ILWACO — A regular audit of Ocean Beach Hospital revealed problems with hospital documentation, equipment use and staff training.

The audit, completed by the state’s Department of Health in March 2019, resulted in the loss of OBH’s chemotherapy services, as reported by the Chinook Observer. Other findings have since required hospital leadership to update its policies.

“We don’t look at this process as punitive. We look at it as educational,” said OBH Chief Executive Officer Larry Cohen. “The surveyors are very helpful.”

The DOH surveys OBH roughly every 18 months. The March survey lists 22 deficiencies found at OBH.

OBH was required to submit a ‘plan of correction’ to identify how the hospital would address the deficiencies.

None of the deficiencies put patients in immediate risk, said DOH’s external communications supervisor Jessica Baggett.

Training-related issues

Three patients placed in restraints at the hospital were monitored during the survey. Hospital policy requires that patients in restraints are checked on at least once an hour.

Patient A came to OBH for treatment of psychosis related to methamphetamine intoxication on Sept. 18, 2018. The hospital didn’t have documentation to prove the patient was checked on for a period of one hour and 41 minutes.

Patient B came to OBH on Sept. 27, 2018 for treatment of altered mental status. Hospital records show a period of two hours and two minutes, and another period of four hours and 18 minutes, where the patient wasn’t checked on.

Patient C came to OBH on Oct. 30, 2018. The patient was left alone in restraints for a period of six hours and 56 minutes, and another period of nine hours and 30 minutes, according to hospital records.

The DOH review found similar findings with OBH’s handling of other patients in restraints. At the time of the March review, hospital staff thought the hourly check-ins had to be completed by a doctor.

“We only have one provider,” Cohen said. “If we’re busy with five or six patients, they’re running around. That’s probably why the requirement wasn’t met.”

The hospital has since started training nurses to complete the hourly check-ins, said Chief Nursing Officer Linda Kaino.

Other training issues included not doing regular training for reprocessing endoscopes and not doing an annual evaluation of the hospital’s safe patient handling program. Issues were also found for staff procedures regarding standards of care in the emergency department, staff refusal of patients, and monitoring patients while administering blood products.

In the hospital’s emergency department, hospital staff didn’t get immunization information for two children who visited OBH in March.

“They want us to get up-to-date records,” Kaino said. “We weren’t necessarily doing that all the time.”

The hospital also was found to be out of compliance under the state’s Retail Food Code.

Equipment/facility-related issues

OBH stopped its chemotherapy services in July when Dr. Ivan Law, who provided oncology services, left the hospital for a job at a Spokane cancer treatment group.

Law left OBH because the hospital wasn’t complying with federal pharmacopeia regulations.

Under 2019 federal requirements, hospitals that mix chemotherapy drugs must do so in a sterile environment, with positive pressure and ventilation. OBH tried to find a way to follow regulations but ultimately couldn’t meet ventilation requirements.

“The chemo issue was huge. It took up probably more than half of our time [during the survey],” Cohen said.

“We tried to fit it, to be able to do it. [The requirements] just got bigger and bigger.”

Had Law stayed with OBH, the hospital could have continued its chemotherapy services until December, which is the deadline for following the new regulations.

Other equipment/facility issues found included the hospital keeping expired medication and supplies, not following regulations for multi-dose vials, and not separating clean and dirty items.

Hospital staff removed the expired medication and supplies, and replaced multi-dose vials with single-use vials.

The hospital’s separation of clean and dirty items was limited to a single room, where hospital staff sectioned off half the room for clean items, and the other half for dirty.

Hospital staff has since moved clean items to a separate room to be in compliance.

Documentation-related issues

Most of the audit’s issues were related to hospital documentation. Many of the issues were fixed before the auditors left, Kaino said.

Hospital signage, policies and medical record-keeping were among the main issues found regarding documentation.

Regarding signage, the hospital was found to not have signs indicating its emergency department was a safe haven for abandoned infants. The hospital did have signage for this at the time of the survey, according to Cohen.

Policy issues included not having a hospital-wide assessment and performance improvement plan. The hospital also didn’t perform a patient handling hazard assessment, or include updated equipment in the hospital’s safe patient handling policy.

Hospital staff also didn’t get specific names of adults picking up patients after procedures.

“We’d say ‘husband,’ but not specify their name,” Kaino said.

“Sometimes people will say they have someone and they don’t. Getting a name adds another level of responsibility.”

The hospital has since started getting specific names. Updates have also been made to hospital policies, Kaino said.

“It’s all about patient safety,” Cohen said.

Medical record-keeping issues were found regarding timeliness, completeness and accuracy.

The hospital was also found to not be documenting and reporting information on medical records and equipment maintenance.

Many of the record-keeping issues were addressed before the survey completed.

Several of the review’s documentation questions came up because Kaino was out of town during the survey, she said.

“We’re so small, we only have one person in many of those departments [that are looked at],” Kaino said. “So when they’re gone, sometimes there’s a person with three or four hats.”

Other issues listed above have been addressed since the survey, according to Cohen and Kaino.

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