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QUALITY ASSURANCE SURVEILLANCE PLAN
FOR
HOME OXYGEN AND VENTILATOR SERVICES
VA Pacific Islands Health Care System (VAPIHCS) Solicitation 36C26126Q0452 This Quality Assurance Surveillance Plan (QASP) has been developed to evaluate contractor performance while implementing the Performance Work Statement (PWS) for Home Oxygen and Ventilator Services. It is designed to provide an effective surveillance method for monitoring contractor performance against the objectives and timelines established in the PWS.
The Contractor, and not the Government, is responsible for management and quality control actions to meet the terms of the contract. The role of the Government is to monitor quality assurance to ensure contract standards are achieved. The Contractor is required to develop a comprehensive program of inspections and monitoring actions.
This QASP aligns directly with the PWS for Solicitation 36C26126Q0452 and includes ventilator-specific surveillance metrics, order processing timelines, home visit cadence requirements, and quarterly reporting requirements as specified in the PWS.
| Category |
| ID |
| Performance Indicator |
| Measure / Standard |
| AQL |
| Surveillance Method |
| PWS Ref |
| Order Processing & Timeliness |
| OT-1 |
| Order confirmation receipt provided within 1 working hour of notification |
| NUM: # confirmed within 1 hr / DEN: Total orders placed per quarter |
| 95% |
| COR electronic log |
| 3.1 |
| OT-2 |
| Initial set-up completed same day when Rx received by 3:00 PM local time (all days incl. weekends/holidays) |
| NUM: # completed same day / DEN: Total Rx received by 3:00 PM |
| 95% |
| COR electronic log; contractor delivery records |
| 3.2.D |
| OT-3 |
| Initial set-up completed within 24 hrs when Rx received after 3:00 PM |
| NUM: # completed within 24 hrs / DEN: Total Rx received after 3:00 PM |
| 95% |
| COR electronic log |
| 3.2.E |
| OT-4 |
| Emergency telephone response within 30 minutes of call |
| NUM: # responded within 30 min / DEN: Total emergency calls |
| 95% |
| Call logs reviewed by COR |
| 1.8.A |
| OT-5 |
| Emergency service provided at patient home within 2 hrs, no later than 6 hrs |
| NUM: # provided within 6 hrs / DEN: Total emergency service requests |
| 95% |
| COR electronic log; contractor incident reports |
| 3.5.C |
| Home Visits & Assessments |
| HV-1 |
| 90-day home visit completed for all home oxygen patients by CRT/RRT |
| NUM: # with current 90-day visit / DEN: Total O2 patients requiring visit |
| 90% |
| Contractor home visit reports reviewed monthly by COR |
| 3.2.A.ii, 3.4 |
| HV-2 |
| 30-day (monthly) home visit completed for all ventilator patients by CRT/RRT |
| NUM: # with current 30-day visit / DEN: Total ventilator patients requiring visit |
| 95% |
| Contractor home visit reports reviewed monthly by COR |
| 3.2.A.i, 3.4 |
| HV-3 |
| Individual home visit reports submitted to COR within 5 business days of visit |
| NUM: # submitted within 5 business days / DEN: Total home visits performed |
| 90% |
| COR electronic log; date-stamp review |
| 3.2.A.iv, 3.31.E |
| HV-4 |
| Home Visit compliance report (all patients) submitted by 15th of each month |
| Report received on or before the 15th of each month. Includes: last visit date, next visit due, incomplete visits with action plan. |
| Met / Not Met |
| COR log of report receipt dates |
| 3.31.A-B |
| HV-5 |
| Complete home safety assessment performed at set-up and during each home visit |
| NUM: # with current documented home safety assessment / DEN: Total patients requiring assessment |
| 90% |
| COR random home visits; contractor documentation review |
| 3.3, 3.18 |
| Patient Safety |
| PS-1 |
| Patient/caregiver education completed and documented at set-up and reinforced during visits (equipment, emergency procedures, infection control, fall prevention) |
| NUM: # with documented current education / DEN: Total patients |
| 90% |
| COR random home visits; documentation review |
| 3.2.A.v, 3.20, 3.23 |
| PS-2 |
| Emergency preparedness education documented (escape route, backup supply, power failure procedures) |
| NUM: # with documented emergency preparedness education / DEN: Total patients |
| 90% |
| COR random home visits |
| 3.2.A.v.l, 3.5 |
| PS-3 |
| Backup oxygen system provided (minimum 18-hr non-electrical supply per Rx flow rate) |
| NUM: # with compliant backup system / DEN: Total patients with concentrator Rx |
| 95% |
| COR random home visits; contractor delivery records |
| 3.5.D, 4.11 |
| PS-4 |
| Critical/sentinel events reported to COR within 1 business day; follow-up report within 5 business days |
| NUM: # reported within 1 business day / DEN: Total known critical events per quarter |
| 95% |
| COR electronic log |
| 3.25, 3.32 |
| PS-5 |
| Patient refusal of service reported to COR during home visit (phone) with written follow-up within 5 business days |
| NUM: # reported per protocol / DEN: Total refusals per quarter |
| 90% |
| COR electronic log |
| 3.32.C |
| PS-6 |
| Patient decline of backup system documented and reported to COR within 5 business days |
| NUM: # reported within 5 business days / DEN: Total backup system declinations per quarter |
| 90% |
| COR electronic log |
| 4.11.B |
| PS-7 |
| High-risk smoker notifications provided to COR within 1 day of home visit |
| NUM: # reported within 1 day / DEN: Total high-risk smoker identifications per quarter |
| 95% |
| COR electronic log |
| 3.9 |
| Equipment & Maintenance |
| EM-1 |
| Preventive maintenance performed on all equipment per manufacturer schedule (minimum annually) |
| NUM: # with documented completed PM / DEN: Total equipment items due for PM |
| 95% |
| PM records provided to COR quarterly |
| 3.6, 3.15 |
| EM-2 |
| Equipment labeled with contractor name and 24-hr emergency phone number |
| NUM: # equipment items with compliant labels / DEN: Total items inspected |
| 100% |
| COR random home visits |
| 3.2.B |
| EM-3 |
| No Smoking / Oxygen in Use signs posted at all entrances; fire safety warnings provided at set-up and every 90 days |
| NUM: # patients with compliant signage / DEN: Total patients inspected |
| 95% |
| COR random home visits |
| 3.2.C, 3.21 |
| Staff Qualifications & Competency |
| SQ-1 |
| All CRT/RRT staff licensed and hold minimum 2 years experience in home O2/ventilator services |
| NUM: # with documented current license + 2 yrs experience / DEN: Total CRT/RRT staff performing services |
| 100% |
| Annual competency report provided to COR; personnel file review |
| 5.2.B |
| SQ-2 |
| All delivery/recovery and patient education staff have documented initial and annual competency, orientation, and background checks |
| NUM: # with current documented competency / DEN: Total contracted staff performing delivery/recovery and education |
| 95% |
| Annual competency report; COR personnel file review |
| 1.9, 5.2.G-J |
| Reporting |
| RP-1 |
| Customer Satisfaction Survey results submitted quarterly by 5th working day after quarter-end |
| Quarterly report received by 5th working day after quarter-end. Trends identified; action plan for adverse trends; grievances reported and resolved within 5 days. |
| Met / Not Met |
| COR log of report receipt dates |
| 3.26 |
| RP-2 |
| Infection Control Report submitted quarterly by 5th working day after quarter-end |
| Quarterly report received by 5th working day after quarter-end. Analyzed by facility Infection Control Preventionist (ICP). No adverse trends noted. |
| Met / Not Met |
| COR log; facility ICP analysis |
| 3.27 |
| RP-3 |
| Performance Improvement Report submitted quarterly by 5th working day after quarter-end |
| Quarterly report received by 5th working day after quarter-end. Trends identified; corrective actions documented. |
| Met / Not Met |
| COR log of report receipt dates |
| 3.28 |
| RP-4 |
| Contract Usage Report submitted monthly by 15th of each month per facility |
| Monthly report received by 15th. Includes total units per CLIN, total dollars invoiced by CLIN, unique patient count. |
| Met / Not Met |
| COR log of report receipt dates |
| 3.29 |
| RP-5 |
| Fall Prevention Report submitted quarterly by 5th working day after quarter-end |
| Quarterly report received by 5th working day. Includes incident timing, injuries, causes, corrective actions, patient education. |
| Met / Not Met |
| COR log of report receipt dates |
| 3.30 |
| After-Hours & Emergency Coverage |
| AH-1 |
| 24/7/365 emergency service capability maintained with local on-duty employee or paging-range staff |
| Direct local number with live employee for after-hours orders; no call-center referral |
| Met / Not Met |
| COR periodic after-hours test calls |
| 1.7.B, 1.8 |
| AH-2 |
| Emergency unable-to-respond notification provided to COR within 2 business days with written explanation |
| NUM: # notifications within 2 business days / DEN: Total emergency services not provided within 6 hrs |
| 90% |
| COR electronic log |
| 3.5.D.ii |
| Discontinuation & Transition |
| DT-1 |
| COR notified within next business day when patient no longer available for services |
| NUM: # notified within 1 business day / DEN: Total discontinuation events per quarter |
| 90% |
| COR electronic log |
| 3.19.A |
| DT-2 |
| Equipment removed from patient residence within 5 business days of discontinuation |
| NUM: # removals within 5 business days / DEN: Total equipment removals per quarter |
| 90% |
| COR electronic log; contractor pickup records |
| 3.19.B |
