Ambulatory Healthcare Office Procedures for Risk Reduction

Questions and Answers

What is the primary goal of risk reduction techniques in ambulatory healthcare offices?

To reduce the probability of an unintended event causing injury, loss, or legal action

Which of the following is an example of a risk reduction technique?

Using CNT and Standard Precautions with every patient

What is the purpose of an Exposure Control Plan?

To reduce the risk of exposure to toxic chemicals

Which of the following is a federal standard that practitioners must comply with?

OSHA's Hazard Communication Standard Signup and view all the answers

Why is it important for practitioners to keep abreast of changes in the legal landscape of healthcare practice regulation?

To reduce the risk of legal action and harm to the provider or other individuals Signup and view all the answers

What is the purpose of risk reduction techniques in ambulatory healthcare offices?

To reduce the risk of injury, loss, or legal action Signup and view all the answers

Which of the following is a recommended risk reduction technique?

Using CNT and Standard Precautions with every patient Signup and view all the answers

What is the purpose of complying with federal standards and guidelines?

To reduce the risk of injury, loss, or legal action Signup and view all the answers

What is the primary purpose of an Exposure Control Plan (ECP)?

To minimize the incidence of employee exposure to workplace risks Signup and view all the answers

Which of the following employees may be exposed to bloodborne pathogens?

All employees who may come in contact with blood or OPIM Signup and view all the answers

What is the purpose of the Employee Exposure Determination section of the ECP?

To identify employees who are at risk of exposure to bloodborne pathogens Signup and view all the answers

What is included in the Methods of Implementation and Control section of the ECP?

Engineering Controls and Work Practices, including handwashing facilities and sharps containment Signup and view all the answers

What is the purpose of the Hepatitis B Vaccination section of the ECP?

To offer hepatitis B vaccinations to new employees Signup and view all the answers

What is the primary principle of applying CNT in a clinical setting?

Understanding of principles Signup and view all the answers

How often must employees receive training on the OSHA BBP standard?

Annually Signup and view all the answers

What is the primary purpose of Standard Precautions?

To protect healthcare workers from exposure to pathogens Signup and view all the answers

What is the primary purpose of the OSHA Bloodborne Pathogens Standard?

To provide guidelines for protecting healthcare workers from bloodborne pathogens Signup and view all the answers

What is the purpose of the Recordkeeping section of the ECP?

To maintain records of all aspects of the ECP, including employee training and medical records Signup and view all the answers

When should hands be washed, according to Standard Precautions?

Before and after patient contact, and immediately if contaminated Signup and view all the answers

How long must employee training records be maintained?

For at least 3 years after the duration of employment Signup and view all the answers

What should be done with contaminated needles?

Discard them into a puncture-resistant biohazard container Signup and view all the answers

What is the main goal of the Clean Needle Technique (CNT)?

To prevent the transmission of bloodborne pathogens Signup and view all the answers

What is the purpose of the Sharps Injury Log?

To record incidents of sharps injuries Signup and view all the answers

What is required of healthcare workers, including acupuncturists, to prevent the transmission of bloodborne pathogens?

Consistent use of infection prevention methods for all patients Signup and view all the answers

What is the main goal of the Needlestick Safety and Prevention Act (NSPA)?

To provide employers with guidelines for selecting safety-engineered devices Signup and view all the answers

Who is responsible for developing and implementing an ECP?

The employer or practitioner Signup and view all the answers

What is required by OSHA standard 1910.1030(d)(2)?

Employers must evaluate and implement engineering controls to reduce exposure Signup and view all the answers

What is the term for the procedures established by the CDC to prevent occupational exposure to bloodborne pathogens in healthcare settings?

Standard Precautions Signup and view all the answers

What should be done if a healthcare worker's protective barrier becomes torn?

Replace the barrier immediately Signup and view all the answers

What should be done with needle containers when they are two-thirds to three-quarters full?

They should be sealed and discarded Signup and view all the answers

What is the primary goal of an Exposure Control Plan (ECP)?

To control risks in the workplace and prevent the spread of blood-borne pathogens Signup and view all the answers

Why is it important to use infection prevention methods consistently for all patients?

Because medical history and examination cannot reliably identify all patients infected with HBV/HIV Signup and view all the answers

Which body fluids are included in Standard Precautions?

All of the above, plus several others Signup and view all the answers

What is the purpose of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?

To protect patient confidentiality and ensure the security of healthcare information Signup and view all the answers

Who should participate in evaluating and implementing safety-engineered devices in healthcare settings?

Both employers and employees Signup and view all the answers

What is the responsibility of practitioners with regard to state statutes and regulations?

To comply with state statutes and regulations that allow non-physician acupuncturists to practice acupuncture Signup and view all the answers

What is the purpose of incident reporting following an injury to a healthcare practitioner?

To prevent similar incidents from occurring in the future Signup and view all the answers

What is the classification of a cotton ball containing enough blood that it can be wrung out?

Biohazardous waste Signup and view all the answers

What is the term OSHA uses to refer to biohazardous waste?

Regulated waste Signup and view all the answers

What is the ultimate goal of risk management in the practice of acupuncture?

To prevent accidents and injuries to patients and healthcare workers Signup and view all the answers

Who is considered a biohazardous waste generator?

Facilities or persons that produce or generate biohazardous waste Signup and view all the answers

What is required of waste generators according to OSHA rules?

To prepare, maintain, and implement a written plan to identify and handle biohazardous waste Signup and view all the answers

How must biohazardous waste be packaged, except for sharps?

In impermeable, red, polyethylene or polypropylene bags Signup and view all the answers

Where should biohazardous waste be stored?

In a designated area away from general traffic flow Signup and view all the answers

What is the best source for information and recommendations on local regulations regarding hazardous waste?

State or county pollution control agency and/or health department Signup and view all the answers

What is included in OSHA's definition of regulated waste?

Liquid or semi-liquid blood, contaminated items, and pathological wastes Signup and view all the answers

What should be done with biohazardous waste awaiting pick up?

It should be stored in a designated area and disposed of by a medical waste disposal company Signup and view all the answers

What is the importance of being familiar with local regulations regarding hazardous waste?

It is necessary to ensure proper disposal of hazardous waste Signup and view all the answers

What is the duration for which the Hepatitis B Vaccine Declination Statement/Policy should be maintained?

For the duration of employment plus 5 years Signup and view all the answers

What is the primary purpose of the OSHA Hazard Communication Standard (HCS)?

To develop and disseminate information about chemical hazards Signup and view all the answers

What is included in the Chemical List of a Hazardous Communication Plan?

All hazardous chemicals found at the practice location Signup and view all the answers

What is the purpose of reviewing and updating the Exposure Control Plan (ECP) annually?

To review new or revised tasks or procedures added to the practice Signup and view all the answers

What is the purpose of the OSHA Consultation Program?

To help employers implement systems to prevent or control hazards Signup and view all the answers

What should be done with items that are used during a patient visit but are not saturated with blood or OPIM?

Discarded in regular waste Signup and view all the answers

What is biohazardous waste?

Any solid waste or liquid waste that may present a threat of infection to humans Signup and view all the answers

What should patients do with press tacks or other imbedded devices that they need to remove at home?

Return to the practitioner for proper removal and disposal Signup and view all the answers

What is the purpose of the Material Safety Data Sheets (MSDSs)?

To provide information about chemical hazards Signup and view all the answers

What is the purpose of reviewing standards regarding indoor air quality and fire safety in AOM practice locations?

To address the need for sufficient ventilation in acupuncture settings Signup and view all the answers

What is the best practice when sending a patient home with press tacks or other sharps?

Provide them with a small sharps container Signup and view all the answers

What is the duty of acupuncturists regarding their practice environment?

To ensure both patients and employees are safe Signup and view all the answers

What should be included in the Company Policies regarding chemical exposures in the Hazardous Communication Plan?

Written records of chemical exposures and policies Signup and view all the answers

What is the purpose of the Hazardous Communication Plan?

To develop and disseminate information about chemical hazards Signup and view all the answers

What should be provided for every staircase in an acupuncture practice?

A substantial handrail and adequate lighting Signup and view all the answers

Why is carpeting in areas where biohazardous waste is generated or stored not recommended?

Because it is difficult to clean Signup and view all the answers

What should be maintained according to the manufacturer's instructions and local fire regulations?

Fire extinguishers and fire sprinkler systems Signup and view all the answers

What should be readily available to the acupuncturist in the workplace?

Material safety data sheets and safety manuals Signup and view all the answers

What should be in accordance with local codes?

Electrical installations Signup and view all the answers

What should be done to all structures and equipment in an acupuncture practice?

Regularly inspect and perform preventative maintenance Signup and view all the answers

What is the primary purpose of maintaining treatment records in acupuncture?

To provide accurate and complete information about patient care Signup and view all the answers

What should be included in the patient's treatment record?

Medical history, condition, and treatment of each patient Signup and view all the answers

Why are treatment records considered legal documents?

Because they are required to meet certain standards Signup and view all the answers

What should be done if a change needs to be made in a paper record during a treatment?

Draw one line through the text and initial the change Signup and view all the answers

What should be included on every page of a chart?

The date, patient's full name, and other identifiers Signup and view all the answers

What should be used to write handwritten records?

Blue or black non-erasable ink Signup and view all the answers

What should be done to prevent the loss of patient records?

Set policies and implement procedures to prevent loss Signup and view all the answers

What is the purpose of including the date on every page of a chart?

To ensure that all pages are clearly identified if copied Signup and view all the answers

What should be included in the narrative notes?

Conversations with patients regarding treatments and preventative testing Signup and view all the answers

Why are treatment records protected against theft, fire, or water damage?

To maintain the integrity of the records Signup and view all the answers

When documenting corrections in a chart, what should be done?

Draw a line through the correction and initial it Signup and view all the answers

What should be avoided in a chart to prevent unauthorized access?

Leaving the chart in an open area Signup and view all the answers

What is the purpose of documenting information in a chart?

To create a record of the patient's visit Signup and view all the answers

What should be used to record actual statements made by patients?

Quotation marks Signup and view all the answers

What should be done with excess empty space on a page in a paper chart?

Draw a line through it and initial it Signup and view all the answers

What is the recommended standard medical charting procedure?

SOAP notes Signup and view all the answers

What should be included in the Assessment section of an AOM chart?

Both TCM and biomedical diagnosis Signup and view all the answers

What should be recorded in the Subjective section of an AOM chart?

The patient's personal profile, health history, and supplements Signup and view all the answers

What should be done with a note added after the completion of a visit?

Label it as an addendum and insert it in correct chronological order Signup and view all the answers

What is the purpose of documenting information objectively in a chart?

To provide a clear and accurate record of events Signup and view all the answers

How soon can improvement be expected from a combination of acupuncture/moxibustion and cupping?

After 4-6 treatments Signup and view all the answers

What is the purpose of planning in Treatment Plan?

To establish goals and outcomes based on patient needs Signup and view all the answers

What should be included in a treatment record?

The specific points stimulated, modalities applied to points, dietary and lifestyle recommendations, and any need for referral or consultations Signup and view all the answers

What is the purpose of implementing the AOM plan with the patient?

To review and modify the plan as necessary and obtain written consent Signup and view all the answers

Why is it important to maintain accurate records of patient names and addresses in an investigation of an outbreak?

To prevent cross-infection related to HBV Signup and view all the answers

Under what circumstances can a practitioner release information about a patient?

With the patient's consent Signup and view all the answers

What is the purpose of the HIPAA Security Rule?

To protect electronic protected health information Signup and view all the answers

What is protected by the HIPAA Privacy Rule?

Individually identifiable health information held or transmitted by a practitioner or its business associate Signup and view all the answers

What is a 'covered entity' under HIPAA?

Only healthcare professionals who conduct certain business electronically Signup and view all the answers

What type of information is included in Protected Health Information (PHI)?

Individually identifiable health information held or transmitted by a practitioner or its business associate Signup and view all the answers

What is a critical requirement for every AOM office?

Having a written Bloodborne Pathogens Exposure Control Plan Signup and view all the answers

What is a recommended practice for acupuncture practitioners?

Maintaining active CPR certification Signup and view all the answers

What should be done with biohazardous waste in an AOM office?

Dispose of it through a medical waste disposal company Signup and view all the answers

What is the primary purpose of the Notice of Privacy Practices (NOPP)?

To inform patients of their rights and the practitioner's obligations regarding protected health information. Signup and view all the answers

Which of the following is a requirement for the Notice of Privacy Practices (NOPP)?

It must include an effective date. Signup and view all the answers

What is a critical component of Standard Precautions?

Hand hygiene and personal protective equipment Signup and view all the answers

What is the primary principle underlying the concept of informed consent?

The patient's right to autonomy and self-determination. Signup and view all the answers

What should be done with a patient's medical record?

Keep it confidential and only release with patient consent Signup and view all the answers

What is a recommended practice for dealing with mental health issues?

Evaluating other healthcare situations for which to be prepared Signup and view all the answers

What is the purpose of disclosing the diagnosis to a patient as part of the informed consent process?

To disclose any reservations the provider has concerning the diagnosis. Signup and view all the answers

What should be posted in a prominent place in an AOM office?

A list of emergency numbers for fire, ambulance, and poison control Signup and view all the answers

What is the primary purpose of obtaining written consent from patients?

To provide material proof of consent and ensure that patients understand the procedure and its risks Signup and view all the answers

What is the purpose of disclosing reasonable treatment alternatives to a patient as part of the informed consent process?

To present the patient with alternative treatment options that are considered appropriate for the situation. Signup and view all the answers

What is the primary reason why oral consent may be difficult to prove in court?

Because it may be difficult to prove that consent was given verbally Signup and view all the answers

What is a critical requirement for AOM office personnel?

Following Standard Precautions Signup and view all the answers

What is the threshold for disclosing risks and consequences of a treatment as part of the informed consent process?

Only risks that occur more than 1% of the time must be disclosed. Signup and view all the answers

What is the purpose of disclosing the prognosis without treatment as part of the informed consent process?

To inform the patient of the potential consequences of not receiving the treatment. Signup and view all the answers

What should be done with patient information?

Keep it confidential and only release with patient consent Signup and view all the answers

Why is informed consent particularly important in acupuncture and other techniques that may cause damage to the body?

Because they may result in physical harm or damage to the body Signup and view all the answers

What is a recommended practice for performing certain procedures?

Repeating the request for consent before performing procedures Signup and view all the answers

Which of the following is a legal duty of a practitioner with respect to protected health information?

To maintain the confidentiality of the information. Signup and view all the answers

What is the primary cause of slips, trips, and falls in healthcare settings?

All of the above Signup and view all the answers

What should be done in response to a bodily fluid spill?

Evacuate the area, block it off, and use two sets of utility gloves to clean the area Signup and view all the answers

What is the purpose of state laws regarding reporting communicable diseases?

To protect the public's health by requiring healthcare providers to report certain diseases. Signup and view all the answers

What is the purpose of checking with the local public health office regarding reporting requirements for communicable diseases?

To ensure that a practitioner is aware of the specific reporting requirements for their practice location. Signup and view all the answers

What is strongly recommended for all acupuncture practitioners to maintain?

An active CPR certification Signup and view all the answers

What should be included in a first aid kit for employee use?

Supplies for treating minor cuts and bleeding Signup and view all the answers

What is the primary goal of preventing trips and falls in healthcare settings?

To reduce the risk of injury to patients and employees Signup and view all the answers

What is the primary reason for having policies in place for dealing with minor and major health issues in treatment settings?

To ensure that employees are prepared to deal with emergencies Signup and view all the answers

Why is it important to have access to an Automated External Defibrillator (AED) in treatment settings?

To be prepared to deal with cardiac emergencies Signup and view all the answers

Study Notes

Office Procedures for Risk Reduction

Federal Standards and Guidelines

OSHA's Bloodborne Pathogens Standard:
- Protects healthcare workers from infections, including HBV and HIV
- Requires use of personal protective equipment, hand hygiene, and safe handling of sharp objects
- Applies to all healthcare professionals, including licensed acupuncturists
CDC's Standard Precautions:
- Includes hand hygiene, use of personal protective equipment, safe injection practices, and respiratory hygiene/cough etiquette
- Applies to all healthcare workers

Exposure Control Plan (ECP)

Required by OSHA for all healthcare facilities, including acupuncture practices
Covers preventing the spread of bloodborne pathogens, including HBV vaccination
Must include:
- Written policies
- Program administration
- Employee exposure determination
- Methods of implementation and control
- Regulated waste
- Hepatitis B vaccination
- Post-exposure evaluation and follow-up
- Employee communication
- Employee training
- Recordkeeping
- Hepatitis B vaccine declination statement/policy

OSHA's Hazardous Communication Standard

Requires development and dissemination of information about hazardous chemicals in the workplace
Applies to all healthcare/acupuncture practice settings
Covers:
- Container labeling
- Chemical list
- Material Safety Data Sheets (MSDSs)
- Employee training and information
- Hazardous non-routine tasks
- Policies regarding informing other employers/contractors

Other Hazards

Indoor air quality and fire safety standards apply to most AOM practice locations
Electrical equipment usage is regulated by state and federal standards
Practitioners should review standards and applications annually

Disposing of Biohazardous Waste

OSHA regulates the handling and disposal of biohazardous waste
Requires:
- Written plan for handling and disposal
- Employee training program
- Packaging and labeling of biohazardous waste
- Separation and disposal of sharps
- Storage of packaged waste in a designated area
State and local regulations may be more stringent than OSHA regulations### Hazardous Waste Management
Some governments require permits and inspections for offices that generate hazardous waste, including acupuncture practices.
Used needles and contaminated waste must be disposed of by a licensed service, and proof of disposal may be required.
Practitioners may need a permit to transport contaminated waste, and must ensure that hazardous waste is transported by an approved carrier.

Safety Considerations

Acupuncturists must ensure that their practice environment is safe for patients and employees, following recognized standards established by OSHA.
Key areas to focus on include:
- Maintenance of floors, passages, and stairs
- Provision of handrails and adequate lighting
- Regular inspection and maintenance of equipment and structures
- Compliance with local electrical and construction codes
- Proper disposal of biohazardous waste
- Availability of safety equipment and first aid facilities

Recordkeeping

Patient records should be complete, accurate, and up-to-date, including treatment records, medical history, and consent documentation.
Records should be protected against theft, fire, or water damage, and should be maintained in a secure and confidential manner.
Key elements of a treatment record include:
- Patient information and demographics
- Past medical history and allergies
- Family history and social history
- Dated and signed records of every visit
- Flow sheets and narrative notes
- Consent documentation and treatment plans
Records should be written in black or blue ink, with corrections marked clearly and initialed.

Confidentiality

Practitioners must maintain confidentiality of patient information, with exceptions for discussions with other healthcare professionals or reporting of communicable diseases or abuse.
The HIPAA Privacy Rule protects individually identifiable health information, and practitioners must provide a notice of privacy practices to patients.
Key elements of a notice of privacy practices include:
- Description of how protected health information may be used and disclosed
- Patient rights and practitioner obligations
- Contact information for further information

Informed consent is authorization by the patient or their legal representative for a medical procedure or treatment.
Practitioners must ensure that patients are fully informed of the risks and benefits of a procedure, and must obtain consent before treatment.
Informed consent is a key element of the practitioner-patient relationship, and is essential for protecting patients' autonomy and rights.### Informed Consent
Five basic elements must be disclosed to patients in a language they can understand:
- Diagnosis, including reservations
- Nature and purpose of proposed procedure or treatment
- Probable risks and consequences (more than 1% occurrence)
- Reasonable treatment alternatives
- Prognosis without treatment
A valid, written consent must include:
- Signature
- Procedure details
- Addressing nature, alternatives, risks, consequences, and patient understanding
- Date

Safety Practices

All patients should be treated the same by following Standard Precautions
Preventing trips and falls:
- Slips occur due to lack of friction or traction
- Trips occur due to objects causing loss of balance
- Prevention involves good housekeeping, quality walking surfaces, proper footwear, and pace of walking
Response to bodily fluid spills:
- Evacuate personnel, block area, and use gloves
- Surround spill with paper towels, absorbent material, and dispose of in hazard waste
- Clean and disinfect area with detergent and EPA-approved disinfectant
First aid:
- Acupuncture practitioners should be prepared to deal with minor and major health issues
- Maintain active CPR certification and have access to an AED if possible
- Policies and training for dealing with minor cuts, bleeding, allergic reactions, and burns

Mental Health Issues/Suicide

Practitioners should evaluate healthcare situations for preparation
Legal reporting requirements in some states regarding mental health issues and suicide
Having a plan and policy in place for dealing with these circumstances

Summary of Recommendations

Critical: Every AOM office must have a written Bloodborne Pathogens Exposure Control Plan and Hazardous Communication document
Critical: All AOM office personnel must follow Standard Precautions
Critical: Every AOM office must comply with fire department regulations, Building and Safety codes, and State and Federal standards
Critical: All AOM offices must create, maintain, update, and train personnel on possible exposures to infectious agents and other hazards annually
Critical: All AOM offices must prepare, maintain, and implement a written plan to identify and handle biohazardous waste
Critical: Patient records should be kept of all patient visits and treatments performed
Strongly Recommended: Practitioners should require written consent before instituting clinical procedures
Strongly Recommended: Every AOM office should have a simple first aid kit and post a list of emergency numbers

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Description

This quiz covers federal and legal standards required for ambulatory healthcare offices, including OSHA and CDC guidelines. It's a resource for practitioners to locate sources and examples for federal standards.