Kylie Williams

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Power Tools for Technical Communication By: Kylie S. Williams

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Interim Summary Report April 12, 2017 On March 21, 2017, a confidential complainant forwarded to the Office of Inspector General (OIG) documents describing equipment and supply issues at the Washington D.C. VA Medical Center (the Medical Center) sufficient to potentially compromise patient safety. OIG promptly reviewed the documentation. On March 29, 2017, OIG deployed a Rapid Response Team to assess the allegations. OIG’s team conducted interviews, collected documents, and conducted a physical inspection of the Medical Center’s satellite storage areas on March 29–30, 2017. The team returned for an additional site visit on April 4–6, 2017, and is on-site for a third inspection at the time of this report’s publication. OIG has preliminarily identified a number of serious and troubling deficiencies at the Medical Center that place patients at unnecessary risk. Although we have not identified at this time any adverse patient outcomes, we found that:  there was no effective inventory system for managing the availability of medical equipment and supplies used for patient care;  there was no effective system to ensure that supplies and equipment that were subject to patient safety recalls were not used on patients;  18 of the 25 sterile satellite storage areas for supplies were dirty;  over $150 million in equipment or supplies had not been inventoried in the past year and therefore had not been accounted for;  a large warehouse stocked full of non-inventoried equipment, materials and supplies has a lease expiring on April 30, 2017, with no effective plan to move the contents of the warehouse by that date; and  there are numerous and critical open senior staff positions that will make prompt remediation of these issues very challenging. At least some of these issues have been known to the Veterans Health Administration (VHA) senior management for some time without effective remediation. Although our work is continuing, we believed it appropriate to publish this Interim Summary Report given the exigent nature of the issues we have preliminarily identified and the lack of confidence in VHA adequately and timely fixing the root causes of these issues. We are also including recommendations for immediate implementation. 1 The Medical Center Placed Patients at Unnecessary Risk The Medical Center placed patients at unnecessary risk by failing to ensure that appropriate medical supplies and equipment were available to providers when needed; that recalled supplies or equipment were not used on patients; and that sterile supplies were stored appropriately. Supply Shortages and Inventory Management Practices The Generic Inventory Package (GIP) is the authorized software program used by VA medical facilities to manage the receipt, distribution, and maintenance of supplies. On May 6, 2015, the Medical Center became one of several pilot sites for a new type of inventory sys.

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Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her clinics. As Chief of Paediatric1 Orthopaedic surgery at the Children\'s Hospital of Western Ontario (CHWO), she was very concerned by the long times that the young patients (and their parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already pent-up distress and concern that they were feeling, and parents were understandably irritated at missing significant time at work. Currently, on an average, patients were spending roughly two hours in the clinic. Patient health was not Dr. Leitch\'s only concern. Clinical staff had increasingly complained about being overextended, yet budgetary pressures to reduce the cost of service continued to mount. She was not convinced that all staff was being effectively utilized, and there was an unresolved request from the Radiology department for more advanced equipment. Dr. Leitch also served on several government task forces. From these, she knew that federal and provincial policymakers were increasingly concerned with the economic impact that health-care wait times had on national economic productivity. In a moment of weakness, Dr. Leitch recently had volunteered her clinic to hospital management as a “test case” to demonstrate that patient care could be done in a more timely fashion, without increasing costs. An objective of reducing wait times by 20 per cent was established to show meaningful improvement that would be clearly evident to patients, staff and management. A monthly executive meeting was fast approaching, and expectations were starting to run high that Dr. Leitch would present preliminary recommendations that would offer significant reductions. PAEDIATRIC ORTHOPAEDIC CLINIC As part of London Health Sciences Centre, located in the city of London, Ontario, Canada, CHWO was a large, regional health-care centre that provided specialized paediatric services to children. The population of the 10 counties forming the primary catchment area for CHWO was 1.4 million, including approximately 400,000 children. Many of the CHWO\'s specialty services also attracted referrals from across Ontario, as well as from neighboring provinces and states in Canada and the United States. The Clinic was open for three half-day sessions per week, Monday through Wednesday, from 8:30 a.m. to 1:00 p.m. During the remainder of the week, the facilities were used by other sub- specialties of surgery. Staffed by a surgeon, two senior resident students, three clerks and four registered nurses, the Clinic examined about 80 patients during each half-day session, of which 60 per cent were returning for a follow-up appointment (and so termed follow-up patients). In addition to the staff noted above, other medical students might spend up to one month training in the Clinic. PATIENT FLOW AT THE CLINIC Front Desk: Registration & Verification of Documents The Registration desk was the first point of contact.

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Running Head: PREOPERATION OBSERVATION 2 Title: Pre operation Student’s Name: Professors Name: Date: Pre operation My clinical rotation this week is pre-operation room, it is different from other units I have ever worked on. This unit needs a fast pace, but for medical surgery and specialized units such as labor and maternity was a slow pace. By 11:30 I had already met six patients, the patients were running all over the floor even before I got to the room. Every physician is on their ways to give care to the patients and no one took a break on that day or got time to have breakfast. This is because every physician was busy giving his/her best care to the patients. Pre-operation is mainly focused on giving comfort to the patient by letting him/her know every step of the procedure (Pre NEET, 2013). Pre-operation helped me to know how to run pre-operation unit, by making calls to receive the patients and sending them to the surgery, and it enables me to know how to set, operate and resembles robotic equipment that was used throughout the procedure. I got to wear my protection clothes and took surgery compression devices that are most important in the operation, and later I make sure that every patient is informed about the procedure and released them to the operation room. I prepared an operation dress and bandages that will be applied in the operation. After we entered the operation room there was no time came out of the room and the physicians said this is will only be done during any other procedure that held in the operation surgery. It is important to have a rest, and every physician goes out of the room, and look for patients to promote safety to the patients (Savage, 2011). A sixty-four years old woman came complaining of two nights sleepless and she is having blood pressure. And her vital signs were Tem 97.2, Pulse 79, BP 162/89 and respiratory 20.02, 98%. I asked her name, date of birth and she asks about the allergy and answered her question. And I asked her the time she arrived. My Nursing diagnosis was anxiety, iv insert, anesthesia and evasive procedure as it is evidenced by his blood pressure 128/89. Patient verbalizing, she was scared and she was trying to misplace her hand during iv insertion. My goal is to help the patient until she can report a decrease in anxiety and decrease of fear and decrease of blood pressure. Also to see her reporting that her blood pressure has lowered to the normal level. My intervention was to provide reassurance and give hope to her and allow her to be with her family and later provide answers to her questions. And after that, I washed instruments that I used to do the surgery with and later sterilized the instruments (Scully, 2010). Goal met after I had answered her questions, the patient blood pressure lowered and she did not get hurt during the insertion iv and reports the decrease o ...

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