ma liability 2017 final - scripps mercy physician partners
TRANSCRIPT
WELCOMEThe webinar will start shortly…
By Amy McLain, RN, BSN
Senior Risk Management & Patient Safety Specialist
Cooperative of American Physicians
Medical Assistant Liability:Their Vital Role and Sources of Risk
Webinar Learning Objectives
1. Understand the definition of a medical
assistant and what kind of training is required
to be an MA
2. Understand the MA’s scope of practice in the
medical office
3. Understand who can supervise the MA and how
4. Identify areas of risk associated with MAs
5. Identify ways to improve patient safety and
reduce medical liability risk
Laws Governing Medical Assistants
• California Business and
Professions Code
Sections 2069-2071
• California Code of
Regulations Title 16,
Article 2, section 1366-
1366.4
• California Health and
Safety Code Section
1204
Definition of a Medical Assistant
An unlicensed individual who performs basic
administrative, clerical, and technical
supportive services under the supervision of a
licensed physician, podiatrist, physician
assistant, nurse practitioner, or nurse
midwife.
On the Job Training
• Physician determines the content of MA
training
• A MA can be trained by a licensed physician
or podiatrist, RN, LVN, NP, PA, or a
qualified MA acting under the direction of a
licensed physician or podiatrist
• Written, signed, dated documentation of
training must be kept by employer
MA training MA
A “qualified medical assistant” is a medical assistant who is:
1. Is certified by a medical assistant certifying organization approved by the MBC (see slide 7), or
2. Holds a credential to teach in a medical assistant training program at a community college, or
3. Is authorized to teach medical assistants in a private postsecondary institution accredited by an accreditation agency recognized by the United States Department of Health or approved by the Bureau for Private Postsecondary Education.
Formal Education
• A secondary, postsecondary, or adult education program in a public school authorized by the Department of Education
• A community college program
• A postsecondary institution accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP.org) and the Accrediting Bureau of Health Education Schools (ABHES.org)
Certification
Board Approved Medical Assistant Certifying Organizations
American Association of Medical Assistants 20 N. Wacker Drive, #1575 Chicago, IL 60606-2963 http://www.aama-ntl.org
(312) 424-3100
American Medical Technologists 710 Higgins Road Park Ridge, IL 60068 http://www.amt1.com
(847) 823-5169
California Certifying Board of Medical Assistants P.O. Box 462 Placerville, CA 95667 http://www.ccbma.org
(866) 622-2262 or (530) 622-1850
Multiskilled Medical Certification Institute, Inc. P.O. Box 17 7007 College Boulevard Overland Park, KS 66211 http://www.mmciinc.com/
(888) 625-8408 or (913) 754-3287
Scope of Practice
• Clerical, administrative, and technical
support within an office or clinic setting -
not an inpatient setting
• Cannot diagnose, treat, or perform invasive
tasks or those requiring assessment
• Cannot be used to
replace a highly
skilled licensed
professional—MAs are
not nurses
Warning!
Physicians can be charged with aiding and
abetting the unlicensed practice of medicine.
Supervision
• An MA must always work under the direct
supervision of a licensed physician or
designated supervisor before performing
non-invasive technical support services of
any kind.
• A physician or designated supervisor
MUST BE physically present in the
treatment facility during the performance
of those procedures by an MA.
MA can…
Additional Training Required
• Medication (IM, SQ, Intradermal)
• Inhalation meds
• Venipuncture
• Skin puncture
• Skin tests
� A minimum of 10 clock hours with 10
satisfactory performances demonstrated
� Training includes: A&P, equipment choice,
technique, ER procedures, follow-up, law
MA can …(not complete list)
• Assist patients in ambulation
and transfers
• Prepare patients for
examinations and procedures,
including positioning, draping,
shaving, and disinfecting
treatment sites; and prepare
patients for gait analysis
testing
• Collect & record patient data
• Provide patients information
and instructions
MA can …(not inclusive list)
• Collect, by non-invasive
techniques, and preserve
specimens for testing, including
urine, sputum, semen, and stool
• Swab the throat in order to
preserve the specimen in a throat
culture
• Draw blood for tests, including
finger sticks and venipuncture
• Measure, describe, record, and
report skin test reaction
MA can …(not inclusive list)
• Apply and remove bandages and
dressings to superficial incisions
or lacerations
• Apply orthopedic appliances,
such as knee immobilizers,
envelope slings, orthotics, and
similar devices
• Obtain impressions for orthotics,
padding and custom-molded
shoes; select and adjust crutches
to patient; and instruct patient
in proper use of crutches
MA can perform…(not inclusive list)
• Simple laboratory and screening tests
customarily performed in a medical office
• Hearing tests under direct supervision
• Ear lavage to remove impacted cerumen
• Electrocardiogram, electroencephalogram,
• Spirometry pulmonary function testing
MA can administer…(not inclusive list)
• Oxygen to a patient via mask or
nasal cannula
• Allergy skin tests
• Fetal non-stress tests
• First aid or cardiopulmonary
resuscitation in an emergency
• Cut the nails of otherwise healthy
patients
• Remove sutures or staples from
superficial incisions and lacerations
MA can …(not inclusive list)
• Administer flu shots, allergy shots, and
other vaccines, and narcotic injections
• Administer medication
• Call in refills to pharmacy under direct
supervision
Case Study #1 :
No One Told the Doctor !
• A 3½ year-old with strabismus and ptosis
underwent repairs of both by an
ophthalmologist.
• Maxitrol (steroid) eye drops were ordered
for one week followed by ongoing Normal
Saline Solution eye drops.
• An MA renewed the Maxitrol without the
physician’s knowledge for 15 months!
• The patient was subsequently diagnosed
with totally opaque cataract, cataract
removed with lens implant resulting in
lifelong disability & need for glasses.
Case Study #1 :
No One Told the Doctor !
No refill guidelines
Lack of supervision
Ineffective communication
Not in MA’s Scope of Practice (not inclusive list)
• Placing the needle or starting and
disconnecting the infusion tube of an IV
• Administering medications or injections into
the IV line
• Charting the pupillary responses
• Inserting or remove a urine catheter
• Injecting collagen
• Using lasers to remove hair, wrinkles,
scars, moles or other blemishes
• Administering chemotherapy
• Independently performing telephone triage
Not in MA’s Scope of Practice (not inclusive list)
• Perform chemical peels or microdermabrasion
• Apply orthopedic splints, casts, or Unna boot
• Interpret results of skin tests, spirometry, lab
tests, or pregnancy tests
• Determine that a test is needed
• Perform sclerotherapy
• Collect nasopharyngeal swabs
• Cauterize wounds
• Perform physical therapy
• Draw up, mix, or administer any anesthetics
Case Study #2: Paying a Heavy Price to Look Good
• A 67 year-old woman, 10 days post-facelift,
presented for CO2 laser treatments at a
medi-spa.
• A back-office assistant/nursing student withdrew
7cc of Epinephrine, instead of Lidocaine with
Epi, and gave unlabeled syringe to the MD.
• The patient coded in office, 911 was called and
the patient was transferred to the ER.
• Her injury was diagnosed as
respiratory distress and a
“chemically induced heart
attack”.
Case Study #2:
Paying a Heavy Price to Look Good
Lack of training
Not in MA scope
of practice
Lack of supervision
Violation of medication protocol
2016 CAP Closed Claims Medical
Assistant Data Study
Common Medication Errors
1. Violation of safe medication administration
practices
2. Improper technique/administration
3. Refill errors
4. Mislabeled medications
Case Study #3:
Kenalog
• A 31-year-old female who was being treated for an insect bite received a Kenalog injection in her right upper arm by an MA.
• The patient later complained of right arm weakness, as well as a palpable lump, a tingling sensation, and pain at the injection site.
• It was determined that the drug leaked out into the patient’s surrounding adipose tissue, causing necrosis and dimpling.
• The patient needed fat grafting..
Case Study #3:
Kenalog
Lack of training
Lack of supervision
Preventing Medication Errors
� Training and Competency
� Policies and procedure
�Identify refill guidelines for staff
�Limit types of meds
�Symptoms that require a physician
visit
�Drugs that may not be renewed
�Document ALL refills
� Control access
� Allergy alerts
Preventing Medication Errors
� Store “look-alike, sound-alike” drugs
separately
� Correctly label syringes and storage
containers
� Give medication to only one patient at a
time
� Limit distractions
� Single-dose vials vs Multi-dose vials
� A supervisor must verify medication before
administration
Safe Medication Administration
2016 CAP Closed Claims Medical
Assistant Data Study
Preventing Falls
� Assist with ambulation
� Have a family member sit/stand by patient
� Have patient lie down on exam table
� Use reclining chairs with arm rests
� Ensure pathways are free of obstructions
� Staff monitor patient
Office Systems: Recall And Tracking
Medication Errors 49%
Office Systems Errors 12%
Scope of Practice 5%
Improper Performance 7%
Misconduct 2%
Failure to Monitor 25%
2006-2014
• Diagnostics/referrals reports
• Chronically ill, complex
patients
• High risk (OB, Cardiac, CA)
• Health maintenance,
screenings, immunizations
• Age-appropriate screenings
• No-shows
Office Systems: Recall & Tracking
Communication Failures
“The single biggest problem in
communication is the illusion
that it has taken place.”
- George Bernard Shaw
Communication Failures
• Distractions & Interruptions
• Workload & Fatigue
• Punitive Culture/Steep Hierarchy
• Production pressures
• Unclear roles and responsibilities
• Absence of clearly defined process
• EHR limitations
• Assumptions
• Documentation
Effective Communication Strategies
� Complete medical record documentation
� Identify critical information to be relayed
to MD
� Provide written education materials to
patients
� Encourage questions and consultation
� Listen
� Confirm understanding
� Avoid assumptions
� Avoid jargon
Improvement Opportunities
• What types of critical
information do you
communicate in your
practice?
• Where could this
communication break
down?
• What safeguards can you
implement to prevent
breakdown?
Understanding Error
Policies and Procedure
Training
Supervision
Office Systems of
Patient
INJURY
Effective Communication
Scope of Practice
Patient
SAFETYSAFETYSAFETYSAFETYRisks
Thinking Like a Risk Manager
• What’s in the best interests of Patient Safety?
• What could possibly go wrong?
• What improvements can we make?
Resources
• CAAHEP.org
• ABHES.org
• www.capphysicians.com
• Risk E-Notes
• CAPsules
• Risk Management Institute (Members only)
• www.mbc.ca.gov
• FAQ
• Approved certification organizations
Open Q&A Session
• Any Questions??
• Additional questions/comments, email: