Field Report

For those of you who missed me last week, I was out of town at a client’s office that was undergoing a recertification survey. In the grand scheme of things, the survey was terrific with no real issues until the last day of survey. At that point, true to form, an issue with wound care was discovered.

This wasn’t an accidental discovery. The surveyors came armed with knowledge that my client’s OBQM reports were slightly higher than average in wound deterioration and falls. No issues were identified regarding falls but wound care was an issue.

In this case, the wound care was done correctly. There was a confusing frequency issue when wound care orders changed but the frequency did not. I doubt that would have ranked even a mention in survey. But the way this survey was conducted was much more in depth than previous surveys. The entire chart was reviewed to determine what my client could have done differently. And it is worth sharing with you because it happens all the time.

The patient was scheduled to go to the hospital for major surgery. Upon checking into the hospital, the surgery was cancelled and the patient was sent home on Lovenox. Neither the patient nor the physician thought to call the home health care agency. The agency did try to call the hospital but the hospital said that no patient had been admitted by that name. So the agency waited assuming the patient was in another hospital. Several days later the agency somehow re-established contact with the patient and began treating the patient.

The question that the surveyors had was valid. Why didn’t my client know that the patient was out of the hospital? It is true that nobody called the agency. And maybe you could argue that my client fulfilled their responsibilities by calling the hospital. But the question the surveyors had was simply, ‘Could the agency have done more?’ And the answer is ridiculously simple. Yes.

And in the future they will. But take note. This survey didn’t nitpick over confusion in frequencies. They didn’t cite the agency for not following wound care orders to the T. Throughout the survey questions were asked about other patients and the answers were sometimes lacking. But these were not issues that were trends or led to an adverse outcome. What the surveyors took issue with was the fact that patient who received care suffered an adverse event that might could have been avoided. And that’s what counts.

I would have preferred a flawless survey but this survey was honest and the changes that my client will make in order to correct the conditional level deficiency will go a long way to preventing hospitalizations in the future. And if that’s the direction surveys will be taking, it is fine with me.

Meanwhile, the agency did very well other than the confusion regarding this patient. Heed the warning. Every agency has one train wrecked chart. It is no longer a strategy to hope that it won’t be discovered by random chart selection. These surveyors knew where to look before they hit the door.

And congrats to my client who had an overall very good survey.