Getting Past a Survey When You’re Not Ready!

Several times in my career I’ve had to take a facility that was in it’s survey window and I just knew we were nowhere near ready.  It’s pretty stressful to realize the impending doom that survey can present if they find everything you know is wrong.  And there just isn’t enough time to get everything fixed.

There are a few things you can do to improve your odds of having a decent survey at least clinically.  Some quick-fix clean-up tips to protect you from survey Hell are listed below.

  1. Thin your charts to the bone!  Get everything possible off that chart and back to medical records overflow.  Get started now!
  2. Assign the department heads a set of rooms each.  They make rounds in these rooms, write work orders and grievances as needed, call the sponsors, etc. on a regular basis and address all concerns that arise.
  3. Every week – Take your QI/QM’s and your Resident Level Indicator list and pick 5-10 residents who flag out for the most areas.  You should ensure all those areas are addressed fully in the notes, care plans, etc.  Pick a couple of residents who have zero or only a couple of flagged areas as well and discuss.  You have several ways to clean up this report.  If a resident flags out for Incontinence with no toileting plan, then look to see if they can try a toileting plan.  If they flag out for Antipsychotic without a psychotic condition, see if the doctor will give you a diagnosis.  They’re taking the medication for a reason, right?
  4. Look at your last few surveys and see if there are common denominators.  If you got tagged on Incontinence Care 2 out of your past 3 surveys, I’d have incontinence care training checkoffs going on right now with successful return demonstrations required for every CNA and nurse in the building ongoing until survey.
  5. Review your R.I. list (Resident Identifiers) from your last few surveys.  You know, the list the surveyors give you when the survey is over letting you know who they reviewed.  ie- RI#3 = John Doe.  If Resident John Doe was on each list from the last 3 surveys, there’s a good chance he’ll make this list as well.  Go talk to him now to see if there are any problems and then disect that chart.
  6. And, the final quick tip is one I hate to say, but it’s true:  It’s easy to have a good survey if you don’t have complex residents.  So, if you’re really worried about your upcoming survey (especially if it’s a critical survey, a revisit, etc.), and you’re ok taking a hit on census, be picky on who you admit between now and survey time.  Wounds, trachs, complex disease processes, etc. all pose more opportunities to get cited.  If you’re having problems in these areas, for goodness sake, start culling some referrals and stop admitting just anything that has a payor source.  Play it smart, get past the survey, get the training done and then begin working on building a strong census again.

Guys, that will get you started.  Good luck and remember to know the watermelon book better than your surveyors.

What tips do you have for getting past survey?

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2 Responses to “Getting Past a Survey When You’re Not Ready!”

  • Derrick on

    Great post. My suggestion…make a survey binder with all of the key items that surveyors will request in a QIS survey. If you can get the items to them quickly and accurately when they walk in the door…starting off on the right foot can take you quite a ways to a successful survey. Have your staff update the items daily so they are accurate each morning while in your survey window.

  • Mark on

    Excellent advice, Derrick! How do you like the QIS survey versus the traditional?


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