10/24/08 — Staff changes assist Cherry comeback

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Staff changes assist Cherry comeback

By Phyllis Moore
Published in News on October 24, 2008 1:46 PM

Representatives from a state-hired consultant group returned to Cherry Hospital Wednesday, as officials there continue to shore up a plan of correction targeting improved patient care from the nursing staff.

As the hospital continues to work toward recertification -- federal funding for Medicaid and Medicare was revoked effective Sept. 1, officials this week detailed some of the efforts being made to remedy the problems.

Compass Group Inc. of Cincinnati was hired last month to do an evaluation of the operational and management structure of the hospital. Prior to that, a state survey team spent several days at the hospital investigating a complaint about patient safety. Cherry was given 23 days to complete a plan of correction.

Such a plan was already in place and was being implemented even before the state investigated, said Bonnie Gray, director of nursing.

"We have policies and procedures in place that decide how we do our work," she said.

"That's required by the regulatory bodies," added Dr. Jack St. Clair, hospital director. "It's a living, breathing document. It's ongoing. It never ends."

Periodic status reports are regularly required and submitted to the state, as well as the Joint Commission and Centers for Medicare and Medicaid, St. Clair said.

The latter are two parallel tracks, the director explained, but since CMS decertified the hospital, status reports have only been sent to the Joint Commission.

The plan of correction has already been accepted by the Joint Commission, which maintains accreditation of Cherry, Mrs. Gray said.

Once evidence is complete, indicating that all the conditions have been met and improvements made, a report will be sent to CMS, which must still do a full survey before recertification will be upheld.

"Of course we want to expedite our plan of correction," she said. "It's up to us to evaluate ourselves against the plan of correction and everything else that drives us at Cherry Hospital, but we're going to have a full survey from top to bottom as soon as we let them know that we're ready."

In the meantime, results of Compass' assessment visit were released earlier this month. While findings centered around leadership and management issues, a good portion also dealt with patient care and treatment.

The consultants' return to Cherry will only enhance the hospital's ability to remedy the situation, the officials said.

"The Department of Health and Human Services has negotiated a contract with the Compass Group as a follow-up to their report and they're sending in a team of two consultants starting Wednesday who will work with us very closely to identify areas of this organization and its operation that (need) further enhancement as well as helping us conduct this self-evaluation," St. Clair said. "They'll really be coming in on the scene in a very timely way."

While St. Clair was uncertain how long this visit will be, the goal is for Compass to help expedite the application process for recertification.

"We were very impressed with their expertise when they were here before," Mrs. Gray said. "We welcome their assistance."

Several efforts have already been made to improve teamwork and communication in her department, the nursing director said. From increasing the nurse-patient ratio and training to closer monitoring of patients, it's an "ongoing cycle of improvement."

The first move was to double the nurse-patient ratio in the adult acute admission wards, some which have at least 24 beds. They are now staffed with two registered nurses around-the-clock.

"Having two nurses on the wards has made a huge difference," St. Clair said. "The change in patients' condition happens regularly here. Having those two nurses readily available who can assess on a regular basis is the key to us being able to be more responsive to patients."

Providing additional nurses on duty was accomplished, he added, after another ward was closed and nurses there were reassigned.

Ongoing training, as well as introducing mentoring and coaching initiatives, will also add an extra layer of nursing oversight, Mrs. Gray said.

Another item in the plan of correction deals with hand-off communication at each shift change.

"It's important that oncoming staff go into shift reporting and receiving pertinent information about the patients they are going to be caring for in the upcoming shift," Mrs. Gray said. "We ensure that's happening consistently in a designated location on each ward and that all staff get that before assuming their duties for the shift."

While the system can be improved upon, officials at Cherry maintain there are many things that are also being done well.

"We have some very competent, caring professionals at Cherry Hospital who are committed to excellence," Mrs. Gray said. "Their hearts are in the right place and they do their jobs very well, they care for the patients and they care about the future of Cherry Hospital. That includes registered nurses, licensed practical nurses and our health care technicians.

"Some of the things they do very well are teamwork, and this event -- the unfortunate event that led to where we are, has heightened our approach to teamwork and working with each other."

There will always be challenges, she said. Hiring and keeping good workers is just one of those.

"The need for ongoing workforce development is present in every hospital," Mrs. Gray said. "We are keenly aware of the need for that."

Over the last couple of months, the employee vacancy rate is up from 7 percent to more than 9 percent, St. Clair said.

The nursing shortage, as well as negative publicity for the hospital of late, has not helped the situation.

"It's a hard, challenging and rewarding field for those who love it -- psych and mental health nursing," Mrs. Gray said. "Mental health issues are prevalent, but when a plan comes together and the patient gets better, it's very rewarding.

"Bad things happen everywhere but the good care that we do far outweighs the mistakes that have been made and we're going to be better in the long run. ... Cherry is a good place to grow professionally and to make a difference. At the very core of who we are here, there's still a spark, there's still a pride of affiliation and there's a rich sense of history here."