After Inspection, Hampton VA Improving Stroke Patient Procedures
An inspector general’s report released Tuesday faulted the Hampton VA Medical Center in how it assessed, screened and collected data on stroke patients, and the center’s director said improvements are on the way.
The center, which has struggled with long wait times for patients, received a clean slate for its nursing home, or community living center, and mostly positive findings in a category called quality management.
The report card, known as a combined assessment review, covered operations for fiscal years 2013 and 2014 through Sept. 22. It includes an employee survey and an inspection that covered nine areas. The Office of Inspector General in the U.S. Department of Veterans Affairs audits, inspects and evaluates VA activity.
On acute ischemic stroke care, the inspector general assessed nine areas and recommended improvement in four of them. Two more were considered non-applicable. They reviewed the records of randomly selected patients who experienced stroke symptoms. They also talked to key hospital employees.
An ischemic stroke occurs due to a blockage of a blood vessel supplying blood to the brain. It is the most common type of stroke, according to the American Stroke Association, accounting for 87 percent of all cases.
Where applicable, the report said clinicians should have completed the National Institute of Health stroke scale, which assesses the degree of severity of a stroke.
“None of the 23 applicable (electronic health records) contained documented evidence of completed stroke scales,” the report states.
Clinicians are also supposed to screen patients for difficulty swallowing before orally taking food or medicine. In six of 24 applicable cases, the record did not show that was done.
There was also no evidence that the hospital collected certain data on its stroke patients and reported the information to the Veterans Health Administration.
As a result, the inspector general recommended Hampton strengthen its process for completing and documenting stroke scales, post stroke guidelines in appropriate places, improve the screening process on swallowing difficulties and collect the required data.
Michael Dunfee, medical center director, concurred with the recommendations and submitted a response plan in each case.
He said a “progress note template” has been included in electronic medical records that will be completed on all emergency patients who show signs of stroke, as well as inpatients who may develop these signs while hospitalized. The staff planned to educate all nurses in the emergency room and acute care inpatient units on the stroke scale by Dec. 15. Medical records of stroke patients will be reviewed monthly.
Likewise, the screening for swallowing has been incorporated into the record, and the hospital says it has posted stroke guidelines in required areas.
On collecting data, the hospital said it will begin reporting stroke-related data by next month.
The inspector general also noted that Hampton’s “Veteran X” program, a peer-to-peer recovery group, was selected among 3,500 entries as a top innovative program and is being considered for nationwide implementation within the VA.
Tags: Veterans News
