Turning your survey into child’s play
July 1, 1999 4 minutes read
Turning your survey into child’s play
Preparation, preparation, preparation is the key
Editor’s note: This is part of a continuing series of stories about agencies that received accreditation with commendation from the Joint Commission on Accreditation of Healthcare Organizations.
There are growing opportunities for agencies that provide pediatric services — perhaps as much as a $5 billion market for pediatric home care is there for the taking. But such growth can create problems — like how to find adequate and appropriately trained staff, plus trouble with limited third-party insurance reimbursement, and the work it takes to meet state and federal government regulations.
But Pediatric Services of America’s (PSA) Santa Cruz, CA, branch overcame those obstacles a year ago to become accredited with commendation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
According to Bev Grammer, RN, MPA, director of nursing and an administrator at the agency, says PSA’s success was predicated on the same fundamentals that other agencies profiled in this series indicated were important: long term preparation and reviewing the JCAHO manual page by page.
"We didn’t prepare at the last minute," says Grammer. "We started a year before the survey."
The agency took every chapter in the JCAHO standards manual and created training sessions. "The four supervisors and management read through the materials at least a dozen times," she says. "Then we did an inservice."
The hourly inservice was done as part of the regular weekly supervisor’s meeting. As part of a larger corporation — there are 110 branches around the country — PSA also benefited from the experience of other branches and the resources of the corporate office.
"Our national quality improvement director came out and spent time with us," Grammer recalls, "doing training, auditing personnel files and charts." The results of those audits were discussed with the Santa Cruz management and passed on to supervisors and staff in the form of a checklist of items that needed attention.
After management and nursing supervisors went through those items, the staff was apprised of the problems through memos and a quarterly quality improvement newsletter. "It just didn’t make sense to pull 90 or 100 people in for an inservice, especially when some live an hour away," Grammer explains. "We wanted to get the most information out as quickly and cheaply as possible, and this was what we decided to do."
Once the agency went through the manual and had the corporate audits, PSA held a mock survey. The benefits of that early preparation paid off in some concrete ways. In one instance, chart audits found that inadequate attention was being paid to matching medical and administration records to the medication profile for clients. That led to an ongoing medication tracking system.
Above and beyond the norm
But Grammer thinks there was more to the commendation than just preparing to JCAHO standards. She says it was successful partly because PSA Santa Cruz went beyond what the commission and even PSA’s corporate policies demand. For example, the agency has been concerned about staffing trends and the difficulty the agency was having in keeping good employees on staff.
Grammer formed a committee that looked at percentages of staffing per client and tried to find ways to deal with turnover and retention problems — something that plagues most agencies these days. The result was some new and better ways to recruit nurses. "I think the surveyor was impressed that we had a year of documentation on this committee and its efforts and that it went beyond what our corporate office demanded. To take the tools we have available to us and turn it into something that achieves a positive outcome is something special."
What makes the surveyors sit up and take notice, Grammer continues, is to take a problem and look at it in a structured way. "You have to go beyond the basic, and then you have to track your records and monitor them meticulously."
Grammer says it’s easy to fall into the trap of preparing for a survey just a couple of months prior to recertification. "But if you have your procedures in place and adhere to them, you don’t have to scramble. There are just some things you have to do continuously."
For instance, she says, you can’t look through every chart two months before a survey. Nor can you read every nursing note. But you can have your supervisors divide the task of looking at chart orders, medical records, and medication profiles for a several-month period. Those kinds of continual efforts pay off. In one instance, Grammer found that nurses were not thoroughly documenting patient weight. "It was hard for bed-bound patients, but it’s important to do."
Grammer never thought the survey would turn out badly. "I knew we were thorough. But I was still pleasantly surprised when we got the commendation."
Luck — or at least felicitous timing — can play a part in such success, too. One client came out from the hospital the day before the survey and the surveyor was taken to the client’s home. "The case was beautifully set up, the family could demonstrate we communicated education to them, and the discharge went well. I’m sure that helped."
There is a danger that staff can get complacent, Grammer says, especially after you let them know you received a commendation. "But another trap you can fall into is that they don’t come for another three years. The key is not to do nothing during that time. You have to stay on top of changes, both from our corporate office and guidelines and rules from the government and from the commission." n
Source
• Bev Grammer, RN, MPA, Director of Nursing and Administrator, PSA Santa Cruz, 815 River St., Santa Cruz, CA 95060. Telephone: (800) 882-9017.
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