	Background

VA policy specifies how VAMCs can purchase expendable medical  supplies and RME. VA has two inventory management systems, which VAMCs use to track the  type and quantity of supplies and equipment in the facilities. VA’s purchasing and tracking policies include the following three  requirements for VAMCs:  1. The committee, which  typically includes administrative staff and clinicians from various  departments, reviews the proposed purchases to evaluate the cost of  the purchase as well as its likely impact on veterans’ care. 3. VAMCs must enter information on all expendable medical supplies that  are ordered on a recurring basis and all RME that is valued at $5,000 or  more and has a useful life of 2 years or more into the appropriate  inventory management system, either GIP or AEMS/MERS. GAO’s Preliminary Work Identified Examples of Inconsistent Compliance with VA’s Purchasing and Tracking Requirements at Five Selected VAMCs

At the five VAMCs we visited, our preliminary work identified examples of  inconsistent compliance with the three purchasing and tracking  requirements we selected for our review. In some cases, noncompliance  with these requirements created potential risks to veterans’ safety. Officials at two of the five VAMCs we visited stated that VAMC committees  reviewed and approved all of the expendable medical supplies the VAMCs  purchased for the first time. Officials from these three VAMCs told us that certain expendable  medical supplies—for example, new specialty supplies—were purchased  without VAMC committee review and approval. Specialty supplies, such as  those used in conjunction with dialysis machines, are expendable medical  supplies that are only used in a limited number of clinical departments. Without obtaining that review and approval, however, the VAMCs  purchased these supplies without evaluating their cost effectiveness or  likely impact on veterans’ care. As a result, these purchases may have been  made without assurance that they were cost effective and safe for use on  veterans and that the VAMC had the capability and trained staff to  reprocess these items correctly. Signatures of purchasing and approving officials. At one of the five VAMCs we visited, VAMC officials discovered that one  staff member working in a dialysis department purchased specialty  supplies without obtaining the required signature of an appropriate  approving official. However, the staff  member ordered an incorrect item, which was permeable to blood,  allowing blood to pass into the machine. At the time of our site visits, officials from one of the five VAMCs we  visited told us that information about expendable medical supplies that  were ordered on a recurring basis was entered into GIP, as required. This lack of information can pose  a potential risk to veterans’ safety. In addition, in the event of a manufacturer or FDA recall or patient  safety alert related to a specialty supply, VAMCs may have difficulty  determining whether they possess the targeted expendable medical  supply. According to VAMC officials and the VA Office of the Inspector General, in  response to a patient safety alert that was issued on the auxiliary water  tube in December 2008, officials from the VAMC checked their inventory  management systems and concluded—incorrectly—that the tube was not  used at the facility. However, in March 2009, the VAMC discovered that  the tube was in use and was not being reprocessed correctly, potentially  exposing 2,526 veterans to infectious diseases, such as HIV, Hepatitis B,  and Hepatitis C.
In addition, officials from VA headquarters told us that when information  about certain RME is entered into AEMS/MERS, it is sometimes done  inconsistently. VA Reports It Plans to Change Its Oversight of Purchasing and Tracking

During our preliminary work, we discussed with VA headquarters officials  examples of steps VA plans to take to improve its oversight of VAMCs’  purchasing and tracking of expendable medical supplies and RME. For  example, VA plans to change its oversight of the use of purchase cards. VA headquarters officials  stated that VA plans to shift greater responsibility for these reviews from  the VAMCs to the VISNs, effective October 1, 2010. VA headquarters officials stated that SAM will help improve VA’s  ability to monitor information about expendable medical supplies and  RME across VAMCs. VA provided us with an implementation plan for  SAM, which stated that this new system would be operational in March  2011.
Why GAO Did This Study

VA clinicians use expendable medical supplies--disposable items that are generally used one time--and reusable medical equipment (RME), which is designed to be reused for multiple patients. VA has policies that VA medical centers (VAMC) must follow when purchasing such supplies and equipment and tracking--that is, accounting for--these items at VAMCs. GAO was asked to evaluate VA's purchasing and tracking of expendable medical supplies and RME and their potential impact on veterans' safety. This testimony is based on GAO's ongoing work and provides preliminary observations on (1) the extent of compliance with VA's requirements for purchasing and tracking of expendable medical supplies and RME and (2) steps VA plans to take to improve its oversight of VAMCs' purchasing and tracking of expendable medical supplies and RME. GAO reviewed VA policies and selected three requirements that GAO determined to be relevant to patient safety. At each of the five VAMCs GAO visited, GAO reviewed documents used to identify issues related to the three requirements and interviewed officials to gather further information on these issues. The VAMCs GAO visited represent different surgical complexity groups, sizes of veteran populations served, and geographic regions. GAO also interviewed VA headquarters officials and obtained and reviewed documents regarding VA headquarters' oversight. GAO shared the information in this statement with VA officials.

What GAO Found

During its preliminary work at the five selected VAMCs, GAO found inconsistent compliance with the three VA purchasing and tracking requirements selected for review. Noncompliance with these requirements created potential risks to veterans' safety. (1) Requirement for VAMC committee review and approval. At two of the VAMCs, officials stated that the required designated committee review and approval occurred for all of the expendable medical supplies and RME that the VAMCs had not previously purchased. These reviews are designed to evaluate the cost of the purchase as well as its likely impact on veterans' care. However, at the remaining three VAMCs, officials stated that the required committee review and approval of the expendable medical supplies, such as those used in conjunction with dialysis machines, did not always occur. As a result, these purchases were made without evaluating the likely impact on veterans' care. (2) Requirement for signatures of purchasing and approving officials. At one of the VAMCs, VAMC officials discovered that a staff member in a dialysis department ordered an expendable medical supply item for use in dialysis machines, without obtaining the required signature of an approving official. That staff member ordered an incorrect item, the use of which presented a risk of exposing veterans to infectious diseases, such as Human Immunodeficiency Virus. (3) Requirement for entering information in VA's inventory management systems. Officials from one of the five VAMCs told GAO that information about expendable medical supplies that were ordered on a recurring basis was entered into the appropriate inventory management system, as required. At the remaining four VAMCs, officials told GAO that information about certain expendable medical supplies--those used in a limited number of clinical departments such as dialysis departments--was not always entered into the system. This lack of information can pose a potential risk to veterans' safety; in the event of a recall of these items, these VAMCs may have difficulty determining whether they possess the targeted item. VA reports that it plans to improve its oversight of VAMCs' purchasing and tracking of expendable medical supplies and RME. For example, VA headquarters officials stated that, effective October 1, 2010, VA plans to shift greater responsibility for reviews of purchase card transactions from the VAMCs to the Veterans Integrated Service Networks, which are responsible for overseeing VAMCs. VA headquarters officials also told GAO that VA is developing a new inventory management system, which it expects will help improve VA's ability to track information about expendable medical supplies and RME across VAMCs. VA expects this new system to be operational in March 2011.