Healthcare Facility Inspection of the Durham VA Health Care System in North Carolina

This Office of Inspector General (OIG) Healthcare Facility Inspection program report describes the results of a focused evaluation of the care provided at the Durham VA Health Care System. This evaluation focused on five key content domains:
   •    Culture
   •    Environment of care
   •    Patient safety
   •    Primary care
   •    Veteran-centered safety net

The OIG issued 11 recommendations for improvement in two domains:
1.    Environment of care
   •    High-alert medications in a secure or locked area
   •    Expired medical supplies and clean supply areas
   •    Cleaning and disinfection
   •    Safety of crossing area
   •    Accurate directories
   •    Navigational features for sensory-impaired veterans
   •    Staff communication with sensory-impaired veterans
   •    Environment of care trends
2.    Patient safety
   •    Joint Patient Safety Reporting system
   •    Communication and follow-up for urgent, noncritical abnormal test results
   •    Patient safety trends