Take a look at the brochure for your next professional society meeting and you'll likely find a session about patient safety on the agenda. Preventing medical errors, communication systems to improve patient compliance, maintaining problem and medication lists, and patient education are all hot topics.
As these issues grab headlines, however, don't overlook some of the more basic aspects of office safety. Providing a physically safe practice setting is an important component of quality care and is good business, too; many of the measures you put in place to protect patients also safeguard your staff and reduce the risk for accidents and lawsuits.
Many medical offices are safer today thanks to two prominent government mandates. "OSHA was the big bogeyman 10 years ago, but now people are in compliance and as a result, patients are safer," says Bruce Bagley, MD, medical director of quality improvement at the American Academy of Family Physicians.
The other directive that ultimately improved safety is the Americans with Disabilities Act (ADA). "The requirements for ramps, safety bars in bathrooms, and that sort of thing have all made the offices safer for everyone," adds Bagley.
Know your practice's needs
What makes your office a "safe office" varies by specialty, the scope of services you offer, the size of the practice, and even geographic location. What constitutes risk in a two-physician, small-town surgical group is quite different than in a large, inner-city primary-care clinic. In terms of your location, you'll need special procedures in place if you have icy sidewalks in the winter or if your office is in a tornado-prone area. Lab and radiology services add complexity to the safety equation.
G. Steve Rebagliati, MD, MBA, director of medical affairs and quality management at the Oregon Health Sciences University in Portland, says times have changed when it comes to medical-office safety. "The trend in the past has been to look backward. This was called critical event review. The new trend is to look ahead, to anticipate what can go wrong, and plan for that. You should think about the major categories of emergencies you could have depending on where you are," he says.
The supplies and equipment you keep on hand for emergencies will depend on your patient population and how close you are to a hospital with an ER. If you have a crash cart it should be stocked in proportion to the size of your practice. Put someone in charge of checking it monthly to make sure everything is in working order and in the proper place and that drugs are not outdated. (For an example of crash cart supplies and set-up, go to www.ucdmc.ucdavis.edu/cne/Resources/ClinSkil/Crashcrt/topdrawer.htm.)
Automatic external defibrillators (AEDs), now commonplace in airports, shopping centers, and other public areas, can also be practical for medical offices, especially in rural or congested areas where getting an ambulance to the office could cost valuable minutes. The machines are simple enough that almost anyone can use them and they are reasonably priced at around $1,500. Remember, however, that purchasing an AED is not a substitute for having staff trained in CPR.
Policies in place
Kathleen LePar, RN, MBA, senior consultant with Beacon Partners in Weymouth, Mass., is an advocate of concrete policies, procedures, and systems-based safety plans. "Training staff on your policies is so important," says LePar. "If you make a policy and put it in a book on a shelf, you won't get the outcome you want."
A good safety manual accomplishes several things. First, it forces physicians and staff to think about safety and the issues that are unique to the practice. Second, it's an excellent training tool for new staff and for refresher courses for everyone. Third, it can help you stay in compliance with OSHA, CLIA, ADA, HIPAA, and local building codes.
The Medical Group Management Association (MGMA) publishes "Operating Policies and Procedures Manual for Medical Practices" by Bette Warn and Elizabeth Woodcock. It includes sample policies on exposure control, sharps disposal, fire control, developing a safety committee, and more.
Buying a manual like this is an excellent place to start, but the best option is creating a handbook unique to your practice. A three-ring binder with sections on bloodborne pathogen exposure, infectious disease, hazardous waste disposal, emergency procedures, hazardous substances, building exit plans, and reporting unsafe situations — to name a few — can be easily updated and used for training new staff.
Speaking of training
Too many practices make the mistake of assuming an experienced medical office employee knows how to recognize, prevent, and deal with safety hazards or emergencies. Just as bad is presuming that when staff has been trained once that's the end of the story.
