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Department of Veterans Affairs Office of Inspector General Combined Department of Veterans Affairs Office of Inspector General Office of Healthcare Inspections Report No. 10-00048-118 Combined Assessment Program Review of the Overton Brooks VA Medical Center Shreveport, Louisiana March 29, 2010 Washington, DC 20420 Why We Did This Review Combined Assessment Program (CAP) reviews are part of the Office of Inspector General's (OIG's) efforts to ensure that high quality health care is provided to our Nation's veterans. CAP reviews combine the knowledge and skills of the OIG's Offices of Healthcare Inspections and Investigations to provide collaborative assessments of VA medical facilities on a cyclical basis. The purposes of CAP reviews are to: • Evaluate how well VA facilities are accomplishing their missions of providing veterans convenient access to high quality medical services. • Provide fraud and integrity awareness training to increase employee understanding of the potential for program fraud and the requirement to refer suspected criminal activity to the OIG. In addition to this typical coverage, CAP reviews may examine issues or allegations referred by VA employees, patients, Members of Congress, or others. To Report Suspected Wrongdoing in VA Programs and Operations: Telephone: 1-800-488-8244 E-Mail: [email protected] (Hotline Information: http://www4.va.gov/oig/contacts/hotline.asp) Combined Assessment Program Review of the Overton Brooks VA Medical Center, Shreveport, LA Table of Contents Page Executive Summary ................................................................................................... i Introduction ................................................................................................................ 1 Profile ...................................................................................................................... 1 Objectives and Scope ............................................................................................. 2 Results ........................................................................................................................ 3 Review Activities With Recommendations .............................................................. 3 Reusable Medical Equipment ............................................................................ 3 Suicide Prevention Safety Plans ........................................................................ 6 Quality Management ......................................................................................... 7 Environment of Care ………………………………………………………………. 10 Coordination of Care ………………………………………………………………. 12 Physician Credentialing and Privileging …………………………………………. 13 Review Activity Without Recommendations ............................................................ 14 Medication Management ................................................................................... 14 VHA Satisfaction Surveys ....................................................................................... 15 Appendixes A. VISN Director Comments .................................................................................. 17 B. Medical Center Director Comments ................................................................... 18 C. OIG Contact and Staff Acknowledgments ......................................................... 24 D. Report Distribution ............................................................................................. 25 VA Office of Inspector General Combined Assessment Program Review of the Overton Brooks VA Medical Center, Shreveport, LA Executive Summary Introduction During the week of January 25–29, 2010, the OIG conducted a Combined Assessment Program (CAP) review of the Overton Brooks VA Medical Center (the medical center), Shreveport, LA. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we also provided fraud and integrity awareness training to 170 employees. The medical center is part of Veterans Integrated Service Network (VISN) 16. Results of the The CAP review covered seven operational activities. We made recommendations in six of the activities reviewed; Review three recommendations were repeat recommendations from the prior CAP review. For these activities, the medical center needed to: • Implement the corrective action plan to ensure competency of Supply, Processing, and Distribution (SPD) employees and assess and document annual competencies for all employees who reprocess reusable medical equipment (RME). • Require SPD employees to conduct regular inventories in the SPD storage area to check for outdated items. • Ensure that standard operating procedures (SOPs) for RME are established in accordance with manufacturers’ instructions and that all draft SOPs and the guidelines for low level disinfection are implemented. • Ensure that safety plans are developed as soon as possible after patients are identified as being at high risk for suicide. • Require the Peer Review Committee (PRC) to submit quarterly reports to the Medical Executive Committee (MEC). • Ensure that an adequate mechanism is implemented to track compliance with Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) training. • Require that monitoring of the copy and paste functions in the electronic medical record is fully implemented. • Require employees to comply with annual tuberculosis (TB) screening. VA Office of Inspector General i Combined Assessment Program Review of the Overton Brooks VA Medical Center, Shreveport, LA • Ensure that medication reconciliation monitors are fully implemented. • Implement a yearly fire drill schedule to ensure compliance with the National Fire Protection Association (NFPA) regulations. • Ensure the security of medications. • Require that designated employees receive N95 respirator fit testing and implement an effective tracking system to monitor compliance. • Require compliance with Veterans Health Administration (VHA) and local policy regarding inter-facility transfer documentation. • Require that Focused Professional Practice Evaluation (FPPE) plans are implemented for newly hired physicians and that they comply with VHA requirements. The medical center complied with selected standards in the following activity: • Medication Management. This report was prepared under the direction of Christa Sisterhen, Director, St. Petersburg Office of Healthcare Inspections. Comments The VISN and Medical Center Directors agreed with the CAP review findings and recommendations and provided acceptable improvement plans. (See Appendixes A and B, pages 17–23, for the full text of the Directors’ comments.) We will follow up on the planned actions until they are completed. (original signed by:) JOHN D. DAIGH, JR., M.D. Assistant Inspector General for Healthcare Inspections VA Office of Inspector General ii Combined Assessment Program Review of the Overton Brooks VA Medical Center, Shreveport, LA Introduction Profile Organization. The medical center is a Clinical Referral Level 1C facility located in Shreveport, LA, that provides a broad range of inpatient and outpatient health care services. Outpatient care is also provided at three community based outpatient clinics (CBOCs) in Monroe, LA; Longview, TX; and Texarkana, AR. The medical center is part of VISN 16 and serves a veteran population of about 109,000 throughout 12 parishes in Louisiana, 11 counties in southern Arkansas, and 9 counties in east Texas. Programs. The medical center provides a full range of patient care services. Comprehensive health care is provided through primary and specialty care in the areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, and geriatrics. The medical center has 119 hospital beds. Affiliations and Research. The medical center currently has active affiliations with 32 educational institutions and trains students from 81 programs. In fiscal year (FY) 2009, the medical center trained 282 medical residents and fellows from 17 specialty programs sponsored by its medical school affiliate—Louisiana State University’s Health Sciences Center School of Medicine, Shreveport, LA. The medical center currently supports 63.5 resident training positions. The medical center is affiliated with seven schools of nursing and trained 327 nursing students in FY 2009. It also trained an additional 286 students from various allied health disciplines, including pharmacy, social work, physical therapy, and nutrition. In FY 2009, the medical center’s research program had 40 projects and a budget of $321,656. Areas of research included cancer, diabetes, and mental health (MH). Resources. In FY 2009, medical care expenditures totaled $212 million. FY 2009 staffing was 1,397 full-time employee equivalents (FTE), including 134 physician and 418 nursing FTE. Workload. In FY 2009, the medical center treated 36,262 unique patients and provided 34,500 inpatient days in the hospital. The inpatient care workload totaled VA Office of Inspector General 1 Combined Assessment Program Review of the Overton Brooks VA Medical Center, Shreveport, LA 6,044 discharges, and the average daily census was 94.5. Outpatient workload totaled 379,838 visits. Objectives and Objectives. CAP reviews are one element of the OIG’s efforts to ensure that our Nation’s veterans receive high Scope quality VA health care services. The objectives of the CAP review are to: • Conduct recurring evaluations of selected health care facility operations, focusing on
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