Medical emergencies in the healthcare setting

Safety in the healthcare facility

Patient safety

Patient safety is a critical component of the quality of care provided in a healthcare facility. The U.S. Department of Health and Human Services (DHHS) has conducted extensive research on the features of safe patient environments in providers’ offices. The DHHS has found the following factors to be crucial to patient safety.

• Open lines of communication must be established among all employees about possible safety issues, and employees must work together to solve these problems before a patient is injured.
• If an injury occurs (e.g., a medication is administered to the wrong patient), policies and procedures must be in place so that all employees recognize the potential for an error and protocols are established for preventing a similar problem in the future.
• Procedures must be standardized in the facility’s policies and procedures manual so that all employees can refer to specific guidelines on how procedures should be performed. For example, in the case of a blood spill, the policies and procedures manual must outline a specific, step-by-step procedure for cleaning up the spill that safeguards both patients and staff members.
• The facility must provide ongoing staff training in patient safety factors.
• Staff members must work as a team to maintain a safe environment for patients. For example, all staff members must follow Standard Precautions to prevent the spread of disease in the facility.

Throughout this text, you have learned about situations that could result in serious harm to your patients. You must constantly be on guard to protect patients from possible injury. For example, studies have shown that healthcare workers frequently confuse drug names, which results in administration of the wrong medication; they also fail to identify a patient correctly before performing a procedure and neglect to perform hand sanitization consistently, thus promoting the spread of infectious diseases. The medical assistant is an important link in the delivery of quality and safe care. Can you think of anything you have learned thus far in your studies that could help keep patients safe in the provider’s office?

Employee safety

The healthcare facility should safeguard patients as well as staff members from the possibility of accidental injury. This includes making sure the facility has appropriate safety signs throughout the building as well as appropriate symbols and labels that identify potentially dangerous items. Data compiled by the Occupational Safety and Health Administration (OSHA) reveal that the leading causes of accidents in an office are slips, trips, and falls. You must think and work safely to prevent accidents. The following are some suggestions from OSHA for vigilant accident prevention methods:

• Use proper body mechanics in all situations. For example, bend your knees and bring a heavy item close to you before lifting rather than bending from your back; push heavy items rather than pulling them; and use a gait belt or ask for assistance when transferring patients.

• Constantly check the floors and hallways for obstructions and possible tripping hazards, such as telephone and computer cables or boxes.

• Store supplies inside cabinets rather than on top, where they can fall off and injure someone; store heavier items on lower shelves so they do not have to be lifted any higher than necessary.

• Clean up spills immediately; slippery floors are a danger to everyone.

  Use a step stool to reach for things, not a chair or a box that could collapse or move.

• Have handrails and grab bars available as needed in the facility; use them, and encourage patients to use them.

• Do not overload electrical outlets.

• Perform a safety check of the facility routinely; look for unsafe or defective equipment, torn carpeting that could catch heels, adequate lighting both inside and outside the facility, and so on.

A primary concern for personnel and patient safety is infection control. Standard Precautions protocols require employers to provide appropriate and adequate personal protective equipment (PPE). The goal is to protect staff members from occupational exposure to blood-borne pathogens while at the same time safeguarding patients in the facility. OSHA’s guidelines include managing sharps and providing current safety-engineered sharps devices; providing hepatitis B immunization free of charge to all employees at risk of exposure to blood and body fluids; using latex-free supplies as much as possible to prevent allergic reactions in both staff members and patients; identifying all chemicals in the facility with Safety Data Sheets (SDSs) and adequately storing potentially dangerous substances; and performing proper hand hygiene consistently throughout the workday.

Another serious concern that faces all of us today is the prevention of workplace violence. Unfortunately, rarely does a week go by without reports of violence in a public place. Employees in a healthcare facility are no exception. We started the text with information about and exercises in communication techniques in the workplace: problem solving, therapeutic communication, and assertive behavior. All of these are helpful in dealing with a difficult patient. Employers should provide training on how to identify potentially violent patients and should discuss safe methods for managing difficult patients. Many employers offer training on how to manage assaultive behaviors.

Environmental safety

Environmental safety guidelines include numerous work safety practices, such as office security, management of smoke detectors and fire extinguishers, posting of designated fire exit routes, and securing certain items (e.g., narcotics, dangerous chemicals) in locked storage areas in the facility. In addition to these concerns, staff members should constantly be on the alert for possible safety hazards in and around the building, such as improper lighting, unlimited access to the facility, and inadequate use of security systems.

The medical assistant must be prepared to use a fire extinguisher to prevent injury to patients and to protect the medical facility. An ABC fire extinguisher is effective against the most common causes of fire, including cloth, paper, plastics, rubber, flammable liquids, and electrical fires. Most small extinguishers empty within 15 seconds, so it is important to call 911 immediately if the facility fire is not small and confined. If the fire is small, no heavy smoke is present, and you have easy access to an exit route, use the closest fire extinguisher. However, do not hesitate to evacuate the facility if you believe any danger exists to yourself or others.

Methods of fire prevention and response:

• Store potentially flammable chemicals and supplies according to the manufacturers’ guidelines.
• Inspect electrical equipment and cords throughout the facility; take care not to overload outlets.
• If a fire is suspected, immediately disconnect oxygen supplies or turn off oxygen tanks to prevent an explosion.
• Smoke alarms should be located throughout the facility, checked periodically, and replaced as needed.
• Fire safety equipment should be available and current. Fire extinguishers must be inspected at least annually. If an extinguisher is discharged, it must be replaced immediately.
• Fire extinguishers should be located in multiple sites throughout the facility and mounted on the wall for easy access.
• If you smell smoke or suspect a fire, immediately notify the fire department (or call 911) and evacuate the facility. Do not use elevators if a fire is suspected.

Each facility should have a policy and procedure in place for evacuating the building. According to OSHA, the facility’s plan first should identify the situations that might require evacuation, such as a natural disaster or a fire. The following provisions should be included in the facility’s evacuation plan:

• An emergency action coordinator must be designated, and all employees must know who this individual is. This person (usually the office manager) is in charge if an emergency occurs.
• The coordinator is responsible for managing the emergency at the facility and for notifying and working with community emergency services.
• Evacuation routes with clearly marked exits must be posted in multiple locations throughout the facility. Maps of floor diagrams with arrows pointing to the closest exits are an easy means of finding the closest door out, even for individuals unfamiliar with the facility.
• Exit doors must be clearly marked, well lit, and wide enough for everyone to evacuate.
• Hazardous areas in the facility that should be avoided during an emergency evacuation must be identified, such as areas where chemicals and oxygen tanks are stored.
• A meeting place outside the facility must be designated for all those evacuating to make sure everyone got out of the facility safely.
• Employees should be trained to assist any co-worker or patient with special needs.
• A designated individual must check the entire facility, including restrooms, before exiting. He or she must make sure to close all doors (especially designated fire doors) when leaving to try to contain the fire or other disaster

Disposal of hazardous waste

The use of PPE when potential exists for exposure to blood and body fluids; the importance of flushing the eyes with an eye wash unit if they are exposed to potentially infectious or toxic material; and the consistent use of sharps containers. Regardless of individual responsibilities in the facility, all employees must be aware of potentially dangerous situations and must comply with all safety measures to protect themselves and their patients.

OSHA defines regulated waste as any contaminated item that might release blood or other potentially infectious material; contaminated supplies with dried blood or other potentially infectious material on their surfaces; contaminated sharps; and waste products that contain blood or other potentially infectious material. Healthcare facilities must make special arrangements for the disposal of regulated waste, which often costs as much as 10 times more than regular garbage disposal. It therefore is important to put only supplies contaminated with blood or body fluids into red bag collection systems and sharps containers. The following measures should be used for proper disposal of hazardous materials in the provider’s office:

• Place signs on or near the biohazard container to identify its purpose and the materials that should be deposited in it. All biohazardous waste containers should display a biohazard label.
• Make sure all biohazardous waste containers are covered and have a foot pedal for opening and closing the container. This prevents the spread of infectious material and reduces the likelihood that noninfectious material will be tossed inside. Biohazard containers should be kept only in treatment areas where contaminated materials are likely to be produced.
• Place a regular garbage container next to a biohazard container to encourage staff members to use the biohazard bags only as needed.
• Place only sharps in sharps containers; gauze, bandages, and so on belong in a contaminated waste container. Noninfectious items, such as patient gowns that are not contaminated with body fluids, and packaging material, belong in the regular trash.