Clinic safety: Incidents, medication, consent

There is a very common misconception that abounds in most clinics regarding safety and who is responsible for clinic/patient safety. Staff often feels that clinic safety is a management problem-not their concern.

While management may be responsible for a large part of physical clinic safety, it also falls squarely on technicians, and other staff members, to ensure that the clinic is running at a high level of safety for both staff and patients.

There are a number of components to clinic/staff/patient safety:

Let’s talk about some components to safety that we all should follow.

Incident reports

If something happens in the clinic that you did not expect, that’s an incident.

Here’s an example. You are using the phoropter in a darkened room. You pull the phoropter over and place it in front of the patient. The phoropter falls off the arm stand and hits the patient in the nose before landing in his lap because the securing screw was not tight and the phoropter wiggled free from the arm.

When an incident occurs, staffers need to calmly address the patient’s concerns due to the incident-make sure the patient is unhurt, etc. Then alert the clinic lead and/or the doctor to inform them of the incident. 

This should then be filed with your practice’s office manager, human resources representative, or person responsible for clinic insurance claims. There is a chance the patient may seek outside medical care and submit a bill to your clinic.

Follow the same procedure if a staff member or other employee is hurt while at work.

Over-the -counter medications

Most staff members don’t realize that while they are at work, what a common person might do at home, you cannot do in the office.

How often has a patient in the clinic asked you for two Tylenol because she has a headache? If this person were in your house and asked you for Tylenol, you would give it to her. But when you are in your office, you can’t provide Tylenol without checking with the doctor first.

When you are at work, you cannot give any medication-over-the counter medication or otherwise-to a patient without checking his medical/medication history. Then you need to document that you gave the patient the medication per his request and the doctor’s permission.

Giving the patient medication of any type is called dispensing, and clinic staff is not allowed to dispense medication except under a doctor’s orders.

Be careful of nursing home patients! Always check with the nursing home to ensure that what the patient is asking for is allowed for them to have. We had a nursing home patient once tell us she did not have time to eat breakfast before she came to clinic because the appointment was so early, and she was very hungry. She asked for a glass of orange juice to carry her through the appointment. She was a very kind, rational, and sweet older lady, and everything she said made sense, so my relatively new technician gave her a glass of orange juice. The patient immediately began to aspirate the orange juice because she had a feeding tube. She had no tracheal attachment to her stomach, and the orange juice went where it did not belong! It was clearly marked on her transfer papers that she was absolutely not to have anything by mouth. Needless to say, this became a major incident.

Institute a policy that states nothing is given to any patient unless the doctor is asked first. In the case of nursing home patients, the facility should be called prior to giving the patient anything.

Obtaining consent

If you do something-anything-to a patient, such as cut, laser, or remove, you must have the patient’s consent every time you perform the procedure.

I have heard both doctors and staff members maintain that if you received consent on June 1 from a patient for chalazion removal, then the patient returns June 14 because that chalazion is back, you aren’t required to receive another consent. Every time you perform a procedure, you must have a consent form signed and dated. Also, don’t forget to document in the chart what you did and why.

While there are some procedures for which a consent can “carry forward” for a given period of time (such as cancer treatments and laser treatments for age-related macular degeneration [AMD]), for most other procedures it is safer for all involved to obtain consent prior to the procedure.

This is key to remember: Make sure that you obtain consent from the patient before anesthesia or mood-altering drugs (such as Valium) is given.

Reporting unsafe behavior

Any and all unsafe behavior, even on the part of a doctor or supervisor, needs to be reported.

For example, if your doctor, or another staff member, is recapping needles, or an employee is standing on stools with wheels while reaching for something on the top shelf, these behaviors need to be reported to the administrator or lead technician.

Some staff members may think that the rules to keep them and patients safe are overkill and really shouldn’t apply to them. This in itself is unsafe behavior and must be reported. Escalate to a disciplinary action, if necessary improvements are not shown.

Following are some examples of behavior that should be reported:

• Feeling unsafe at work, for any reason

Work should be a safe place. All employees have the right to feel safe in the work environment. There can be no excuses or exclusions. This includes feeling safe with the doctor, the patient, and other staff members.

Be aware of the different “types” of people that you come into contact with every day-staff and patients alike.

The toucher or hugger. Some people are naturally touchy or huggy people. However, that behavior may make others uncomfortable. If a patient or fellow staffer is invading your space, first ask the other party to stop touching you. If the other party persists, involve your manager to help her understand that you are not comfortable with this type of behavior.

Remember that this goes both ways. Your colleagues or patients may not welcome a touch or hug from you. Patients especially are vulnerable in a medical setting and may misinterpret this act of kindness. Along with information and diagnoses, acts of kindness can potentially be misinterpreted when the patient is under stressful conditions.

The powder keg. Sometimes, even though they know better, people’s emotions can get the better of them. We’ve all encountered irate patients. Doctors can have a bad day, or your colleague might have one, too. However, such behavior is unacceptable from doctor, staff, and patient alike and shouldn’t be tolerated.

Employees need to have an “out” when they are working with an angry doctor, staff member. I have advised my staff for years that if they think they are in a situation with a patient that is getting out of hand, they need to walk away from the situation and call for the manager for help.

Remember that you will never win an argument with a patient-stop arguing.

• Harassment

This is easy. There will be no harassment. Period.

No sexual harassment and no physical harassment is acceptable. This means back-handed comments, innuendos, inside jokes, or threatening actions.

If this happens to anyone at any time, speak with a manager immediately. Managers must be sure the staffer is heard and offer help to get out of the situation. Disciplinary action must then be taken with the offending party.

• Workplace hazards

Encourage staff members to report practice and property hazards, such burnt-out parking lot lights, frayed wires on equipment, or carpets that are a potential tripping risk.

Form a safety committee to be involved in the safety of each clinic. Committee members should report in writing monthly-or sooner for immediate risks-on any hazards they see that need to be addressed.

The last thing any manager wants to hear a staff member say is, “I told them over and over it was dangerous.”

Unsafe workplaces can lead to staff or patient injuries. Besides the pain of the injury, poor safety can also potentially lead to financial pain if a lawsuit occurs because of it.

Conduct safety drills in the office. Be aware of what can happen at different times of the year (tornado, hurricane, blizzard, etc.)

When was the last (or ever) time your clinic held a fire drill? Does every staffer know what to in the event of a severe thunderstorm or tornado heading your way? Where do you send patients? How do you secure the office?

Ensure your office has the appropriate signage, an updated first aid kit, and yearly safety review sessions. You also should be monitoring your Occupational Safety and Health Administration (OSHA) policies to ensure that your office is complying with OSHA standards for employee safety on the job.

These are a few of the safety concerns everyone should be aware of in the workplace. Many employees believe that these are areas for which only management should be responsible. It takes everyone involved to ensure that your work environment is safe for all: employees, doctors, and patients. It’s everybody’s job.