"The best-run groups set aside regular staff training hours," says Rebagliati. "They'll create a training roster and over the course of a year cover subjects that will give them the biggest return on the investment of time, depending on the patient population.

Developing something like this just takes a few hours of thinking, and then creating a plan that fits your budget and that you'll follow through on." 

Sandra Adams, OSHA compliance manager for West Clinic, an oncology/hematology practice in Memphis, Tenn. has instituted a comprehensive online training program for staff. "It's on our intranet," she says. "I let managers know when training is due so that during a slow time staff can log on and do the program and answer the questions. Then they enter a code word to move on to the next training." Adams says her staff members are trained every year around their anniversary dates; many safety experts agree that annual training is a good idea.

If you don't have the technical capabilities to provide online training, there are plenty of low-tech ways to keep staff up to speed. Presentations at staff meetings, hands-on practice sessions, video training (www.safetytrainer.com, www.coastalhealth.com), and sending staff to seminars are all good options. 

Your local hospital most likely offers CPR courses for their staff. Inquire about sending members of your office staff to this training.

Depending on your patient population, you may want to have clinical and physician staff trained in advanced cardiac life support as well. Having employees certified in basic cardiac life support (BCLS) or advanced cardiac life support (ACLS) raises the confidence level among staff so that they are better prepared to handle an emergency should one arise. 

Good communication is another key factor in maintaining a safe office. "Staff should know how important it is to report something when it happens. Tell them it's not about blame or shame when someone makes a mistake," says LePar. "It's often a systems problem and it should be addressed. Let the staff know who to go to and that it's OK to make a report." 

Managing infectious diseases

When HIV/AIDS first made headlines in earnest, the push was on to protect staff and physicians from potentially infected blood products. "Universal precautions" was the name of the game and everyone jumped on board (much to the delight of latex glove manufacturers). It has been reported recently in the lay press that "AIDS fatigue" may be setting in — younger people don't remember the initial scare and have become more casual in their behaviors. 

Likewise, be sure your practice doesn't suffer from "universal precaution fatigue." It's worth looking around, quizzing staff about procedures, and retraining everyone periodically on the importance of consistently using gloves, eye protection, and other personal protective gear, as well as avoiding needle sticks and the proper disposal of infectious waste.

In 2001, OSHA updated standards on needle-stick prevention to state that employers should involve staff in the selection of safer needle devices and keep a log of injuries caused by contaminated sharps. Comprehensive information is on OSHA's Web site (www.osha-slc.gov/SLTC/bloodbornepathogens/index.html) where you can also find documents that can be used for training or inclusion in your safety manual.

Sandra Adams says one way to drive home the point about wearing personal protective equipment is to use real-life illustrations. "Without revealing names, I give examples of people I know who have been exposed to let staff know it really can happen. Even though we think we know our patients well, we don't always know if they have a communicable disease," she says.

Have a plan in place in the event there is exposure to HIV, hepatitis, TB, staph, or other serious infectious diseases. "Think ahead of time about your patient population and what relative exposures you have. Keep a packet on hand with lab forms, consents, information about where an exposed individual goes for follow-up, and whether immediate prophylaxis is needed," says Rebagliati. 

More services, more concerns

Practices with in-office lab and X-ray facilities have special safety issues. If you are diligent about CLIA guidelines, that should cover you for safety as well as quality in your lab. Everyone — not just lab techs —  should be aware of which chemicals are hazardous and what to do if there is a spill or exposure. Include this in your training and keep medical safety data sheets updated.