Federal Reports

The agreed-upon procedures review of AmeriCorps grant funds awarded to the Delaware Governor’s Commission on Community and Volunteer Service (DGCCVS), and two subgrantees, Division of Parks and Recreation and Reading Assist Institute, identified questioned Federal costs of $11,463, questioned match costs of $46,380, questioned education awards and interest forbearance of $8,721 and compliance findings. The costs tested were incurred between April 1, 2016, and March 31, 2018. Most of the questioned costs identified were associated with (1) food and beverages that were not adequately disclosed in the budget, and (2) full-term members who were changed to less than full-time without required DGCCVS approvals.DGCCVS concurred with most of the compliance findings but generally disagreed with the recommended amount of questioned costs. CNCS management concurred with most of the recommendations and stated it will resolve the questioned costs during audit resolution.

This evaluation had two objectives: (1) to describe the range of homestay models that Peace Corps posts were implementing and better understand their advantages and challenges; and (2) to assess the impact of homestay requirements on Volunteer safety, language acquisition, integration, and health. We found that the majority (63 percent) of Peace Corps posts implemented homestay requirements during service, though the number of months required varied. Evidence from this analysis does not support the assumption that better Volunteer outcomes will be achieved in all contexts. Given the costs of administering and potential risk associated with homestay programs, posts that transition to or increase homestay requirements should rigorously monitor safety and language outcomes.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate concerns related to a patient’s response to oxycodone, an opioid pain mediation, including initial post-surgery care and during an acute change in condition (event) at the facility. The OIG also assessed management actions taken by the facility after the event. The OIG found that although providers ordered and nursing staff administered oxycodone consistent with manufacturer’s recommendations, the patient developed signs and symptoms of altered mental status, slowed breathing, and low oxygen in the tissues. The patient was administered naloxone and the symptoms immediately improved. Naloxone has no effect as an antidote in reversing adverse drug event symptoms when given to patients who have not taken opiates. Naloxone’s effectiveness in treating the signs and symptoms supports that the patient was having a response to oxycodone. Providers assessed and treated the patient’s adverse drug event symptoms and the patient did not have further episodes. Facility managers did not consider the patient’s response to oxycodone as one that required a review to determine causative factors and did not report the event to the Veterans Health Administration Adverse Drug Event program or conduct a root cause analysis or an aggregate review. These reviews would have allowed for communication between facility staff and leaders, and patient safety improvement considerations regarding the oxycodone vulnerabilities. The OIG found a clinical disclosure, though warranted, was not documented. An institutional disclosure was conducted approximately six weeks after the event. The Director did not ensure compliance with facility’s peer review policy. In addition, the Surgical Work Group did not meet monthly and meeting minutes lacked discussion of required data. The OIG made six recommendations related to resident supervision; reviewing, capturing and reporting adverse drug events; peer reviews; and documentation of clinical disclosures, and Surgical Work Group meetings.