Healthcare Inspection–Hemodialysis Nursing Care Issues at the John Cochran Division of the St. Louis VA Medical Center, St. Louis, MO

The OIG conducted an inspection to determine the validity of allegations regarding the provision of nursing care in the hemodialysis (HD) unit of the John Cochran Division of the St. Louis VA Medical Center. Specifically, a complainant alleged that a licensed practical nurse (LPN) did not provide appropriate care to two HD patients, resulting in their subsequent need for emergency care, and that the HD unit had nursing leadership issues that affected patient care. We substantiated that the subject LPN did not recognize and report changes in the condition of Patient 1 during HD but did not substantiate the LPN provided less than standard care for Patient 2. We did not substantiate the allegation that the HD nurse manager favored the subject LPN or that nursing practice changes unfairly affected HD nursing staff. The HD unit had multiple problems that required improvement. The unit was lacking a strong leadership presence in the nurse manager and charge nurse roles. It was difficult to differentiate between the role of the RNs and the LPNs. There was no defined responsibility for the charge nurse and no policy for reporting events to the charge nurse or a physician. We made six recommendations. The Acting VISN Director and facility Director concurred with the inspection results and recommendations.