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State acquits hospital of earlier flaws

For the second time this year, the state Division of Facility Services cleared Durham Regional Hospital of quality violations that threatened the hospital's federal Medicare and Medicaid support.

A surprise survey conducted Aug. 6 to 9 found several breaches of federal standards at the hospital, including mismanagement of a dialysis service provided by an outside contractor and improper nursing care. If left uncorrected, the citations would have disallowed Durham Regional--which is run by Duke University Health System--from treating patients covered by Medicare and Medicaid.

Durham Regional responded with a plan of correction Sept. 10, and began to implement changes immediately after the plan was accepted, officials said.

Four state officials then conducted a comprehensive survey of the hospital Sept. 20, and found the problems had been corrected. Durham Regional had been given a narrow window for when that follow-up survey would occur, but no specific date.

"As a result of the follow-up survey, [Durham Regional] was brought back into compliance.... No new deficiencies were cited during the follow-up survey process," according to a state report issued to Durham Regional.

Durham Regional was similarly cleared of state citations in May, after a March survey found violations of federal quality standards in nursing care.

"Obviously we're very pleased they found us to be in compliance," said Katie Galbraith, director of marketing and corporate communications for Durham Regional. "Certainly we felt we had fixed these problems."

Durham Regional administrators now feel the hospital meets all the required state and federal standards, Galbraith noted. "We're very confident in the level of care we're giving to the community," she said.

Galbraith pointed to a number of steps the hospital took in reaction to the violations found by the state.

Hospital officials revised the contract for a dialysis service that was cited for lax management in the August survey. "It was revised to demonstrate the current responsibilities of hospital unit and contract staff," Galbraith said.

In addition, the hospital has revised its policy in its post-anesthesia care unit, clarifying how nurses administering pain medication are to differentiate between standing orders and orders directly given by doctors.

The hospital is also stressing greater education for nurses and doctors in the proper documentation of wounds and pressure sores, which was the August survey found inadequate. Computer screens are being updated to help nurses document wound care, Galbraith said.

Monitoring is also being increased in all the areas with which the state found fault, Galbraith said.

She said the state's survey process exists to improve patient care, and has done so at the hospital. "Surveys like this are becoming more common, and we welcome the feedback from DFS and other regulatory organizations... and we welcome the feedback from our patients," she said. "We're always in a continuous improvement process."

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