several deficiencies including F225 and F226 abuse, F441 infection control and F497 employee records. It seems like we can all recite what is required but for some reason it just does not happen because of:

1.What I am seeing as the greatest cause of in accurate employee records is related to manager turnover and division of duties.

2. Employee records not maintained in the same area for example maintained in specific departments, managers files maintained in another location, contract employee files not maintained with other employee files.

3. Lack of training in preparing and maintaining employee files.

4. Access to paper work required for files.

Here is a short list of what the state focuses on during a survey in employee records

1. For new hires they focus on BCI log, references, proof of licensure/certification, orientation, Hepatitis B vaccine acceptance or refusal and TB

2. For State Tested Nurse Aides that have been employed over 1 year they look at all of the above and in addition to that they look at 90 days and annual evaluation, 12 hours of in-servicing for each, annual STNA specific competencies and annual TB

3. Nurses include an annual license verification and specific nurse competencies

Here are some suggestions for maintaining control of this area

1. Choose the gate keeper carefully. They must be trustworthy and very organized. Facilities come in all sizes and most do not have a human resources person so some other examples of appropriate positions are: receptionist, staff developer, scheduler or central supply person.

2. Once this person is chosen they will need education including what is required in an employee file, how it is organized, the rules governing employee records.

3. A safe secure locked cabinet for employee records.

4. A good copy of all forms

5. Allowed the time to maintain the records.

6. A list of all requirements for the file to be signed off on during processing to ensure that all the components are there.

7. Each department should sign off on the employee before the file is filed away.

8. I also recommend that the administrator also sign off on the record as well.

9. Complete audits of employee files monthly.

Leadership Definition Quote

I borrowed this quote but feel like it matches my own personal philosophy in regards to what leadership is truly about.

Leardership Quotations by Harry Selfridge

Over the last 2 years I have enjoyed watching the PBS series "Selfridges". I watched how the series showed him as a kind motivational leader. Even though he had a lot of vices he was loved by his staff. I found the following quotes that are attributed to him. I feel that these are still very modern ideas about being a manager that we can all use as we manager our facilities and staff.

"The boss drives his men; the leader coaches them."

"The boss depends upon authority, the leader on goodwill."

"The boss inspires fear; the leader inspires enthusiasm."

"The boss says 'I'; the leader, 'we'."

"The boss fixes the blame for the breakdown; the leader fixes the breakdown."

"The boss knows how it is done; the leader shows how."

"The boss says 'Go'; the leader says 'Let's go!'"

"The customer is always right."

Traveling

I know many of you will be able to understand that these type of problems are funny. Because if we didn't laugh we would cry. Well here are a few of my escapades. I have been working over 100 miles from home for a few months so there have been a couple.

I got a new travel bag and was very excited about it. I guess my life is pretty boring when I get excited over a travel bag. Well I had packed most of my stuff the night before and put some in my car. The next morning I got up and finished packing and put my bags in the car and headed to work. After I got off I went to the hotel and got my bags out of the car. I started looking for my new bag I loved so much and even rechecked the back seat and trunk. My car is a little Toyota so it was obviously not there. I had forgot my lovely new bag with all of my toiletries, underwear and shoes. At least I had cloths because they were on hangers. Thank goodness for Walmart.

I have sleep apnea and my husband gets mad at me because I won't use my CPAP machine. This is not a plea for sympathy I just think it's funny. Well after giving me a lecture he talked me into using it. I packed it the first week and he called me each night to make sure I was using it. The next week after I got to work I received a call from him and another lecture for forgetting the CPAP machine. Guess who drove it up to me that evening. I also got another lecture.

I had been staying in the same hotel for almost the entire time while working in a particular area. I usually asked my corporate contact to reserve my room for me but I forgot to do it 1 week. On Monday I called the hotel to make sure they had a room for the week and guess what? They did not have a room for the week. I contacted my corporate contact and told them they did not have a room for the week. I then received an email that I had a room in Columbus. I called another hotel which was about 25 minutes away but no traffic to deal with. They had a room. I emailed the office and asked them to change my reservation. They told me it had a 24 hour cancellation policy and could not be cancelled ( even though it had only been 15-20 minutes since the reservation was made). I bit the bullet and headed out with my GPS. The hotel was in the far north side of Columbus in Delaware right smack dab in the middle of a giant road construction site on the highway. I go in to check in and the receptionist tells me that the card the office used failed. I give him my card to use and then ask if I could cancel if I got a room somewhere else and he told me sure. I call the hotel I wanted to go to in the first place and make a reservation and after a total of 60 miles travel I reach my hotel.

National Nursing Home Week 2016

5 fun filled days to dress up and enjoy good food and games. Nursing Home Week is always special for the residents and the staff. Our staff have 5 fun days planned with:

Monday miss match

Tuesday support your favorite team

Wild West Wednesday

Tropical Thursday

Fancy Friday

National Nurses Week 2016

I put these pictures up to share how nursing has grown over the years. I included my own picture to see if any of my staff would recognize it.

Best Practices

I want to share the top 10 best practices that I feel make a successful facility. I do not take credit for these and have learned many of them through working in many settings. I feel that if you implement these into your daily practices you will be successful and have good survey results.
1. walking team rounds
      a. include nursing manager, MDS, social services, activities and dietary
      b. review nurses notes, telephone orders, 24 hour report, check MAR's/TAR's for holes errors medication availability, labs, x rays, ADL documentation
2. guardian angel program with daily rounds
3. morning meeting with all department managers
4. all hands dining
5. weekend manager program
6. monthly open door meetings
7. routine mock survey utilizing specialty service such as ABAQIS
8. stop and watch program with all staff involved to identify resident condition changes early
9. quick responses to all concerns including resident, responsible party and staff
10. an effective ongoing staff education program