The fate of Haywood Regional Medical Center was once again placed in the hands of the Centers for Medicare and Medicaid Services as Interim CEO Al Byers mailed off the hospital’s plan of action to correct deficiencies Monday afternoon (March 31).

Upon receipt of the packet, the Atlanta-based government agency can re-inspect the hospital anytime.

Following the initial re-inspection, the hospital will enter a period of “reasonable assurance” lasting 30-120 days. Then it will be fully re-inspected and become eligible for the reinstatement of Medicare and Medicaid funding.

HRMC lost its ability to bill for Medicare and Medicaid Feb. 24 after inspectors found the hospital had failed to correct serious problems with medication administration.

With the help of consulting firm the Compass Group, HRMC has worked feverishly to retool and revamp procedures in the hopes of reinstating Medicare and Medicaid.

Reviews and new procedures for nurses

Nurses went back to school last week at the mandatory nursing skills fair.

At one station, respiratory therapist Tracy Baker demonstrated the proper way to give respiratory care to a patient in case a therapist is not available within a 30 minute window. At another booth nurses observed the correct way to use restraints. Others milled around, checking out displays on everything from preventing falls to hand hygiene.

Gail Holder, R.N., a staff educator and 19-year employee of the hospital, was in charge of setting up the skills fair. She said the whirlwind process has been perhaps the biggest challenge of her career.

“We’re used to putting skills fairs together, but with the short time and high volume...I’m just working harder than ever,” she said.

The nursing staff has focused particularly on improving medication administration. The hospital has trained certain members of the nursing staff as specialists who will supervise medication administration 100 percent of the time, said nursing supervisor Bettye Conley.

The supervisory system won’t be in place indefinitely, so other measures have been used to smooth out the process. Nurses will rely on electronic orders rather than handwritten ones, making it easier to ensure the correct dosage of medication is given and that a medication isn’t given unless it’s been ordered.

A bottleneck at the pharmacy will also be alleviated, allowing patients to receive dosages on time. Before, the pharmacy stocked the medication machine at 9 a.m. — the exact time many nurses needed to give patients a dose.

Additionally, nurses will talk to patients about medication and make sure a patient is able to tolerate a medication comfortably. Problems arose at the hospital before when a patient was given two different medications they were allergic to.

Patient complaints

A new, more centralized patient grievance process has also been established. Before, complaints were scattered among various individuals with nowhere to direct them. Inspectors noted HRMC’s slow and sometimes nonexistent responses to patient grievances.

Director of Staff Development Kim Kwiatkowski has since been placed in charge of handling all patient grievances.

“Because we do get complaints from so many different sources, people would individually try to respond back to those complaints. Now all grievances go through Kim,” said Vice President Eileen Lipham.

The staff development department now tracks and logs all complaints that are received through various avenues, such as surveys, phone calls or internally. A letter notifying receipt of a complaint is sent to a patient within seven days. The complaint is then investigated, responded to and resolved.

Data analysis and quality oversight

The hospital has come up with a new way of collecting and analyzing data to monitor quality of care.

Data will be collected and examined in contrast to similar hospitals, then shared with hospital employees and the board.

A newly created steering committee headed by a professional performance improvement expert will be responsible for tracking and managing the data and determining solutions. The steering committee is comprised of doctors, vice presidents, middle management and lower-level employees, representing “all components of patient care,” said Dr. Robert Riehle, interim chief medical officer.

Hospital data will be presented once a month to an oversight committee made up of three hospital board members and three members of the medical staff.

The flow of information among all hospital employees is in sharp contrast to the tight control of information and culture of secrecy detailed in the Compass Group’s findings.

“Information that should have been freely shared was not,” said Compass President Kate Fenner in her report to hospital board members.

The hospital board will also assist in oversight at HRMC by improving knowledge of hospital bylaws. Byers said the board has been offered three scholarships for intensive, pricey training sessions given by the Institute for Healthcare Improvement.