You likely have been hearing for a while that the Medicare Survey Process has changed. Surveyors are no longer simply reviewing paperwork and assessing policies and procedures but are centering on patient outcomes and care provided. Surveyors only examine documentation but want to know about how processes are used with the patient. I'm unsure if nurses clearly understand what's expected of them on a survey.

Typically, as a New Year is upon us, we examine what we've done well and in what areas we can improve. Although this focus is usually on losing weight and exercising more (both great), I suggest that home care nurses also reflect on their primary role--applying the nursing process to their patients and families.

Suggestions From CMS

Recently, Mary Weakland, MS, RN, Nurse Consultant for CMS, shared the following tips clinicians can use to positively contribute to a successful agency survey at the VNAA National Policy Conference in Washington, DC. You'll find that these suggestions reflect what you know best-professionally implementing the nursing process.

[black small square] Remember Nursing 101: Use the fundamentals when conducting comprehensive assessments, interventions, and evaluations.

[black small square] Documentation Should Follow: Surveyors especially focus on reviewing your plan of care, how and when you've communicated with the patient's physician, if you're following orders, whether you're noticing changes in the patient's condition and doing something about them, and if you're evaluating care and making needed changes on an as-needed and regular basis.

[black small square] Be Informed About Your Agency's Quality: Surveyors look for quality indicators in your documentation as well as evaluate how efficiently you coordinate care. It's essential that you understand your agency's OBQI processes and how the agency is specifically addressing the national outcome indicators through Home Health Compare.

[black small square] Do Your Homework: Learn the survey process by reading Appendix B of the State Operations Manual "Guidance to Surveyors: Home Health Agencies" found online at: http://www.cms.hhs.gov/manuals/107_som/som107ap_b_hha.pdf.

Although the holidays are busy, put these ideas in your resolution file along with all the others. In early January, think about these ideas, talk them over with your colleagues and managers, and see how simple approaching a survey from the nursing process can be.

I marvel every day on how much I rely on my basic diploma nursing education to apply the nursing process to my daily work. Sometimes the best New Year's resolutions are not about focusing on negative things but are reflecting on positive things we do and know. I'm betting that the basics of the nursing process will continue to serve you well in 2005 and through anything a Medicare survey can throw at you!! May your New Year be Happy and Blessed.