Upload
duonghanh
View
214
Download
1
Embed Size (px)
Citation preview
In This Issue ...
Making Safety and SecurityYour Practice Standard .....1
When Weather BecomesDangerous .....................5
Keeping Office MedicalEquipment Safe andEffective ......................10
(Continued on page 2)
When we think of physician office safety and security, we often conjure images of angry or
unstable patients creating disturbances or, in extreme examples, getting violent. But not all
safety and security concerns stem from unpredictable crises. Many issues that fall into this very
important risk management category arise from the routine operations of a busy practice, where
there are potential hazards — literally and figuratively — around every corner.
In other words, many office-based safety and security concerns are not only preventable,
but they are predictable. As such, protecting patients and staff
members may be as simple as establishing and following a set
of standard policies and procedures that have less to do
with emergencies and more to do with common sense.
That way, whether delivering standard care, keeping
the office running smoothly or responding to
unforeseen circumstances, everyone on the staff
will know what to do to protect themselves and
patients.
Define office policies and proceduresYour office’s safety and security strategies must be
clearly established and based on a variety of
organizational, industrial and governmental
guidelines. Begin with the recommendations of
professional organizations, such as the Centers for
Disease Control and Prevention (CDC), the Medical
Group Management Association (MGMA), the American
College of Medical Practice Executives (ACMPE), and the
Occupational Safety and Health Administration (OSHA), (e.g., on
blood-borne pathogens and hazard communications). From there, build your plan according to
any additional requirements defined by the hospital or network with which your practice is
affiliated, as applicable.
Make the policies accessible to employeesBe sure that your practice’s written safety guidelines are readily available to all staff members.
Post them in a secure online location or maintain a printed copy in an employee-only area of
the office. Require new employees to review policies and procedures as part of training and
orientation.
Making Safety and Security Your Practice Standard Simple Steps to Keep Risk at Bay Contributing Authors: Mary Adam Thomas and Cindy Siders
Physician Edition • Winter 2013
101 Arch StreetP.O. Box 55178Boston, MA 02205-5178tfn 800.225.6168f 617.330.6995www.coverys.com
RiskRxClinical Risk Management Newsletter
Fahrenheit for non-refrigerated items
and 36-46° Fahrenheit for refrigerated
items.2 To maintain their security,
prescription drugs should be stored in
a locked location that is only accessible
by authorized personnel who are well-
trained in procedures that monitor the
practice’s drug inventory. Follow
board of pharmacy requirements for
narcotics and scheduled drugs and
ensure that prescription pads are stored
in a secure location. There is no such
thing as being too careful when it
comes to in-office drug supplies.
Physician office medicationstorage safety tips• Store all drugs, including samples,
separate from non-medications,
such as equipment and supplies.
• Keep medications in a locked
cabinet or room.
• Provide only authorized office
personnel with keys and access to
drug supply.
• Place sample medications into
stock immediately upon receipt.
• Separate pharmaceuticals designated
“for external use only” from those
indicated for internal use.
• Store look-alike and sound-alike
drugs separately.
• Rotate medication stock monthly,
using a “first in, first out” process.
• Maintain thorough records of all
prescription drugs received,
dispensed and disposed of.3
Dispose of medicationsresponsiblyThis is yet another area of office
management that requires compliance
with state and federal laws, as well as
with guidelines established by the
Health Insurance Portability and
2
Appoint a safety coordinatorEach physician practice should have
one employee designated as the
office’s safety coordinator. Choose an
individual who will be responsible for
defining, maintaining, training and
executing all elements of safety and
security. The amount of time necessary
to oversee the safety function will
depend on the size of your practice.
Consider assembling a safety
committee that is led by the safety
coordinator. The safety committee may
include colleagues who have specific
duties to assist in implementing the
office’s plans. Ideally, at least one
physician should be appointed to the
committee.
“Choose the right person for the
[safety coordinator] job. Doctors are
usually too busy to serve as safety
coordinators,” notes OSHA expert Ann
Bachman at Doctors Management, a
consulting company in Knoxville, TN.
“The office manager is a better
candidate, but may not know enough
about medicine to master some of the
details – or teach others. Your best
choice may be a veteran nurse.”1
Conduct environmentalsafety roundsPerform scheduled environmental
safety rounds of your office to ensure
that all necessary safety and security
measures are being taken. According
to Mike Johnson, director of plant
operations and safety director at Lake
Region Healthcare in Fergus Falls,
Minnesota, doing safety walk-throughs
are an important part of an overall
strategy. “We do a semi-annual
security round, which we call
‘Environmental Rounds,’ where we
look for specific safety-related issues
in the office setting,” says Johnson,
who oversees safety in Lake Region
Healthcare’s many satellite clinics and
Making Safety and Security Your Practice Standard(Continued from page 1)
physician offices. “I go around with
members of the safety committee and
we cover all possible hazards —
anything from infection control to
maintenance issues — then take the
necessary steps to fix problems as
needed.”
Handle and dispose ofhazardous waste properlyFollow state and federal laws and
guidelines regarding the correct
procedures for disposing of biomedical
waste, including sharps. Train all staff
on proper handling of these materials,
along with appropriate responses in
the event of accidental contamination.
In addition, when educating staff
members on the importance of proper
waste procedures, remember that they
are also working to protect third-party
handlers. “We always make sure to
train our employees to take the time
to empty biohazard waste tubs properly
so that when they’re picked up by the
contract service, the individuals
working for that company are not in
any danger,” says Monica Paczkowski
of the University of North Dakota
Center for Family Medicine. “We want
to protect our staff as well as the
contracted service employee who has
no idea what’s in the boxes he’s picking
up.” Ensure that biomedical waste is
stored in a secured location prior to
pickup for disposal.
Store medicationsintelligentlyEnsuring that the proper storage
conditions are in place for medication
samples is one concern in the office
setting. Quite another set of concerns
relates to the safe and secure storage
of drugs. To maintain their effectiveness,
pharmaceuticals should be kept in
climate-controlled spaces according
to the manufacturers’ instructions,
with temperatures ranging from 59-86°
Accountability Act (HIPAA), which
prohibits the disposal of pill bottles
containing identifying patient
information.4 When in-office
pharmaceuticals expire, go undispensed
or are unusable for other reasons
(such as flawed or broken containers),
it is important that office employees
use proper disposal procedures to
protect patients, staff members, the
general public and the environment.
Disposal options include:
• Flushing — Before sending any
substance into the municipal sewer
system, check the list of products
recommended by the FDA for
disposal by flushing at:
http://www.fda.gov/Drugs/
ResourcesForYou/Consumers/
BuyingUsingMedicineSafely/
EnsuringSafeUseofMedicine/
SafeDisposalofMedicines/
ucm186187.htm#MEDICINES.
• Returning to manufacturer —
Talk to your pharmaceutical rep
about taking back any undispensed
medications.
• Using a third party — If you
contract with a biomedical waste
company, find out if they offer a
pharmaceutical disposal service.
Maintain a safe office settingProper maintenance will lay the
foundation for safety within your
medical office. Start with the basics:
be sure walkways are clear and dry,
keep spaces well lit, watch for curling
rug corners, ensure exits are
appropriately marked and illuminated
as required by building and/or fire
codes, keep hallways clear from
equipment and clutter, etc. Then look
at every aspect of your office from the
perspective of an ill or frail patient. Are
there any details you may have
previously overlooked that could pose
risk to someone with limited mobility,
obesity, poor eyesight, impaired
cognitive function or even frazzled
nerves? As with most aspects of(Continued on page 4)
healthcare risk management, empathy
is one of the most powerful tools at
your disposal.
Safety extends past thework dayIt is important to keep your office
secure after business hours have
ended. Night watch personnel are a
great resource, but not something to
which every practice has access. In lieu
of security guards, consider installing
security cameras at key entry points
to your building or office. Even more
fundamentally, make sure that all
office staff members follow basic
security guidelines when they leave for
the day. Close software applications,
shut down computers, lock interior
and exterior doors behind them, leave
lights on according to office policy,
etc. It is the shared responsibility of all
personnel to do what is possible to
promote and maintain a secure office
environment for patients, visitors and
employees.
Crafting a New Plan: OneOrganization’s Approach toReinventing Office-BasedSafety GuidelinesWhen the University of North Dakota
Center for Family Medicine kicked off
its plans to open a new clinic and
move into a new (rented) two-floor
3 RiskRx Physician Edition Winter 2013
building in Bismarck, the transition
was viewed as an opportunity to make
some safety-related process
improvements.
“We really asked ourselves how we
could give our patients and staff even
more of what they need as we were
going into the new building,” says
Monica Paczkowski, risk manager and
laboratory director. “It was a clear
opportunity for us to start fresh; to
make sure we were doing things the
best way possible. We looked at
whether we should implement new
procedures or continue with what
we’ve been doing and not change
anything.”
As part of their self-audit, they even
reviewed the physical layouts of their
office spaces to determine whether a
change in floor plan might enhance
safety. “With our old building, the
physical restriction of the space was a
real problem because we just couldn’t
do everything we wanted to do,” she
says. “But with our new bigger
building, we can do more. We found
that we are able to do more of what
our patients need.” They now have a
new clean room and a more secure
medication storage space. Patients
are seen on the ground floor and
administrative functions are performed
on the second level.
Another outcome of the transition was
a top-to-bottom review of all infection
prevention procedures followed by
some process improvements. “We
always had a system, but this helped
us formalize best practices. We wrote
down all the things that we were
doing – how we were cleaning the
rooms, taking care of departments,
taking care of patients – and
comparing that to what we should be
doing,” Paczkowski explains. “Since
that time, we’ve done additional
training with staff and implemented
new infection prevention practices.”
Making Safety and Security Your Practice Standard(Continued from page 3)
4
Potential Hazards in theOffice Setting• Sharps containers and cleaning
chemicals stored within reach of
children
• Restrooms that lock from the inside
without a clearly defined plan for
access in case of an emergency
• Waiting room chairs, toilets, exam
tables, wheelchairs, etc., which are
not weight-rated for obese patients
• Emergency supplies and equipment
(crash carts, AEDs) which are not
appropriately stocked and maintained
at regularly scheduled intervals
• Lack of readily accessible personal
protective equipment for blood
and body fluid contamination and
clean-up
• Lack of clearly defined protocols
for managing violent, agitated or
aggressive patients and visitors
• Lack of current material safety data
sheets (MSDS) for the cleaning
chemicals used in the practice
• Staff member security before office
hours, during the lunch hour and
after hours — Consider having
a buddy system (at least two
employees in the building at all
times) or designating when doors
should be locked.
• Lack of appropriate security for
electronic medical records and/or
stored paper records
• Inadequate storage and disposal
practices for medications and
hazardous waste
References
1 Robert Lowes, “Spot the Safety Hazards in
this Office - and Yours,” Medical Economics,
May 7, 2001.
2 State of Wisconsin, Injured Patients
and Families Compensation Fund,
Risk Management Manual for PhysicianOffice Practice, Section 3.2.1 Medication
Storage, Maintenance, and Security,”
2007. Available at:
http://www.wisconsinmedicalsociety.org/
initiatives/risk_management.
3 Ibid.
4 U.S. Department of Health & Human
Services, Office for Civil Rights, The HIPAA
Privacy and Security Rules, “Frequently
Asked Questions About the Disposal of
Protected Health Information,” n.d.,
http://www.hhs.gov/ocr/privacy/hipaa/
enforcement/examples/disposalfaqs.pdf,
09/04/2012, citing 45 CFR 164.530(c).
When educating staff members
on the importance of proper waste
procedures, remember that
they are also working to protect
third-party handlers.
(Continued on page 6)
5 RiskRx Physician Edition Winter 2013
So Johnson added a new code to the
Lake Region Healthcare emergency
response system, which is used
at its main hospital and at all
freestanding clinics. “Code
grey is still what we use for
a tornado watch, but now
we’ve added a code black
for when a tornado is
considered imminent. At
that point, we’ll move
patients into the corridors
where there are no
windows.”
In and around Fergus Falls,
tornados, blizzards and,
occasionally, high
temperatures are the most
common types of severe
weather. Still, Johnson and his
counterparts responsible for patient
and staff member safety at acute and
ambulatory care facilities around the
region are careful to plan for whatever
nature sends their way. The key, they
agree, is preparedness.
First, make a planYour in-office emergency preparedness
plan must clearly spell out response
strategies for each type of extreme
weather incident that is likely to occur
in your region. There should be one
safety leader assigned at all times
when the office is occupied and all
other employees must be well trained
in your practice’s emergency
procedures. The plan should be
updated regularly and adapted (as
Lake Region Healthcare’s was last
year) to reflect new findings about
successful or flawed strategies. The
priority for you and your staff members
is to keep patients, employees and
visitors safe. Some general tips on three
common regional weather patterns:
Late on a springtime afternoon, a
dramatic weather event did more than
change the face of a Midwestern
town. It also offered the healthcare
community a tragically valuable
laboratory where risk managers from
hospitals and physician offices could
study the dos and don’ts of
emergency preparedness.
When a mile-wide category EF5
multiple-vortex tornado tore through
Joplin, Missouri, on May 23, 2011, it
blew straight through St. John’s
Regional Medical Center, plunging the
staff and patients in the 367-bed
facility into darkness and chaos. When
the winds stopped and the damage
was assessed, at least five of the
storm’s 150+ fatalities occurred within
the hospital and scores of people at
St. John’s were counted among the
estimated 1000 individuals injured as
a result of the tornado.
For Mike Johnson, director of plant
operations and safety director for
Minnesota-based Lake Region
Healthcare, the Joplin tragedy yielded
some powerful information. Following
the incident, Johnson read reports,
attended professional reviews and
spoke to people who were on the
scene. In short, he gathered any and
all details from what happened at St.
John’s so that he could apply what
was learned on the ground in Joplin to
the Lake Region Healthcare network
that links a main facility in Fergus Falls
with its rural clinics.
“We actually changed our policies
after Joplin; after I heard some of the
stories from there,” he says. “Our old
tornado response plan was to close
the curtains and move patients away
from windows. But after seeing how
badly the windows were blown out at
St. John’s and how many people were
injured by flying or broken glass, we
knew we needed to adjust that.”
When Weather Becomes DangerousPreparing Your Practice for Extreme Weather By Mary Adam Thomas
Your in-office
emergency
preparedness plan
must clearly spell out
response strategies
for each type of
extreme weather
incident that is likely to
occur in your region.
When Weather Becomes Dangerous(Continued from page 5)
• TornadosWeather forecasting tools are more
sophisticated than ever and news
travels fast over broadcast and
electronic media when a serious
storm is predicted. Still, a tornado
can change quickly from an EF0
rating (with winds from 40-70 mph)
up the scale to the EF5 that Joplin
experienced (with winds ranging
from 261-318 mph). Physician
offices in regions where tornados
occur must be fully prepared for the
possibility that they will need to
respond to such an event.
Implement systems that mimic
those in hospitals, with emergency
codes whose colors (e.g., “Code
Grey”) or mnemonics (e.g., “Code
T”) identify the specific type of
incident expected to take place.
Differentiate between three levels of
tornado alerts, for example: 1 for
watch, 2 for warning and 3 for
imminent. Whichever code you
associate with a tornado alert,
make sure your staff members are
familiar with it and know what to do
when it is announced. Consider the
ways in which patients and
personnel can most efficiently get
out of harm’s way — specifically
away from windows. If your building
does not contain a storm cellar or
other underground shelter, designate
a nearby safe location where staff
members may take patients and
visitors if there is time to evacuate
your office.
• Snow and iceWinter storms are a bit more
predictable than tornados, so you
and your staff members will likely
have more warning if blizzard
conditions compromise the safety
of your patients. According to Jed
LaPlante, Lake Region Healthcare’s
outreach clinic director, most
people stay away from non-emergent
6
appointments during bouts of
extreme cold without having to be
told to do so. “In our system of
satellite sites, just about everyone
has to travel to get there anyway.
So if they don’t feel comfortable
driving on roads in the winter, then
we won’t force it,” he explains.
“We’ll always try to stay open if
patients want to come, but weather
sometimes closes the clinics on its
own.” If potentially dangerous snow
or ice accumulates before the work
day begins, he says, offices will not
likely open. On days when
conditions change for the worse
mid-day, Lake Region Healthcare’s
policy is to start sending patients
and employees home, beginning
with those who live farthest away.
Ensure that adequate arrangements
have been made for snow and ice
removal during the winter and
record grounds maintenance in a
log, including the date and time.
• Extreme heat and humidityNeedless to say, your office’s air
conditioning system is the best
defense against hot summertime
weather. Some of your patients may
be especially vulnerable to the
effects of the heat and humidity, so
make sure to keep a close eye on
the elderly, the very young, the
obese and anyone dealing with a
mental and/or chronic illness. Make
chilled water available for staff
members and visitors throughout
your office, and communicate with
patients about the importance of
hydration. (High temperatures that
affect your power supply and limit
your ability to cool your office are
addressed below under the section
that addresses power outages.)
Ensure that adequate
arrangements have
been made for snow
and ice removal
during the winter
and record grounds
maintenance in a log,
including the date
and time.
(Continued on page 8)
Craft communicationstrategiesPrior, during and following any
weather-related emergency, you must
do your best to relay information to
two sets of people: patients and staff
members.
• Communicating with patientsWorking within the constraints of
the weather event itself, you and
your staff members must convey
information about what’s going on
outside with the individuals who are
inside your practice. “The biggest
thing for patients in an office setting
is the fact that they’re usually in a
room where they don’t have access
to news other than what some of
them might be able to get on their
phones. They’re unaware,” says
Monica Paczkowski, laboratory
director at the University of North
Dakota Center for Family Medicine.
“Part of our job is to make them
aware that we’re under a tornado
warning or some other kind of
weather watch. When those
warnings come through, they need
to know that.” Paczkowski explains
that her organization’s emergency
preparedness plan includes strategies
to assess the severity of a weather
threat and determine whether it’s
best to keep people in the offices
or send them home. “If there was a
tornado that was clearly going to
hit downtown Bismarck, we would
ask our patients to stay in the
practice until the severe weather
passes. And they would understand
that,” she says.
If you know your office will be
closed for some or all of the day,
create a phone tree and email alert
system to contact patients with
scheduled appointments so they
know not to come in. Determine
whether it is safe to have someone
in the office fielding incoming calls.
In addition, utilize local media
resources (radio, television, etc.) to
broadcast pertinent information
about office closures.
• Communicating with staffEmployees should be very familiar
with their specific roles during
weather emergencies, as addressed
in your practice’s emergency plan.
Your safety coordinator should call
out a designated code if a sudden
event such as a tornado arises
to alert fellow workers that an
emergency is imminent or occurring.
Lake Region Healthcare’s Mike
Johnson reports that his organization
7 RiskRx Physician Edition Winter 2013
8
When Weather Becomes Dangerous(Continued from page 7)
has gotten even more precise in
their public announcements
regarding weather emergencies.
“We used to just announce a code
grey, which told employees that a
storm was coming. But we learned
that people feel more at ease if
they know the specifics,” he says.
“So we decided to let people
know exactly why an alert has
been issued. Now, we announce
over the public address system
what the national weather report is
so people are notified to what’s
going on outside.” This strategy
gives everyone on-site more
detailed information and helps
distribute the responsibility more
broadly for a safe response.
Lake Region Healthcare also has an
all-call system that alerts employees
if any of its satellite clinics are
closed due to bad weather. Each
clinic has its own plan for when and
in what conditions closure is
recommended, so safety officers at
each location oversee communication
with that site’s employees as
needed.
Know how to get patientsto safetyYour emergency plan should include
clear and well-rehearsed strategies for
ushering patients to safety in the
event of weather emergencies. Your
staff members should know exactly
how to handle patients with different
needs in evacuation and/or sheltering
scenarios. Include plans that help you
account for all individuals present at
the office at the time of the emergency.
(Electronic check-in systems are often
useful in determining who is on-site at
any one time.)
Adapt to the needs of yourpatientsWeather emergencies may be
unpredictable. But that doesn’t mean
you and your practice have to face
them unpredictably. Prepare for the
unexpected by working with what
you know about your region and its
patterns, then learn from what others
have done.
That’s just what Jed LaPlante says his
team did as it planned for a new 6,000
square foot walk-in clinic being
constructed in Fergus Falls. “We met
with staff from different sites and
asked them to tell us what does and
doesn’t work in their existing buildings.
They told us what scares them most is
what to do in the event of a tornado,”
he recalls. Accordingly, designs for the
new building include a modified X-ray
room that doubles as a storm shelter.
“Our policy for this site now states
that if a tornado warning hits, staff is
supposed to shut all windows and
doors, then escort patients to
Radiology because it’s by far the
safest space in the structure,” says
LaPlante. “This came out of asking
what doesn’t work elsewhere and
creating something that will work in
the new clinic.”
Monica Paczkowski agrees in the
power of learning from existing
examples when it comes to keeping
people safe in the face of weather
emergencies. “Obviously, there are
regulations we all need to follow, but
there’s so much more that can be
done at individual sites,” she says.
“You just have to do what fits into
your situation and what helps you
deliver better care. Patient populations
are different, regionally and even at
different offices, so you need to figure
out what works best for your patients
and their safety.”
Prepare for power outagesExtreme weather can do quick damage
to power supplies, which may place
your patients at great risk. (Most, if
not all, of the fatalities that occurred
inside the Joplin hospital were
reportedly due to suffocation when
respirators failed to operate after the
tornado took out power and destroyed
a back-up generator.) Have contingency
plans in place for the possibility that
your office will be without electricity.
On-site emergency generators are the
obvious solution, although not all
medical office buildings have access
to them. If yours does, test the
equipment at least quarterly to ensure
proper function. Keep coolers and ice
packs on hand at all times for storing
medications requiring refrigeration and
regularly monitor the temperatures of
sensitive stock. Always keep flashlights
and battery supplies readily accessible
throughout your office. If you perform
surgical procedures in your office,
train staff members on what to do
in the event that power is disrupted
mid-procedure.
Contingency PlanIn order to be prepared to continue to provide services if you are temporarily
denied access to your office because of a weather-related emergency, it is a
good idea to store some essential items elsewhere. The specific items that
you may wish to store in such an off-site cache will depend upon the nature
and level of services you may wish to provide following a catastrophe that
makes your usual office unusable. One good question to ask when
considering which items to include in the cache is how difficult would it be to
obtain the items following a disaster. Here is a suggested list — by no means
exhaustive:
• Flashlights
• Charged cellular phone
• Pulse oximeter
• Stethoscope
• Blood pressure cuffs
• Thermometers
• Otoscope/ophthalmoscope
• ACLS kit or crash kit
• Necessary medications (analgesics, antibiotics)
• Wound care supplies (gauze, gloves, tape, suture supplies)
• IV/phlebotomy supplies
• Oxygen with needed accessories
• Insurance forms
• Lab request forms
• Copy of phone tree
• Progress note sheets
• Medical reference books
• Patient list
• Prescription pads
• Pens and paper
Source: Gerard Klinzing and Charles McClure, “Could Your Office Cope With Disaster”
Family Practice Management, Vol. 6, No. 8, September 1999, pp. 22-30.
9 RiskRx Physician Edition Winter 2013
In order to be
prepared to
continue to
provide services if
you are temporarily
denied access to
your office ... it is a
good idea to store
some essential
items elsewhere.
Dr. James routinely performs
dermatological laser procedures in her
office. The manufacturer’s preventive
maintenance program added several
thousand dollars to the purchase price
of the laser equipment, so she elected
to obtain preventive maintenance
through a local contract instead. Her
intentions were good, but the final
contract for services was never
signed. Today, two years after
purchasing the laser equipment, a fire
occurred while using the laser to
remove skin lesions from a patient’s
face. The patient suffered second
degree burns over her entire face.
With a rise in outpatient procedures,
services provided in physician offices
are becoming increasingly complex,
which means that office equipment is
becoming increasingly sophisticated.
Clinical and administrative personnel
are jointly responsible for operating,
cleaning and maintaining a wide
variety of tools used in patient care —
everything from digital thermometers
to automated external defibrillators to
lasers.
Safety-minded and risk-minded
healthcare professionals know that
there is a direct correlation between
medical equipment maintenance and
patient protection, so it is critical that
staff members at all levels of the
practice be thoroughly trained in the
proper use and care of equipment that
is used in the office setting. Taking
appropriate measures to keep
equipment clean and in good working
order will help the practice to avoid
adverse incidents.
Following three basic rules will help
ensure that your office equipment
helps further — rather than hinder —
your commitment to quality patient
care:
10
1. Use equipment properlyBefore allowing a piece of equipment
to be used in your office practice, you
must ensure that those staff members,
including physicians, who are
expected to use the equipment have
been properly trained in its use. Be
sure to have a formal process in place
to log and track those staff members
who have been thoroughly trained on
each piece of equipment. Depending
on the complexity of the device,
training might be delivered by another
member of the staff or by a
manufacturer’s representative. As new
employees are brought on board, be
sure that they too are properly trained
on the equipment they are expected
to use.
If your office is affiliated with a
hospital network with an in-house
education department, take advantage
of their expertise when it comes to
equipment training. “Our education
department is great at developing
competencies whenever there’s a new
piece of equipment brought into any
of our clinics,” says Lake Region
Healthcare’s Jed LaPlante. “Sometimes
we’ll have reps come in and train to
get people completely up to speed
on proper use, then we take that
competency and begin a process of
first-person training. So whoever is
signed off on the equipment can then
sign off other people.”
Revisit your training regimens
regularly — many offices follow an
annual schedule — to ensure that all
staff members are familiar with all of
the equipment with which they would
come in contact at the office.
Keeping Office Medical Equipment Safe and Effective Keys to Best Practices in Operation and MaintenanceContributing Authors: Mary Adam Thomas and Cindy Siders
Taking appropriate
measures to keep
equipment clean and
in good working order
will help the practice
to avoid adverse
incidents.
2. Maintain equipmenteffectively
Keeping equipment running as
intended is more than just a matter of
fixing things when they break. It
involves a comprehensive approach to
preventive and ongoing maintenance
that will extend the life of your office
equipment and protect you, your staff
members and your patients from
harm. “Improper maintenance of
medical equipment can present a
serious risk for physicians and
practices,” cautions Monica
Paczkowski at the University of North
Dakota Center for Family Medicine.
“Depending on the instrument — like
a cauterizing machine or something
like that — it can actually hurt the
patient or employee if it’s not working
properly. Also, if you need to use it
and can’t because it’s non-functional,
you can’t provide adequate care.”
Always follow the instructions from the
manufacturer for routine and
scheduled maintenance to keep
instruments and equipment operating
properly. Establish a formal tracking
process for equipment, noting the
dates of when service is due and has
been provided. Be certain to train staff
members to watch for signs that
equipment may not be operating
properly, to report on such observations
immediately and to remove the item
from use until the identified issue has
been thoroughly addressed.
3. Clean instruments andequipment thoroughly
Cleaning, disinfecting and sterilizing
your office instruments and equipment
are your best defenses against claims
involving contamination and/or
infection. Be sure to follow industry
standards and manufacturer
recommendations for cleaning,
disinfecting and sterilizing. Develop
and post cleaning protocols to ensure
that all staff members are using a
consistent approach. Ensure that
contracted service providers also
follow industry standards and
manufacturers’ recommendations.
Additionally, ensure that your policies
and procedures sufficiently address
the cleaning of all surfaces and
instrumentation in every exam and
procedure room following each patient
visit.
Guidelines for EquipmentManagement1. Maintain an inventory of all office
equipment used in patient care and
review it annually for accuracy.
11 RiskRx Physician Edition Winter 2013
(Continued on page 12)
Cleaning, disinfecting and sterilizing
your office instruments and
equipment are your best
defenses against claims involving
contamination and/or infection.
Keeping Office Medical Equipment Safe and Effective(Continued on from page 11)
CO/MI-30
12
2. File all manufacturers’ maintenance
and use instructions for every piece
of equipment. Maintain a log of all
preventive maintenance and
equipment repair. Note the date of
repair and the service provider in
the log.
3. Test all equipment prior to initial
use.
4. Ensure that all new personnel
receive thorough training in the use
and maintenance of all equipment
as part of orientation procedures.
5. When possible, involve
manufacturers’ representatives in
training staff members on new and
updated equipment. Otherwise, use
trained staff members as in-house
instructors. Keep a log of who has
been authorized to use specialized
equipment.
6. Clean equipment according to the
manufacturer’s recommended
techniques and schedule.
7. Remove any equipment from
service immediately upon
discovering any operating or safety
issues.
8. Ensure that contracts with service
providers state expectations
for compliance with industry
standards and manufacturers’
recommendations.
RiskRx is a publication of Coverys' Risk Management
Department.
All materials are subject to copyright. Reproduction
without prior permission is prohibited.
This information is intended to provide generalguidelines for risk management. It is not intendedand should not be construed as legal advice.
Ensure that all new personnel receive thorough
training in the use and maintenance of all equipment
as part of orientation procedures.
Adapted (in part) from: Western New Mexico
University, Medical Equipment Management
Program, n.d., www.wnmu.edu/plans/
policies/VPSCA/Student%20Health/
EquiptMgmtPgrm.htm, 08/23/12.