The Chicago-based Joint Commission renewed the accreditation of the Lakewood mental hospital after concluding that it fully complied with national standards for patient care, medication use, restraint and seclusion use, building safety and other matters.

“This survey was an absolute winner for us,” Western State CEO Andy Phillips said recently.

The commission sent a doctor, a pharmacist, a nurse and an engineer on an unannounced inspection of Western State in February. The team spent a week investigating the hospital, which included interviewing staff members and pulling 30 charts at random to assess treatment.

Hospital officials were notified April 22 that, after making minor improvements based on the inspectors’ findings, it had passed the inspection.

The Joint Commission does not publicly disclose its findings after an inspection. Phillips provided those for Western State to The News Tribune.

Some focused on making sure forms and policies were updated to include the information the Joint Commission wanted.

For instance, inspectors found the abbreviation “QD,” meaning “every day,” in some medical charts. The inspectors asked Western State staff members to write out the phrase, because the abbreviation can be confused with “O.D.,” short for overdose.

Inspectors also found a case in which a family wasn’t notified in a timely fashion that a patient was put in restraints, as required unless the patient tells staff members not to.

Inspectors also looked at a wide range of issues regarding the use of restraint and seclusion at the hospital.

The two techniques for controlling patients were the subject of a 2007 investigation by The News Tribune that found the hospital has significantly reduced the use of both since the 1990s, when efforts began at Western State and hospitals nationwide to use more humane methods to control patients.

The Joint Commission’s standards are designed to reduce both techniques, and inspectors this year found that Western State complied with almost all the national group’s requirements.

Nurses, for example, are required to check patients every 15 minutes to assess their physical and psychological status and their comfort. They also see whether a patient is ready to come out of confinement.

In three cases, however, inspectors could find no documentation that nurses also checked every 15 minutes for injuries and to see whether the patients needed to use the bathroom, eat or have something else attended to. Instead, the nurses waited for the patients to tell them.

The finding doesn’t necessarily mean the checks weren’t done, hospital spokeswoman Kris Flowers said, just that they weren’t documented in the three cases.

Nonetheless, staff members have been reminded to document all observations and assessments for secluded or restrained patients, she said. They’ve also been reminded to notify families of restraint episodes in a timely fashion, unless the patients don’t want them to.

The Joint Commission reaccredited Western State after it addressed the issues raised by inspectors.

It was a different story after the hospital’s inspection three years ago.

In 2005, the commission attached conditions Western State had to meet before its accreditation was renewed, including improvements in treatment planning, Phillips said.

This time the inspectors had a “number of suggestions of things we could improve,” but they were “all on the margins.” Phillips said. None required significant updates to how Western State cares of patients, he said.

Passing the recent inspection “without conditions is really big,” he said. “No one recalls it (happening before).”

Representatives of the unions at the hospital welcomed the Joint Commission’s approval.

“We are very happy that the hospital is accredited,” said Carol Dotlich, president of the Washington Federation of State Employees, which represents most of Western State workers: everyone except registered nurses and doctors. “We think we do a good job, and we are happy the inspectors think we do a good job.”

The rating “speaks volumes about the quality of the employees we have,” said Craig Gibelyou, a licensed practical nurse and president of the union’s local at Western State. “It’s the workers who are directly responsible for the accreditation. Management can’t get it alone.”

The union remains concerned, the union officials said, about worker injuries, and is working to reduce them. There were 524 injuries in 2007, most from assaults, Dotlich said.

The figure is line with past years, but the number of days missed from work because of those injuries is down, indicating the “severity of injuries is decreasing a bit,” Gibelyou said.

Most hospitals seek Joint Commission accreditation not only as a quality check, but also because it helps ensure they can bill the federal government for medical services. That’s a significant portion of most hospitals’ budgets, including Western State’s.

The commission’s power is real: Last spring, it preliminarily denied the Puget Sound Veterans Affairs hospitals’ accreditation until they fixed safety issues in their psychiatric wards.

The hospitals made the changes, even though V.A. hospitals’ federal funding is unrelated to accreditation by the commission.

Western State officials had been focused since last winter on an inspection from the Joint Commission. Because accreditation is good for three years, a lot was riding on the visit.

Staff members and managers prepared for it by reviewing accreditation requirements and working on how to respond to inspectors’ likely questions.

The “work paid off,” Phillips said.

M. Alexander Otto: 253-597-8616

Western State Hospital

Where: 9601 Steilacoom Blvd. S.W., Lakewood.

What: The 56-building, state-run psychiatric hospital primarily serves the 19 counties of Western Washington.

Average number of patients: 1,050 adults, 70 percent of them men.

Employees: About 2,000

Annual budget: About $170 million

Most-common diagnoses: Schizophrenic disorders

History: Founded in 1871 on the site of Fort Steilacoom as the “Insane Asylum of Washington Territory”