BENNINGTON -- The Board of the Trustees of the Vermont Veterans' Home heard detailed discussions of several issues at its meeting on Wednesday.
These included the impact of recently adopted state laws on the status of some home supervisory positions and on the board of trustees itself; a detailed report on the home's endowment, trust and donations funds; and a report on medication safety and processes.
During her report, Administrator Melissa Jackson reported that under law she is no longer also the home's commandant but is the chief operating officer. The law now also creates four new "exempt" positions, actually existing posts which are now exempt from the state's classified service, meaning they are now subject to removal by a majority vote of the board and not part of a union contract. These positions are the marketing and admissions coordinator, financial director, environmental services manager and nursing services director.
In addition, one member of the 21-member Board of Trustees is to be a classified employee with at least five years of service at the home and shall serve a 3-year term and may be removed by the governor for cause. This member will be elected by secret ballot administered by the board, with the voters being the home's classified employees.
Steve Howard, legislative director of the Vermont State Employees Association, said members were pleased they would be represented on the board.
"We really believe, honestly, that our members are the experts on the care that they provide to veterans, who are many of them like their families," he said.
Howard mentioned hosting candidates' forums for employees on various shifts. Board President Joseph Krawczyk Jr. expressed openness to discussing this and other issues, noting that the board and administration did not oppose adding a union member to the board.
"Absolutely," Howard said, "we're looking forward to it, and I think it will be helpful to the board and also helpful to our members as well."
In another matter, board member Charly Dickerson produced a thoroughly researched six-page report on three accounts meant to improve the lives of veterans: The general endowment consists of land sales, unrestricted gifts and more, now totaling $584,155; the Vuori account consists of an estate willed to the home in 2002, meant to be used for needy veterans, now totaling $759,533; and a donations account of local donations for a specific purpose, such as bingo prizes, chapel needs, art supplies, Christmas decorations, etc., totaling $75,742.
Since 2001, these funds have been managed and invested by the state treasurer, but are not considered state funds and are used at the discretion of the home board of trustees within limits imposed with the original deed of gift. Dickerson wrote that the purpose of his report was to "reiterate current practices, modify some, re-establish policy and protocols, and establish a definitive record moving forward."
He noted that compounding interest and investment, along with new funds willed to the home, have had a very positive effect: In 1991 the total of the funds was about $204,100. Today it is $1.4 million. "Consensus is that these funds should not remain idle and can be used to enhance the living environment of the members at the Home," he said. The funds are not intended to be used as part of the home's usual operating expenses.
The Board of Trustees voted to accept the report of make it part of the meeting's minutes going forward and took other actions requested by Dickerson in his report.
Christina Cullinane, director of nursing services, gave a report on the medication and safety process. "The facility has been in receipt of an increase in ‘error' reporting since mid-May 2014. On the surface, this would seem to be a bad thing, but the increase in reporting is encouraging," she said in her written report. "We encourage reporting of errors in a process that gives educational feedback based in our goal of reducing preventable errors. The recent increased reporting indicates that a higher awareness is out there among the staff."
In her report to the board, Cullinane said the following improvements are needed:
* Increased awareness of the reporting process and its results
* Encourage more reports, especially of adverse drug reactions
* Better working knowledge of pharmacy policies and procedures
System improvements in process include revising the medication incident report, and facilities policies and procedures; getting pharmacy scanners for reorders and returns. Future improvements would include electronic medical records.
VSEA Executive Director Mark Mitchell, later in the meeting raised concerns about filling of prescriptions and regulatory compliance he had heard from nurses at the home.
Regarding medication errors, "What our nurses are reporting is, it's not an internal error in processing here, it's the pharmacy that's generating an inordinate amount of either non-delivery of pharmaceuticals that have been ordered by a doctor/provider or the pharmacy delivers the incorrect dosage or incorrect medicine for a patient and then there's a delay in delivery because the nurse has to write it up and then ask for the correct dosage or the correct medicine to come. There's a delay. In regulatory compliance it's a delay of care or denial of care. It's an issue."
He said the increase of these problems is due to a change in the pharmacy that supplies the home.
"The nurses are reporting not that there's millions and millions of these [problems] but that there used to be virtually none under Kinney's pharmacy, and now with Omnicare there's a much greater number that they're experiencing," Mitchell said.
The next Board of Trustees meeting will be held on Wednesday, Aug. 13.
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