rmpsi€¦ · consider assembling a safety committee that is led by the safety coordinator. the...

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.



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.


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


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.


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.



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.

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