I don't know which is worse, the members of the AAMI committee that are clueless or the surveyors that are absolute idiots.

One of our facilities is in the middle of a survey and the surveyor wants documents that CERTIFY that the carbon we use is virgin carbon.

In the past, this same surveyor has cited us for a patients blood pressure being taken 2 MINUTES later than it should have been.

At another facility this same surveyor didn't like our Bicarb Mixing Log because it didn't document how many bags of bicarb are added each time a batch is made. We use the Fresenius bicarb mixer so, it is only capable of making 1 size (96L) batch of bicarb. If no bicarb is added, the conductivity on the dialysis machines won't come up....If 2 (or more) bags of bicarb is added, it won't dissolve and will jam up the mixer! I can understand this requirement for acid mixing systems where you're adding multiple bags of different powders or, if its even remotely possible for your bicarb system to make different size batches.

While not one of our clinics, I know of a clinic who's water comes from their own private well....that clinic is still required to test for chlorine/chloramine prior to each patient shift!

Sorry for the rant...I'll get down off my soapbox now...

Chuck

For whoever gets their carbon from Marcor...
They now have a letter from their carbon supplier stating that it is in fact virgin carbon.

I could hear the confused looks on everyones faces when I was explaining what I needed and why!

In the exit interview the surveyor said that our bicarb JUGS need to have cone-shaped bottoms....can't to see what V tag she puts that under.

Chuck

This message has been edited. Last edited by: Chuck W,

Chuck when you get those cone shaped jugs let me know how they work. It's seems someone would have to hold them upright, or are they insisting on a little stand too. Sounds like a business opportunity???

Cone-shaped bicarb jugs!!!! I think you need report that Surveyor for being incompetent.

I offer this, not as a defense for lack of knowledge, but rather as an explanation of the reality of the survey process. CMS is mandated to use surveyors employed by the various State Departments of Health (a component of the original state control required in the founding legistation for Medicare.) The typical surveyor may spend 95% of their time assessing nursing homes and outpatient treatment facilities and may only survey one or two dialysis units per year! The reference to "conical bottoms" is located in the system configruation section for elevated bicarbonate distribution systems (V238.) You may get more milage from pointing out this reference and the later references to "Concentrate Jugs" which carries no such configuration requirement ((V243, V244) than by getting hostile. I have gotten more milage from providing a surveyor with a face-saving alternative than by getting angry.

H'mmmmm.
That sounds like a certain CMS surveyor for the Free State who also insisted during a survey that henceforth she wanted to see parameters on our daily RO machine logs for the TDS in concentrate/reject flow because she didn't understand the difference between a 50% recovery machine and newer, 75% recovery machines

Olddog,

As far as I know, the surveyors in Maryland that do dialysis clinics do only dialysis clinics. This particular surveyor has been wreaking havoc in Maryland for 3 years so, she should have learned a lot more than she has by now. IMHO, the surveyors should have dialysis experience. Would you want a dentist to do a kidney transplant?

Smiler,

Her name start with a M?

Chuck

I thought our facility is the only one having problems with the CMS surveyors, six years ago we were cited by CMS on water issues. And CMS did a follow up inspection on this six months later and we were ok. I was surprised to meet and talked to a much older surveyor that did the follow-up inspection and I can tell that she's been doing this for years, not the young and the restless that came to our facility the first time asking tons of useless questions.

I just hope they are not going to ask for a cone shaped jug because it does not exist in our facility.

Actually, I do have a thought about the bicarb jug question. We use the boxy jugs for Bicarb that Fresenius sells. They don't empty completely when turned upside down ( they are the nearly flat on top ones). Seems to me it would be better to use the "jerrycan" style for the bicarb since they drain dry when you turn them upside down ( I'm thinking in terms of old bicarb and disinfection bleach possibly remaining behind from time to time ). So it has always seemed to me the jugs are kind of backwards for what we use them for. Thoughts ?

As long is there's chlorine in the tap water, rinse with tap water and you're good to go. Bleach the jugs if you want but huge time eater to rinse to clear. I've done swabs with bleached then rinsed with RO and cultures grow quicker than regular chlorinated tap water.

Maybe there is less growth because there is still some chlorine in your jugs. My personal feeling, CMS would eat that up for breakfast. How are you clearing all the chlorine out of your jugs and how are you checking it??

We treat our water because of the contaminants can harm patients with kidney failure when you rinse with tap water you are introducing untreated water that will be mixing with the bicarb and come in contact with the patient. NOT GOOD AT ALL.

I think that "Ned" forgot why we have a pre-treatement area. That is the craziest thing I have ever heard of. I would NEVER recommend use of tap water, heck you even have to rinse your conductivity meters with R.O. water. Imagine what CMS would say haha "I.J." ;]