Healthcare Inspection - Community Based Outpatient Clinic Reviews: Pittsfield and Greenfield, MA Dunkirk and Niagara Falls, NY Hermitage (Marzano) and Foxburg (Clarion County), PA Cumberland, MD and Harrisonburg, VA

The VA Office of Inspector General reviewed eight Community Based Outpatient Clinics (CBOCs) the week of June 21–25, 2010. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 1 were Pittsfield and Greenfield, MA; in VISN 2, Dunkirk and Niagara Falls, NY; in VISN 4, Hermitage (Marzano) and Foxburg (Clarion County), PA; and, in VISN 5, Cumberland, MD and Harrisonburg, VA. The parent facilities of these CBOCs are Northampton VA Medical Center (VAMC), VA Western New York Health Care System (HCS)-Buffalo, VA Butler HCS, and Martinsburg VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, suicide safety plans, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISN and facility management: Northampton VAMC: Ensure all designated CBOC staff at both the Pittsfield and Greenfield CBOCs maintain a current basic life support certification. Develop and implement a secure method of transporting medications and patient care documents from the Greenfield and Pittsfield CBOCs to the Northampton VAMC. Maintain auditory privacy during the check-in process at the Pittsfield CBOC. Ensure hand hygiene monitors at the Greenfield and Pittsfield CBOCs are collected, analyzed, and reported as required by the Center for Disease Control and Prevention. Properly secure cleaning chemicals at the Greenfield and Pittsfield CBOCs. VA Western New York HCS-Buffalo: Conduct annual fire safety inspections at the Niagara Falls CBOC. Ensure there is evidence in the medical record at both the Dunkirk and Niagara Falls CBOCs to show that the patient received a copy of the suicide safety plan. Ensure the Primary Care Management Module Coordinator performs in accordance with Veterans Health Administration (VHA) Handbook 1101.02 to reduce the number of veterans assigned to more than one Primary Care Provider. VA Butler HCS: Maintain auditory privacy during check-in process at the Marzano CBOC. Secure and protect all personally identifiable information (PII) at the Marzano CBOC. Require that modifications to the entrance doors be made to improve access for disabled veterans at both the Marzano and Clarion County CBOCs. Adhere to VHA suicide safety plan requirements at the Marzano CBOC. Martinsburg VAMC: Ensure managers verify provider education for compliance to local policy requirements and contract agreements at the Harrisonburg CBOC. Require that clinical functions performed at the Cumberland and Harrisonburg CBOCs are described in the providers’ scope of practice. Require the Harrisonburg CBOC maintain PII in a secure fashion and monitor compliance. Require that staff complete safety plans and monitor for compliance that the plans are completed and patients receive copies of the plan as required by local policy at the Cumberland and Harrisonburg CBOCs.