Changes under way at HRMC
Kim Gardner - Staff writer, The Mountaineer Publishing, Printed 3/28/08
At Haywood Regional Medical Center, the way of doing business is being examined "” and changed "” from top to bottom. The goal: to regain Medicare and Medicaid certification and improve patient care. The hospital lost its certification Feb. 24. Officials are aiming to be ready for another survey as of March 31. A portion of the hospital's cafeteria is dedicated to skills fairs, allowing staff to brush up on skills. One week of the fair was spent reviewing the basics of policies and procedures for all hospital staff, with the second fair more detailed and geared toward clinical staff. The fairs were developed to re-educate staff in nine areas identified by Centers for Medicare and Medicaid Services as places in the hospital that needed improvement. Nine stations were set up in the cafeteria for clinical staff to receive re-education, as well as to take pre- and post-tests on the materials presented at the fair. "We all think it's a great thing," said Tracy Baker, a respiratory therapist. "We all have to work as a team to make sure the hospital gets back on track to take care of patients." Baker, along with fellow respiratory therapist Michelle Caldwell, was presenting information on nebulizer therapy to Becky Murray, a registered nurse with the hospital. All three women agreed that the training is beneficial to helping HRMC receive recertification, but to also continuously improve patient care. "It is a team effort," Murray said. The nine areas at the skills fair were medication administration, hand hygiene, patient complaints, fall prevention, SBAR or nurse-doctor communications, pain management, respiratory therapy, restraints and skin care. The training is only one part of HRMC's efforts to regain certification from CMS. Officials have also reviewed and revamped all areas that were cited as deficient by CMS in February. In a news conference held Thursday, hospital spokespersons discussed three of those areas "” patient complaints and grievances, quality oversight and assurance and medication administration. Patient complaints In the past, complaints were handled by various individuals in the organization, and there were lapses in tracking the complaint and any resulting changes. The hospital developed new policies and procedures to handle patient complaints and grievances, and the program will be overseen by Kim Kwiatkowski in the staff development department. "We did not have very good structure and tracking," Kwiatkowski said of past procedures. "We have fine- tuned it so complaints don't fall through the cracks. Complaints can be received through surveys, phone calls, letters and in-house concerns shared with staff. Kwiatkowski said the new process provides structure and accountability. She added that all complaints will be acknowledged with a letter to the complainant within seven days. Quality assurance The new quality oversight and assurance procedures are being headed up by Dr. Richard Riehle, the interim chief medical officer for HRMC. He said the hospital will collect and analyze data to improve hospital procedures. To ensure this happens, a steering committee will oversee the flow of data, which will be collected and analyzed daily, weekly and monthly. "Haywood Regional is committed to excellent patient care and to continue to improve patient care, and that commitment is from everybody," Riehle said. Data collected from the hospital will be compared to other hospitals of similar size to ensure HRMC is doing its best work. To improve communications among the staff, Riehle said the collected data will be shared with staff throughout the institution, whether it is how processes could be better or when they are done right. The committee will ultimately report to the hospital's governing board, who will receive training in the future, said Al Byers, interim CEO of Haywood Regional. The training will help with "what the board needs to know and what to ask," Riehle said. Amanda Brown will serve as the interim director of quality assessment and oversight until a person can be hired to fill the newly-created position full time. In the past, there was a three-member governing board committee which included at least one physician, that dealt with quality assurance issues. Kate Fenner, CEO of the Compass Group, a national consulting firm helping Haywood Regional through the recertification process, said there was plenty of data collected, but little analysis or subsequent improvements made based on the findings. Medications The third area the hospital is revamping is medication administration. Bettye Conley, who has worked as a nurse for 20 years at HRMC, said the hospital's policies and procedures regarding medication administration has been updated, with medication nursing specialists in attendance whenever medication is administered. She said there will also be electronic directives on medication administration to help eliminate errors, as well as a thorough process to follow for medication delivery from the pharmacy to the patient. Included in the process is patient education, Conley said. When nurses administer the medications, they will talk with the patients about the medications they are receiving, why they were ordered, if they are able to tolerate the medications and if they are comfortable with the medications given. "We want to make sure they understand," she said. This education process also gives patients the right to refuse medication, Conley said. If a patient refuses, then the new policy dictates that the nurse immediately notifies the physician. A procedural change for medication administration was shifting the times pharmacists stock the Pyxis Medstation, a computerized medication tracking and dispensing system located on each nursing floor of the hospital. Before, pharmacists would stock medications at 9 a.m., one of the busiest times of the day for nurses who were attempting to obtain medications for their patients. This caused a logjam, said Eileen Lipham, vice president for professional services. The backlog had the potential to delay the administration of medications, which was one area for which HRMC was cited by CMS. With a new schedule in place, the backlog should be eliminated, Lipham and Conley said. While the training and policy revisions were spurred by the decertification by CMS, Lipham said it has been a good opportunity to refresh nurses' medical training. "Delivering health care is very complex, and is not like working at a factory," Lipham said. "With the human body, you're taking care of patients and every patient is different. (With the current situation) we said let's go ahead and reinforce the education while (the nurses) are here."