Clinical Assessment Program Review of the Wilmington VA Medical Center Wilmington, Delaware

The VA Office of Inspector General (OIG) evaluated the quality of care at the Wilmington VA Medical Center. This included reviews of key processes that affect patient care outcomes—Quality, Safety, and Value; Environment of Care (EOC); Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home (CNH) Oversight; and Management of Disruptive/Violent Behavior. OIG provided crime awareness briefings to 84 employees. OIG identified certain system weaknesses in EOC Committee meeting minutes; general safety; Sterile Processing Service (SPS) employee competencies; hemodialysis unit infection prevention; anticoagulation processes and employee competencies; transfer data and documentation; point-of-care testing actions; CNH oversight, clinical visits, and policies; and management of disruptive/violent behavior policy, committee representation, and employee training. As a result of the findings, OIG could not gain reasonable assurance that: (1) EOC minutes track actions taken for deficiencies until closed. (2) Community based outpatient clinic (CBOC) fire extinguishers are inspected monthly, and CBOC information technology network room logs contain access documentation. (3) SPS employees complete annual competencies. (4) Hemodialysis unit employees wear gloves when handling patient equipment. (5) Clinicians obtain required laboratory testing prior to initiating anticoagulants and have documented competency to manage anticoagulation therapy patients. (6) The facility collects and reports data on transfers out and includes required elements in transfer documentation. (7) The facility takes and documents all required actions in response to glucose point-of-care testing results. (8) The facility oversees the CNH program and performs cyclical reviews of care provided. (9) The facility’s disruptive behavior policy reflects current practice, members attend committee meetings, and employees are trained to reduce and prevent disruptive behaviors. OIG made recommendations for improvement in the following six reviews: (1) EOC, (2) Medication Management, (3) Coordination of Care, (4) Diagnostic Care, (5) CNH Oversight, and (6) Management of Disruptive/Violent Behavior.