AMCA Clinical Medical Assistant Certification Study Guide 2022 PDF

American Medical Certification Association Working Together to Develop Quality Allied Healthcare Professionals! Clinical Medical Assistant Certification Study Guide (CMAC)  Welcome to AMCA’s Clinical Medical Assistant Certification Study Guide. DISCLAIMER: This prep material is int...

American Medical Certification Association Working Together to Develop Quality Allied Healthcare Professionals! Clinical Medical Assistant Certification Study Guide (CMAC)  Welcome to AMCA’s Clinical Medical Assistant Certification Study Guide. DISCLAIMER: This prep material is intended to be used as reinforcement for what you have already learned. It is provided as a courtesy by the AMCA to be used as an optional resource. All prep material is developed independently from the Certification Board, and it is not required, endorsed, recommended, or approved by the Certification Board. Additional Resources: CMAC Certification Program Outline CMAC Exam Blueprint Recommended Book List Candidate Handbook AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Clinical Medical Assistant Certification Study Guide (CMAC) AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Table of Contents 1. Professionalism 1.01 Present a professional appearance and demeanor. 1.02 Act with integrity and respect toward others. 1.03 Take responsibility for personal decisions and behavior in the workplace. 1.04 Respect individual diversity. 1.05 Deal empathetically with concerns of others. 1.06 Manage conflict in a constructive manner. 1.07 Pay full attention to others when listening. 1.08 Ask questions as appropriate to confirm understanding. 1.09 Speak clearly and concisely. 1.10 Communicate effectively with patients, patients’ families, and healthcare professionals. * 1.11 Use effective non-verbal communication (e.g., use of own body language, appropriate response to the body language of others). * 1.12 Use business communication etiquette in speaking and writing (e.g., proper grammar, punctuation, style). 1.13 Provide support to other healthcare professionals when appropriate. * 2. Medical Law and Ethics 2.01 Perform within the scope of practice for a clinical medical assistant. 2.02 Recognize and respond to ethical and legal issues (e.g., conflict of interest, medication errors, malpractice, negligence). 2.03 Describe the purpose and application of the following legislation in the workplace: CLIA OSHA Standards HIPAA Patient’s Bill of Rights HITECH GINA 2.04 Comply with the following legislation in the workplace: CLIA OSHA Standards HIPAA Patient’s Bill of Rights HITECH GINA 2.05 Obtain patient’s consent when appropriate. 2.06 Explain the concept of advanced directives to patients when appropriate. 3. Clinical Medical Assisting 3.01 Infection Control 3.01.1 Perform hand hygiene (e.g., handwashing, alcohol-based hand rub). 3.01.2 Use PPE appropriately. 3.01.3 Use respiratory hygiene and cough etiquette as required. 3.01.4 Use safe injection practices. 3.01.5 Clean medical instruments and equipment (e.g., order of cleaning, types of cleaning products). 3.01.6 Disinfect medical instruments and equipment (e.g., types of disinfectants). 3.01.7 Sterilize medical instruments and equipment (e.g., autoclaving) 3.01.8 Clean and disinfect an examination room with the appropriate disinfectant. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  3.01.9 Follow the CDC Transmission-based Precautions. 3.1.10 Explain how to prevent the spread of nosocomial infection in a hospital setting or a clinic. 3.1.11 Dispose of the used syringes, needles, and other sharps items correctly. 3.1.12 Properly label the biohazard material (e.g., bodily fluids, sharps). 3.1.13 Properly handle and dispose of biohazard material. 3.02 Electrocardiography Testing 3.02.1 Prepare an ECG machine for testing (e.g., loading of ECG paper, patient data entry). 3.02.2 Explain an ECG testing procedure to patients. 3.02.3 Prepare and position patients for ECG testing. 3.02.4 Ensure proper placement of electrodes for an ECG. 3.02.5 Obtain an ECG on patients. 3.02.6 Adjust an ECG testing procedure to patients with special considerations (e.g., elderly people, children, and people with special needs). 3.02.7 Identify and troubleshoot common causes of artifacts and recording errors. 3.02.8 Connect patients to a Holter monitor. * 3.03 Collecting Specimens and Diagnostic Testing 3.03.1 Verify the details of requisitions. 3.03.2 Establish if patients meet the requirements of specimen collection for the test ordered. 3.03.3 Select the appropriate equipment for the purpose of testing and the type of patient. 3.03.4 Provide instructions for specimen collection and procedures to patients (e.g., a clean catch). 3.03.5 Prepare patients for blood collection (e.g., use of tourniquets, effects of hand squeezing and heat). 3.03.6 Prepare a site for blood collection (e.g., aseptic and sterile techniques). 3.03.7 Identify additives and the corresponding color-coded tops in evacuated blood collection tubes. 3.03.8 Use the correct order of draw for venipuncture. 3.03.9 Use the appropriate needle insertion and withdrawal techniques for venipuncture. 3.03.10 Adjust venipuncture to patients with special needs (e.g., various age groups, medical conditions). 3.03.11 Recognize and respond to incidents during blood collection. 3.03.12 Perform venipuncture aftercare using appropriate techniques and bandaging supplies. 3.03.13 Perform a capillary puncture. 3.03.14 Collect urine specimens from adult patients (e.g., random, clean catch, timed, and drug-screen). 3.03.15 Collect urine specimens from pediatric patients. 3.03.16 Collect cultures and smears (e.g., blood, sputum, nasal, wound). AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  3.03.17 Label the specimens correctly. 3.03.18 Document specimen collection procedures. 3.03.19 Perform quality control before running diagnostic testing. 3.03.20 Perform the CLIA-waived POC testing: Hematology (e.g., hematocrit, hemoglobin, ESR, coagulation). Chemistry and metabolic (e.g., blood glucose via a capillary puncture, PKU, kidney and liver function tests). Hemoccult on a stool specimen Immunology (e.g., quick-flu, Rapid Group A Streptococcus test) Urine (e.g., a urine dip, HCG pregnancy test). 3.03.21 Perform chain-of-custody testing (e.g., preemployment drug screening). 3.03.22 Assist healthcare providers in obtaining specimens. 3.03.23 Perform vision tests (e.g., Snellen test, Ishihara test). 3.03.24 Perform respiratory tests (e.g., spirometry, nebulizer). 3.03.25 Recognize normal and abnormal values of laboratory results. 3.03.26 Report abnormal values of laboratory results to the attending provider. 3.03.27 Use appropriate methods for specimen preservation (e.g., refrigeration, fixative). 3.04 Patient Intake 3.04.1 Use appropriate methods for patient identification (e.g., two patient identifiers). 3.04.2 Obtain patient’s problem list, past medical history, current medications, allergies, family history, surgical history, and social history. 3.04.3 Obtain body measurements in adult patients (e.g., height, weight, and BMI). 3.04.4 Obtain body measurements in pediatric patients (e.g., weight and length, chest and head circumference). 3.04.5 Maintain pediatric growth charts. 3.04.6 Measure patient’s vital signs using appropriate methods (e.g., manual and electronic blood pressure, temperature, pulse, respiration rate, oxygen saturation). 3.04.7 Recognize abnormal values in vital signs and report them to the attending provider. 3.04.8 Adapt vital sign measurement to patients with special needs (e.g., diabetes, physical or mental impairment). 3.05 Assisting with Physical Examinations and Procedures 3.05.1 Prepare a room for a physical examination or a minor procedure (e.g., cleaning the room, preparation of a surgical tray). 3.05.2 Prepare patients for physical examinations (e.g., patient positioning and draping, skin preparation). 3.05.3 Assist the attending provider with a physical examination. 3.05.4 Perform a surgical aseptic handwash (i.e., a surgical scrub). 3.05.5 Prepare patients for minor procedures (e.g., skin preparation, use of aseptic techniques, patient instructions). 3.05.6 Recognize the signs of infection. 3.05.7 Perform basic wound care (e.g., dressing change, bandaging, splinting). 3.05.8 Perform staple and suture removal. 3.05.9 Perform eye and ear irrigation. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  3.05.10 Instruct patients on proper post-procedure care (e.g., wound care). 3.05.11 Assist patients with the use of ambulation devices. 3.06 Administration of Medications 3.06.1 Identify common classes of medication, uses, dosage, side effects, and contraindications. 3.06.2 Comply with legal requirements for ordering, dispensing, documenting, and storing medications. 3.06.3 Apply seven “rights” of medication administration. 3.06.4 Calculate solid and liquid medication dosages and dosages by weight. 3.06.5 Administer oral medications. 3.06.6 Select proper sites and equipment (i.e., needle length and gauge) for administering parenteral medications (excluding IV). 3.06.7 Administer parenteral medications using appropriate method (SQ, IM, ID and by inhalation). 3.06.8 Administer vaccinations. * 3.06.9 Dispose of parenteral equipment correctly. 3.06.10 Follow legal requirements for completing prescriptions and refills. 3.06.11 Create and maintain records on medication administration, prescriptions, and refills. 3.06.12 Instruct patients on how to take their medications. 4. Administrative Medical Assisting 4.1 Office Reception 4.01.1 Greet visitors arriving in the medical office. 4.01.2 Conduct emergency triage procedures for new visitors when necessary. 4.01.3 Collect demographic information from patients. 4.01.4 Usher patients into examination rooms. 4.01.5 Answer and direct incoming calls in a professional manner. 4.01.6 Schedule patient’s appointments using common scheduling techniques (e.g., modified wave matrix). 4.01.7 Manage an appointment reminder system. 4.01.8 Process patient’s lab results received from the outside providers. 4.01.9 Inform patients of their test results, as directed by a healthcare provider. 4.01.10 Transmit referrals to the outside providers. 4.02 Medical Record Management 4.02.1 Ensure that patients complete necessary paperwork. 4.02.2 Manage patient’s information in an electronic medical record management system (e.g., use of POMR and SOMR charting systems). 4.02.3 Update patient’s immunization records. * 4.02.4 Obtain medical records from other healthcare facilities (e.g., PAT codes, lab reports). * 4.02.5 File documents using various filing methods (e.g., alphabetically, numerically). 4.02.6 Store patient’s medical records using HIPAA privacy and security rules. 4.02.7 Respond to the requests for release or transfer of patient’s medical records. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  4.02.8 Properly sign out and lock out of the electronic medical record management system. 4.02.9 Document medical errors. 4.03 Patient Care Coordination and Education 4.03.1 Identify the roles of members of a healthcare team. 4.03.2 Coordinate patient care with members of the healthcare team and outside providers. 4.03.3 Provide patients with instructions on self-examination (e.g., breast, testicular). 4.03.4 Educate patients on proper nutrition. 4.03.5 Prepare and maintain informational materials for patients. 4.04 Billing and Insurance 4.04.1 Bill patients for the services performed. 4.04.2 Accept and process payments. 4.04.3 Prepare bank deposits. 4.04.4 Perform daily balancing. 4.04.5 Make collections on delinquent accounts. 4.04.6 Contact insurance carriers for approval of patient procedures. 4.04.7 Verify patient’s insurance coverage. 4.04.8 Prepare insurance claims using correct diagnosis and procedure codes. 4.04.9 Submit insurance claims for reimbursement. 4.04.10 Submit insurance claims as part of an appeal. 4.04.11 Manage CMS and private health insurance claims. * 4.05 Medical Office Management 4.05.1 Open and close the medical office for the day. 4.05.2 Manage the inventory of office supplies. 4.05.3 Manage medical office correspondence (e.g., mail and email). 4.05.4 Follow medical office safety procedures. 4.05.5 Recognize and respond to medical office emergencies. 4.05.6 Maintain office documentation (e.g., Safety Data Sheets (SDS)). AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. 1. Professionalism 1.01 Present a professional appearance and demeanor. Professionalism is behavior based on a body of knowledge and ethical standards to serve the public. The medical assistant’s ethical responsibilities are to admit mistakes, stay within his or her training and legal scope of practice, maintain confidentiality, stay current and uphold the honor of the profession. Some character traits of a competent medical assistant are dependability, honesty, and tolerance. A professional appearance projects competence and increases the patient’s confidence in the medical assistant. Character is closely related to the moral and ethical values of an individual. Medical assistants must arrive at work on time, and not take days off except when an illness or a family emergency arises. Honesty is projected by working within his or her “scope of practice’. Confidentiality, and behaving ethically are musts! Tolerance or a willingness to accept the beliefs and practices of others are other important traits. Tolerance allows the medical assistant to work effectively with co-workers and patients from a variety of religious, ethnic, and cultural backgrounds. 1.02 Act with integrity and respect toward others. Ethics has been a part of medicine since ancient times. These ethics serve as principles in which to guide your career in the medical field. Ethics are based on integrity, responsibility to service and community, respect, self-discipline, and intent to further your career. As a medical assistant, you have a duty to meet reasonable expectations of our patients. This is known as fidelity. Ethics is the knowledge of what is right conduct versus what is wrong conduct. There are also choices involved in ethics which may have more to do with morals. Ethical behavior is never prejudiced or biased. For example, you may have to make a choice regarding a co-worker or even a patient. A co-worker of yours is consistently late. She often asks you to cover for her when she is late. She asks you not to tell and she will return the favor if you are ever going to be late. What would you do? Communication among peers must remain professional and appropriate throughout the workday. Discussions of non-work-related topics should be kept to a minimum and occur only during designated break times. An excellent way to promote communication among your peers is to become active in your local professional organization. Involvement in local community organizations and support groups is also beneficial to promoting you and your profession. Ethics and how you communicate with peers, patients, and others is important to understand to maintain a professional healthcare care as a medical assistant. 1.03 Take responsibility for personal decisions and behavior in the workplace. The cause of stress in the work environment can be caused by not managing tasks, activities or managing schedules efficiently. It requires the medical assistant to have excellent time AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. management skills, setting goals, prioritizing, and analyzing the effectiveness of how time can be used. Not being organized can also cause a lot of stress for the medical assistant. It may be helpful to create a task list. 1.04 Respect individual diversity. Valued diversity in the workplace plays an important role for the medical assistant. Individuals from different cultures may speak a different language, have different ideas on personal space limits. Cultural sensitivity is especially important if communication is going to be effective. Nonverbal communication that is accepted by the sender’s culture, such as smiling, looking straight into the speaker’s eyes, or lightly touching someone’s shoulder to show concern, may create interference if the gesture has a different significant meaning to that culture. The medical assistant should learn as much as possible about cultural or ethical differences, especially for those groups that are frequent patients of the medical practice where the medical assistant works. 1.05 Deal empathetically with concerns of others. The medical workplace can often present scenarios where the medical assistant is required to show empathy towards patients or other medical professionals. Empathy is the ability to understand the feelings and concerns of the other person. Patients will often express feelings or concerns that will need to be addressed with empathy to effectively carry out patient care. 1.06 Manage conflict in a constructive manner. Conflict in the workplace is counterproductive. The following guidelines should assist everyone in minimizing conflicting situations among coworkers and staff: 1. Present with a positive attitude. 2. Be professional at all times. 3. Do NOT feed into negative conversations 4. Do NOT gossip. DO NOT talk about situations that do not involve you. 5. Do NOT assume anything is as it seems. If you do not need to be a part of the situation, walk away. 6. If a conflict with a co-worker cannot be resolved between the two of you, report the situation to your supervisor. 7. Set boundaries for your professional activities. The following guidelines should assist medical assistants and all employees in minimizing conflicting situations with patients: 1. Present with a positive attitude. 2. Remember, most times, anger is not directed at you. It is a reaction to past healthcare experiences and/or life experiences. 3. Be professional at all times. 4. Listen to the patient using active listening skills. Let the patient voice their anger. 5. Validate what the patient is saying. Be empathetic but make no promises to solve the problem. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  6. Using a calm voice and looking at the patient, continue to take care of the patient’s physical and medical needs. 7. Maintain adequate personal space. Give the patient time to refocus their energy towards the reason they are in the office. 8. If you feel threatened by the patient’s anger, leave the room, and ask for assistance. 9. Remember to document the encounter in the patient’s EMR or on the paper chart. 1.07 Pay full attention to others when listening. It is imperative the medical assistant uses active listening while speaking to a patient. Active listening means focusing all the attention on the patient, without thinking of anything else, free of emotions and distractions. Some ways to ensure full attention are: 1. Using eye contact. 2. Sit facing the patient. 3. Avoid a distracting environment, noise, or lack of privacy. 4. Being observant by watching body language, facial expressions, key words. 5. Use relaxed posture when speaking with a patient to ensure a non-threatening environment. 1.08 Ask questions as appropriate to confirm understanding. Different types of questions that are used to gather information from a patient provide the necessary information needed. Using closed questions does not offer much information. Using open-ended questions enables the patient to provide more information and keep the conversation going. Closed questions are questions that give a yes or no response. Example: Do you still have pain? Open-ended questions encourage the patient to provide more information. Example: When did your pain start? Using direct statements is a helpful way to get a response from a patient without feeling questioned. Example: Tell me about your pain. 1.09 Speak clearly and concisely. Being a professional over the phone is a critical part of a medical assistance job. Whether answering a call or placing a call, the medical assistant must demonstrate professionalism in all situations. Professionalism means the medical assistant is too articulate, confident, tactful, empathetic, courteous, and respectful. Active listening and being prepared are important. It is crucial to a non C8 when speaking on the telephone. You should speak clearly and concisely so that the other person can understand what you are saying. Many of the letters of the alphabet sound similar on the telephone. Such as J and G, F or C with F, and M and N. You may need to clarify what the caller by saying. “That is a D as in Delta?” AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Avoid the use of filler words and phrases such as uhm., a., like., and you know. Do not trail off their sentences because that can be perceived as if you are saying., or whatever. Repeat important information such as your appointment is scheduled for January 2nd at 8:00 AM. With Doctor Jones. Speak clearly and concisely. Make sure to pronounce each syllable. If nervous, slow down your speech and concentrate on your words. Avoid talking too much. Refrain from medical jargon when speaking with patients because this makes the message more difficult for them to understand. Remember to never eat, chew gum, or drink when on the telephone. 1.10 Communicate effectively with patients, patients’ families, and healthcare professionals. * When patients arrive, two important things need to occur. First, they need to know where to go and what to do. Second, they need to be greeted as quickly as possible. Every patient has the right to expect courteous treatment in a provider's office, regardless of the patient's economic or social status. The medical assistant must ensure that their greeting is appropriate and does not violate the patient's confidentiality. In facilities where the receptionist is behind sliding glass windows, the environment can appear impersonal to the patient. Although the closed glass windows increase patient privacy, they can also show that the staff and provider are off-limits to the patient. The glass window should be open as much as possible to give the appearance of openness to others. The person sitting at the front reception desk should greet each patient quickly as possible. Some experts say that a person should be greeted within 30 seconds of arriving. If this is not possible, a simple smile and eye contact will help acknowledge the person. Make sure to greet the person verbally as soon as possible. If too much time elapses from the person's entrance to the greeting, the person may feel ignored or unimportant. This can affect the person's perception of the facility and ultimately, the care provided. Patients are sometimes accompanied by a relative or friend. Be cautious if these individuals want to discuss the patient's illness. Avoid a “too casual” attitude such as, “I'm sure there's nothing to worry about.” A show of moderate concern and reassurance that the patient’s well cared for usually take care of the situation. Remember, that health information cannot be released to anyone, including concerned friends and relatives, without the patient’s written consent on the release form. 1.11 Use effective non-verbal communication (e.g., use of own body language, appropriate response to the body language of others). * Non-verbal communication is also known as body language and includes body posture, position, gestures, facial expressions, and intonation. The medical assistant’s body language should be appropriate for the situation. For example, if a patient has just learned of a terminal diagnosis, appropriate body language for this situation would include supportive stance, direct eye contact, and a calm voice. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. Touch is also a form of body language, and when used appropriately it can be therapeutic. Pediatric populations, for example, use different forms of touch such as cuddling infants and hugging children as a normal part of development. Touching may be considered inappropriate in certain cultures. It is always important to seek the patient’s permission prior to touching the patient. 1.12 Use business communication etiquette in speaking and writing (e.g., proper grammar, punctuation, style). As a medical assistant you will have written communication to create a letter to patients or compose a business letter to order supplies, request information, or handle a problem. In addition to using a professional tone, it is important to use proper grammar and correct spelling to convey the information. It is important to respond in a timely manner to written communication. Grammar is a term for the accepted rules to create meaningful sentences in a language. When speaking on the phone always identify yourself to the caller. Convey to the person your undivided attention and willingness to help. Listen without interrupting, provide reasonable alternatives for the caller, and take a clear concise message for the call to be returned. The following steps will ensure proper telephone etiquette: Answer the telephone promptly and kindly. Some offices have a policy that every phone call should be answered by the third ring, and patients should not be immediately placed on hold without speaking to the caller. If the call is placed on hold, the medical assistant should check back with the call every 30 seconds, and always ask for the caller’s permission before being placed on hold. Never allow an angry or aggressive caller to upset you; remain calm and composed. Speak clearly and concisely. 1.13 Provide support to other healthcare professionals when appropriate. * The medical assistant should be available to assist other healthcare professionals when approached: 1. Be ready to support healthcare professionals when approached. 2. Stay within your Scope of Practice. 3. Keep open communication between all parties as needed. 4. Stay updated on all information and procedures associated with the practice. 2. Medical Law and Ethics 2.01 Perform within the scope of practice for a clinical medical assistant. The Clinical Medical Assistant should have knowledge of the following to be able to properly collect specimens: Knowledge of the anatomy and physiology of the integumentary, cardiovascular, musculoskeletal, and nervous systems. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Knowledge of phlebotomy equipment and supplies. Knowledge and skills for performing phlebotomy. Ability to communicate and be understood by patients. Knowledge of legal aspects of performing an invasive procedure. The phlebotomist’s role in transporting specimens includes: Having the correct specimen and lab req/order (if needed). Verifying the patient labels and the lab requisition are for the same patient. Verifying the orders and information on the lab requisition. Understand the requirements for each specimen’s transportation needs. Transporting the specimen(s) according to facility procedures and policies. If transporting the specimen on roadways, following the Department of Transportation’s laws. 2.02 Recognize and respond to ethical and legal issues (e.g., conflict of interest, medication errors, malpractice, negligence). Congress passed the CLIA (Clinical Laboratory Improvement Amendments) which established standards for improving the quality of laboratory testing in the United States. CLIA consists of federal regulations governing all facilities that perform laboratory testing. CLIA regulations established the following three categories of laboratory testing based on the complexity of the testing methods: Waived Tests o A laboratory test that has been determined by HHS to meet the CLIA criteria for being a simple procedure and has low risk for erroneous test results. Waived tests include tests that have been approved by the Food and Drug Administration (FDA) for use for patients at home. Blood glucose testing is an example of a Waive Test. Moderate-Complexity Tests o A Moderate-complexity test is a nonwaived test that is subject to the CLIA 1998 regulations. Most of these tests are performed at hospitals and independent laboratories, and some medical offices. Some examples of Moderate-Complexity tests are urine and throat cultures, hematology, and blood chemistry tests. High-Complexity Tests o High complexity tests are non-waived tests that are subject to the CLIA 1998 regulations. These tests are not completed in medical offices and are performed in laboratories already subject to federal regulations. Some examples of high complexity tests are cytogenetics, histopathology, and cytology tests. A medical assistant does not perform these tests. The Centers for Medicare and Medicaid Services (CMS) AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. CMS is a division of the Department of Health and Human Services. The CMS is responsible for regulating and operating under the CLIA program. In addition to the following CLIA regulations, a clinical laboratory must comply with all other federal, state, and local laboratory regulations. 2.03 Describe the purpose and application of the following legislation in the workplace: CLIA OSHA Standards HIPAA Patient’s Bill of Rights HITECH GINA One of the steps in phlebotomy includes correct identification of the patient in a two-step process. Asking for the patient’s full name and date of birth is the most common way to validate the patient’s identification as mandated by The Joint Commission. Phlebotomy is an invasive procedure that must follow approved and accredited procedures to protect both the patient and the facility. Verifying the patient’s identification BEFORE the procedure and verifying that the labels on the specimens are the patient’s labels/information AFTER the procedure is a 2-step process that protects the patient and the facility. The patient also has the right to refuse to be drawn. When this happens, the phlebotomist MUST document this refusal in the patient’s EMR or paper chart as the EMR and/or paper chart are legal documents. These documents may be used if legal proceedings ensue. Patient Rights Patient’s rights may be legally defined by the state or an institution. The Patient’s Bill of Rights is referred to as the Consumer Bill of Rights and Responsibilities, which was adopted by the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry. This document was created to improve consumer trust in the Health Care System by defining the rights and responsibilities of consumers, health care professionals, health care institutions, and insurance plans. The Patient’s Bill of Right’s varies from state to state. The Medical Assistant and all employees of the medical field must protect the patients’ rights. Patients actively participate in their own health care. The Patient Care Partnership serves as a guide for both patients and their physicians involved in their care. Patient Care Partnership As a patient in XXX Hospital, you have the right, consistent with law, to: Receive treatment without discrimination as to race, color, religion, gender, national origin, disability, or the source of payment. Be informed of the name and position of the doctor who will oversee your care in the hospital. Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask. Refuse treatment, examination, or observation, if retired or a family member, and be told what effect this may have on your health. Privacy while in the hospital and confidentiality of all information and records regarding your care. Review your medical record without charge. Obtain a copy of your medical record for which the hospital can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay. Complain without fears of reprisals about the care and services you are receiving and to have the hospital respond to you; and if requested, a written response. If you are not satisfied with the hospital's response, you can complain to the Patient Representative Office located here in the hospital. Receive information about pain and pain relief measures, be involved in pain management plans, and receive a quick response to reports of pain. The right to request information about advance directives regarding your decisions about medical care. Make known your wishes regarding anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the hospital. Understand and use these rights. If for any reason you do not understand or you need help, the hospital will attempt to help, including an interpreter. A patient may also have a document that expresses his or her wishes in case of terminal illness or an accident after which they cannot express their wishes. This document is called a Living Will. 2.04 Comply with the following legislation in the workplace: CLIA OSHA Standards HIPAA Patient’s Bill of Rights HITECH GINA Safety measures are an important component of the laboratory. Laboratory testing involves the collection and handling of specimens that may contain pathogens. In addition, laboratory testing includes the use of hazardous chemical reagents. It is important that safety measures for equipment, supplies, and the emergency devices be available and readily accessible in the laboratory. It is the responsibility of the Medical Assistant to know where to find the laboratory’s policies and procedures for maintaining the safety of the Laboratory. It is imperative that the Medical Assistant complies with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard and review the Safety Data Sheet (SDS)for the chemical reagent before using it. Preventing Infection Infection is a major threat and health hazard in all our health care facilities. Everyone is at risk and prevention of that risk is an important part of everyone’s job description. The primary goal of an infection control program is to prevent the spread of infection in a health care facility. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  AIDS o AIDS stands for acquired immunodeficiency syndrome and is caused by a virus called human immunodeficiency virus. Most exposures to HIV in healthcare settings are the result of accidental needle sticks. AIDS is transmitted by blood, vaginal fluids, and semen and is not spread through casual contact. AIDS also may be transmitted through the blood of an infected person that enters another person’s bloodstream through a cut, an open sore, or blood that is splashed into the mouth or the eye. Thus, appropriate personal protective equipment must be worn when one is encountering body fluids from all patients. Hepatitis B o This disease is caused by an inflammation of the liver that is caused by the hepatitis b virus, also known as HBV. Since health care providers are at risk for exposure, it is essential for standard blood and body fluid precautions to be practiced. The Occupational and Safety Health Administration states that employers must provide the hepatitis B vaccine for all employees who have an occupational employer risk. Tuberculosis o This disease is caused by Mycobacterium tuberculosis, an airborne pathogen. Health care workers that encounter patients who have tuberculosis must wear personal protective equipment, such as special fitted masks. Nosocomial infections o Any infection that first occurs during a patient’s stay at a health-care facility, regardless of whether it is detected during the stay or after, is known as a nosocomial infection. These infections are usually transmitted to the patient by a health care worker. Proper hand washing techniques are the best method of preventing the spread of nosocomial infection. Learning how to put on and remove protective clothing is vital to ensure the health and wellness of the person wearing the PPE. PPE ‘s or personal protective equipment include: o Masks o Goggles o Face Shields o Respirator Standard Precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are to be used when providing care to all individuals, whether they appear infectious or symptomatic. The standard precautions are: o Consider every person (patient or staff) as potentially infectious and susceptible to infection. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  o Wash hands—the most important procedure for preventing cross-contamination (person to person or contaminated object to person). o Wear gloves (both hands) before touching anything wet—broken skin, mucous membranes, blood or other body fluids, or soiled instruments and contaminated waste materials—or before performing invasive procedures. Transmission-Based Precautions The second tier of precautions is to be used when the patient is known or suspected of being infected with contagious disease. They are to be used in addition to standard precautions. In all situations, whether used alone or in combination, using the utmost care regarding patient and employee is crucial. Transmission based precautions are contact precautions, airborne precautions, and droplet precautions. Contact Precautions Infectious agents (bacteria, viruses, or parasites) transmitted directly or indirectly from one infected or colonized person to a susceptible host (patient), often on the contaminated hands of a health worker. The following precautions should be taken: Wear clean, non-sterile examination gloves when entering the room. Change gloves after contact with infective material (e.g., fecal materials or wound drainage). Remove gloves before leaving the patient's room. Wash hands with antibacterial agent or use alcohol-based hand-rub after removing gloves. Do not touch potentially contaminated surfaces or items before leaving the room. Infection transmission can occur from touching contaminated clothing or linens – considered direct contact. Airborne Precautions These precautions are designed to reduce the nosocomial transmission of particles 0.001mm or less in size that can remain in the air for several hours and be widely dispersed. Special air handling and ventilation are required to prevent airborne transmission. Droplet Precautions These precautions reduce the risks for nosocomial transmission of pathogens spread wholly or partly by droplets larger than 0.001 mm in size. Pathogens are microbes that can cause disease. Droplet precautions are simpler than airborne precautions because the particles only remain in the air for a short time and travel only a few feet; therefore, contact with the source must be close for a susceptible host to become infected. It is recommended to wear a mask when interacting with patients to reduce the incidence of infection. The Hazard Communication Standard (HCS) is a requirement by OSHA to ensure that all employees are informed of the hazards associated with chemicals in their workplace. Employers are required to develop a hazard communication program. The HCS is a written plan that describes what the facility is doing to meet the requirements of the HCS program. The information must be made available and communicated to all employees who work with hazardous chemicals. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. The Employer must comply with the following: Inventory of Hazardous Chemicals Labeling of Hazardous Chemicals Container Label Requirements Safety Data Sheets Employee information and training Do not Offer Medical Advice As a medical assistant, you must never lose sight of what advice you are and are not qualified to give. You will spend lots of time with patients, often without doctors or nurses nearby, and may be tempted to answer their questions on your own. Do not! You might give them the wrong advice. You can offer comfort and help explain what a doctor or nurse has said to the patient, but do not provide medical recommendations. Instead, direct them to the attending physician. If you have any doubt about your qualifications to answer a patient’s question, find someone who will know the right answer. Sterilize With Care One of your duties will be to hand physicians and nurses the equipment that they need to treat patients. But used or poorly prepared equipment can spread serious diseases from previous patients. That is why it is essential that you follow proper cleaning procedures. Obey all the instructions in the letter when sterilizing equipment, and make sure to dispose of any devices that are broken or can only be used once. Even minor contamination can create serious risks for patients. Disposing of Waste Get rid of contaminated or dangerous items left over when the procedure ends. To do this, you must: Place used needles and other sharp objects pointy end first into specialized sharps containers. Get rid of waste disposal containers when they are three-fourths of the way full. Always keep used containers and medical waste away from patients. Always follow your facility and community’s official guidelines for waste disposal. Take Accurate Info Accurate medical history is vital to a patient's safety. Whenever you fill out an official form or enter something in a database, make sure to write legibly and include all the relevant details. If you have any doubts about what you entered, consult a physician to ensure that you did not leave anything out. Failing to AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  report patients’ symptoms, medical histories, and test results may lead the hospital to prescribe the wrong treatment or overlook a serious illness. Reliable records are crucial to your patients’ safety. Follow All Procedures Depending on local laws and the attending physician’s discretion, you may have to administer medications. You must follow all the protocols your physician gives you in the letter. Measure the medication exactly and give the correct dosage at the appropriate intervals. Even a small mistake could make the treatment ineffective or dangerous to the patient. Confidentiality of patient information is a vital ethical principle that needs to be observed by a medical assistant. Information obtained in the care of a patient must be obtained in the care of the patient and may not be revealed without the permission of the patient unless required by law. Whatever you say to, hear from, or do for a patient is confidential. HIPAA Security Rules HIPAA requires the usage of password protection on all electronic devices used to access patient information. If you work in a reception area that is visible to patients, it is important that your computer is positioned in a manner that does not reveal information to patients that may be standing close to your desk. Any information given by a patient to medical personnel that cannot be disclosed is known as privileged communication. HIPAA has allowed patients to have more control over their medical records, patients can make better- educated choices and most importantly the boundaries on patient information are strict and concise. Acknowledging the Notice of Privacy Practices is also kept on file assuring that the patient has read and understands how the provider will keep the patient’s information private. people. Tort is a wrong committed against a person or the person’s property. Torts may be intentional or unintentional. Negligence is an unintentional wrong. Malpractice is negligence by a professional person (unintentional) Intentional torts are acts that are meant to be harmful. Defamation is injuring a person’s name and reputation by making false statements to a third person Libel means making false statements in print, writing or through pictures Slander is making false statements orally Invasion of privacy is violating a person’s right not to have his or her private affairs exposed Fraud is saying or doing something to trick, fool or deceive a person. Assault is intentionally attempting to touch or threaten a person’s body without their consent Battery is touching a person’s body without their consent. Informed Consent is when the person clearly understands what is going to be done. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  Abandonment is when a provider withdraws from the care of a patient without reasonable notice of discharge Two types of civil actions – lack of informed consent and violation of standard of care Patient Preparation and Encounters As a medical assistant you may be responsible for various duties in the office including triage of patients, consent forms, preparing third party information, taking the patient’s vital signs, and updating medical charts. Implied Consent o agreement implied by the patient for examination and treatment when presenting for a routine visit; also, in an emergency consent that is assumed the patient would give if the patient could do so. Informed Consent o consent that is given by the patient after all potential treatment and outcomes have been discussed for a specific medical condition, including risks and possible negative outcomes. Triage o sorting and setting priorities for treatment for patients who are on the phone or at the reception desk. Sign o that which can be seen, heard, measured, or felt by the examiner. Symptom o a perceptible change in the body related to the patient. 2.05 Obtain patient’s consent when appropriate. Legal medical types of consent: 1. Implied consent – when a patient makes an appointment for a visit 2. Expressed consent – verbal/spoken approval by the patient 3. Informed consent – involves the patient’s right to receive and understand all information relative to a/any specific procedure the patient will undergo at the hands of a licensed practitioner. This includes, a. Risks involved b. Why the procedure is necessary c. Proposed treatment applications d. Alternative modes of treatment and the risks involved e. Risk to patient if treatment is refused 2.06 Explain the concept of advanced directives to patients when appropriate. Advanced directives are legal documents which indicate the patient’s choice for medical care and treatment in the event the patient is unable to make those decisions. An advanced directive is completed when a patient is alert, fully aware of his/her wishes. The advanced directive will provide instructions should the patient not be able to voice their choice in AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. treatment. An advanced directive provides specific medical treatments to be followed, such as a breathing tube, feeding tubes, medications, and other medical treatments and care. 3. Clinical Medical Assisting 3.01 Infection Control 3.01.1 Perform hand hygiene (e.g., handwashing, alcohol-based hand rub). Handwashing Hand washing is the most important means of preventing the spread of infection. A routine hand wash procedure uses plain soap to remove soil and transient bacteria. Hand antisepsis requires the use of antimicrobial soap to remove, kill or inhibit transient microorganisms. It is important that all healthcare personnel learn proper hand washing procedures. Washing hands for 1 to 2 minutes is the proper amount of time. The CDC hand hygiene guidelines recommend that handwashing be performed when hands are visibly soiled with dirt or body fluids, before eating, and after using the restrooms. If hands are not visible soiled, the CDC recommends alcohol-based hand rub instead of handwashing due to over handwashing drying out the hands, leading to irritation, chapping, and dermatitis. 3.01.2 Use PPE appropriately. Barrier Protection Protective clothing provides a barrier against infection. Used properly, it will provide protection to the person wearing it; disposed of properly it will assist in the spread of infection. Learning how to put on and remove protective clothing is vital to ensure the health and wellness of the person wearing the PPE. PPE ‘s or personal protective equipment include: Masks/Face Shields/Goggles –wear whenever there is a potential for splashes, sprays, splatter, or droplet of blood that may be generated and pose a hazard through contact with the eyes, nose, and mouth. Respirator – wear when you are potentially exposed to any airborne disease Gowns/Aprons/Laboratory Coats- should be worn when there is anticipated contact with gross contamination. The type of protective clothing depends on the task and degree of exposure anticipated. Gloves- wear when it is anticipated that your hands will have contact with blood, mucous membranes or nonintact skin. Gloves cannot prevent needlesticks or other sharps injury, but they can prevent pathogens from entering the body through cuts, abrasions, or any open skin on the hands. 3.01.3 Use respiratory hygiene and cough etiquette as required. Content Coming Soon… 3.01.4 Use safe injection practices. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. The federal government established OSHA (Occupational Safety and Health Administration) to assist employers in providing a safe and healthy working environment for their employees. OSHA developed the Bloodborne Pathogens Standard, which must be followed by any employee with occupational exposure to pathogens. These regulations went into effect in 1992 to reduce the risk of exposure to employees exposed to infectious diseases. Failure by employees to comply with the OSHA standard could result in a citation. 3.01.5 Clean medical instruments and equipment (e.g., order of cleaning, types of cleaning products). For stainless steel, glass, and other metal items: 1. Placed soiled reusable instruments in a container or sink 2. Put on properly fitting intact utility gloves. 3. Separate sharp-edged and pointed equipment from others and place in a separate container. 4. Soak equipment in the manufacturer’s recommended disinfectant or detergent solution 5. To begin the cleaning process, rinse each piece of equipment in hot, running water, cleaning only one piece of equipment at a time. 6. Scrub the item using hot, soapy water and a plastic scrub brush. 7. Use a low-sudsing neutral-pH detergent specially formulated to dissolve blood and blood products for medical instruments and equipment. 8. Be sure to clean all areas that have hinges, ratchets, and other hidden places. 9. When finished cleaning, rinse in hot water and place on a clean towel. 10. Roll the instrument in the towel to remove moisture, dry thoroughly. 11. Make sure the instrument is in perfect working order and all surfaces are clean. 12. Instruments that only need sanitizing can be returned to clean bins. 13. Wrap items that need disinfection and sterilization in a clean covering for later processing. For plastic and rubber items: To sanitize these items, only a short amount of time in cleaning solution may be required or no time. Follow manufacturer’s requirements for these items. Ultrasonic cleaning is used for delicate items and those with moving parts. Sound waves move through the cleaning solution to clean the item. The order for cleaning products varies from practice to practice depending on the instruments used. Consult the office manuals for specific instructions. 3.01.6 Disinfect medical instruments and equipment (e.g., types of disinfectants). AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. Disinfection is a technique used to destroy many but not all pathogenic organisms such as spores. Caustic chemicals are used to disinfect medical equipment that is not able to be autoclaved. Instruments and equipment that are disinfected are used externally such as stethoscopes, reflex hammer, or visual occlude. Types of disinfectants include: - Sodium Hypochlorite (Household bleach 1:10 solution) - Alcohol - Iodophors - Glutaraldehyde - Formaldehyde Equipment must be sanitized and dried prior to disinfection. Failure to dry the equipment will result in suboptimal concentration of disinfectant which reduces its efficacy. 3.01.7 Sterilize medical instruments and equipment (e.g., autoclaving) Medical Asepsis Asepsis is being free of disease-producing microbes. Microbes are everywhere. Medical asepsis is the practice of removing or destroying pathogens and to prevent pathogens from spreading from one person or place to another. Surgical Asepsis It is the practice that keeps items free of all microbes. Sterilization is the process of destroying all microbes. Contamination is the process of becoming unclean. Disinfection is the process of destroying pathogens. Germicides are disinfectants applied to the skin, tissues, and non-living objects. Sanitization, Disinfection and Sterilization Sanitization is the scrubbing of instruments with special brushes and detergent to remove blood, mucous, etc. Disinfection is the process that destroys pathogenic micro-organisms. Common disinfectants are chemical germicides, household bleach, boiling water, and steam. Sterilization is the process of destroying all microbial forms of life – typically an autoclave is used for this along with distilled water. An autoclave is a device that forces the temperature of steam above the boiling point of water to sterilize instruments and equipment. Most microorganisms are killed in a few minutes at temperatures ranging from 130° C to 150° C. The following step are used when operating the autoclave: 1. Wrap sanitized and disinfected instruments and equipment and label each packet with date, time, name of instrument, and initials. 2. Perform quality control procedures. 3. Load the wrapped instruments into the autoclave allowing adequate space for the steam to be able to sterilize the packs properly. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  4. Set the autoclave for the required time, 20- 40 minutes, depending on how tightly the instruments are wrapped. Water temperature must be 212° F, and steam temperature must be 250°F to 254°F. 5. Run the autoclave through the cycle, making sure the door is opened at the end of the cycle to allow drying time for the packs in the autoclave. Packets must be dry before removing and storing them. 6. Remove wrapped instruments from the autoclave and store them in a clean dry area. Sterilized packets should be stored in reverse chronological order, as. sterilized packets are only good for 30 days. 3.01.8 Clean and disinfect an examination room with the appropriate disinfectant. The following procedure should be completed at the beginning and end of the day and after every patient uses the exam room: 1. Wash hands and don exam gloves. 2. Dispose of all used paper products in the biohazard waste container. (The rationale for this is that you do not know what microbial pathogens may be on the paper). 3. Gather disposable instruments and place in biohazard trash and/or the sharps biohazard container. 4. Gather reusable instruments and place in stainless steel tray with the correct disinfect and cover for transport to the appropriate cleaning processing area. 5. Using disinfectant wipes (or paper towels and liquid disinfectant), wipe down all surfaces in the room including the exam table, all equipment used such as blood pressure cuffs, otoscope, reflex hammer, etc. Wipe down the counters and sink areas. Wipe down the door handle as well. When finished, throw the disinfectant wipes (or paper towels) into the biohazard trash. 6. Dispose of exam gloves, wash hands, and don clean exam gloves. 7. Replace protective coverings such as table paper and coverings for instruments. 8. If using 10% bleach solution for any procedures, be sure to check daily and replace as needed. 9. Record each room cleaning on the appropriate documentation log. 3.01.9 Follow the CDC Transmission-based Precautions. Medical asepsis and infection control are crucial in preventing the spread of disease. Medical Asepsis means that an object or area is free from disease producing microorganisms. Practices must be employed to inhibit the growth of hinder the transmission of pathogenic microorganisms to prevent the spread of infection. Microorganisms are tiny living plants or animals that cannot been seen by the naked eye. Some microorganisms are bacteria, viruses, protozoa, fungi, and animal parasites. Infection is a condition in which the body is invaded by a pathogen. A pathogen is a disease producing microorganism. For a pathogen to survive and produce disease, the infection process cycle must be followed. If the cycle is broken at any point, the pathogen dies. It is the responsibility of the medical assistant to help break this cycle. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. The Modes of Transmission Direct contact -occurs through skin-to-skin contact, kissing, and sexual intercourse. Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors). Airborne transmission- occurs when infectious agents are carried by dust or droplet suspended in air. Airborne dust includes material that has settled on surfaces and become resuspended by air currents as well as infectious particles blown from the soil by the wind. Vectors - mosquitoes, fleas, and ticks may carry an infectious agent through purely mechanical means or may support growth or changes in the agent and transmit to a human being. Droplet spread- refers to spray with large, short-range aerosols produced by sneezing, coughing, or even talking. Droplet spread is classified as direct because transmission is by direct spray over a few feet before the droplets fall to the ground. Vehicles - include food, water, biological products (blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels). A vehicle may passively carry a pathogen. The vehicle may provide an environment in which the agent grows, multiplies, or produces toxin. Methods for preventing the modes of Transmission Hand Hygiene - refers to the process of cleansing or sanitizing the hands. Hand hygiene is considered the most important medical aseptic practice for preventing the spread of infection. Hand hygiene is considered the most important medical asepsis practice. Antiseptic handwashing is washing the hands with an antimicrobial soap. Antimicrobial soap contains an antiseptic. Antiseptic is an agent that functions to kill or inhibit the growth of microorganisms. Wash hands with plain soap or an antimicrobial soap when: The hands are visibly soiled with dirt or body fluids. Before eating. After using the restroom Apply an Alcohol-based hand rub: Before having direct patient contact. After contact with a patient’s intact skin Before applying or after removing gloves After contact with body fluids, non-intact skin, wound dressings. (If the hands are not visibly soiled) When moving a contaminated body site to a clean body site during patient care. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  After contact with an inanimate object like medical equipment. Personal Protective Equipment The OSHA standard specifies that PPE must be used. PPE is clothing or equipment that protects an individual from contact with blood or OPIM, such as: gloves, chin length face shields, masks, protective eyewear, laboratory coats, and gowns. The appropriate type of protection depends on the degree of exposure that is anticipated. Gloves: Gloves are worn when it is anticipated that your hands will encounter blood and OPIM, mucous membranes, or nonintact skin. Gloves can prevent a pathogen entering the body through a break in the skin, abrasion, burn, or rash. Chin-length face shields or masks in combination with eye-protection devices are worn whenever splashes, spray, spatter, or droplets of blood are anticipated. Gowns are worn when gross contamination can be anticipated during performance of a task or procedure. Isolation Precautions The CDC recommended universal precautions, which is a method of infection control that assumed that all human blood and body fluids were potentially infectious. The CDC issued a revised guideline consisting of two tiers or levels of precautions: Standard Precautions and Transmission-Based Precautions. These are outlined below. Standard Precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are to be used when providing care to all individuals, whether they appear infectious or symptomatic or not. Transmission- Based Precautions The second tier of precautions is to be used when the patient is known or suspected of being infected with contagious disease. They are to be used in addition to standard precautions. In all situations, whether used alone or in combination, using the utmost care regarding patient and employee is crucial. Contact precautions Infectious agents (bacteria, virus, or parasite) transmitted directly or indirectly from one infected or colonized person to a susceptible host (patient), often on the contaminated hands of a health worker. The following precautions should be taken: o Wear clean, non-sterile examination gloves when entering the room. Change gloves after contact with infective material (e.g., fecal materials or wound AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  drainage). Wash hands with antibacterial agent or use alcohol-based hand-rub after removing gloves. Do not touch potentially contaminated surfaces or items before leaving the room. Airborne precautions These precautions are designed to reduce the nosocomial transmission of particles 0.001mm or less in size that can remain in the air for several hours and be widely dispersed. Special air handling and ventilation are required to prevent airborne transmission. Droplet precautions These precautions reduce the risks for nosocomial transmission of pathogens spread wholly or partly by droplets larger than 0.001 mm in size. Pathogens are microbes that can cause disease. Droplet precautions are simpler than airborne precautions because the particles only remain in the air for a short time and travel only a few feet; therefore, contact with the source must be close for a susceptible host to become infected. It is recommended to wear a mask when interacting with patients to reduce the incidence of infection 3.1.10 Explain how to prevent the spread of nosocomial infection in a hospital setting or a clinic. Preventing Infection Infection is a major threat and health hazard in all our health care facilities. Everyone is at risk and prevention of that risk is an important part of everyone’s job description. The primary goal of an infection control program is to prevent the spread of infection in a health care facility. AIDS - AIDS stands for acquired immunodeficiency syndrome and is caused by a virus called human immunodeficiency virus. Most exposures to HIV in healthcare settings are the result of accidental needle sticks. AIDS is transmitted by blood, vaginal fluids, and semen and is not spread through casual contact. AIDS also may be transmitted through the blood of an infected person that enters another person’s bloodstream through a cut, an open sore, or blood that is splashed into the mouth or the eye. Thus, appropriate personal protective equipment must be worn when one is encountering bodily fluids from all patients. Hepatitis B - This disease is caused by an inflammation of the liver that is caused by the hepatitis b virus, also known as HBV. Since health care providers are at risk for exposure, it is essential for standard blood and body fluid precautions to be practiced. The Occupational and Safety Health Administration states that employers must provide the hepatitis B vaccine for all employees who have an occupational employer risk. Hepatitis C- This infection is of the liver that is caused by HCV. No vaccine is available for the prevention of Hepatitis C. The most common way to encounter Hepatitis C is through AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  needle sticks and other sharps injuries. The chance of contracting hepatitis C is much lower than contracting hepatitis. Personal protective equipment must be worn when encountering a patient with HCV. Tuberculosis - This disease is caused by Mycobacterium tuberculosis, an airborne pathogen. Health care workers that encounter patients who have tuberculosis must wear personal protective equipment, such as special fitted masks. Nosocomial infections - Any infection that first occurs during a patient’s stay at a health-care facility, regardless of whether it is detected during the stay or after, is known as a nosocomial infection. These infections are usually transmitted to the patient by a health care worker. Proper hand washing techniques are the best method of preventing the spread of nosocomial infection. 3.1.11 Dispose of the used syringes, needles, and other sharps items correctly. The procedure for disposing of used syringes, needles, and other sharps items is as follows: Always wash hands and don exam gloves before giving patient care. Make sure there is a biohazard sharps container close to where you are performing patient care. FOR NEEDLES AND SYRINGES: 1. As soon as the injection is complete, slide the safety sheath over the needle and drop the needle/syringe into the biohazard sharps container. 2. NEVER RECAP THE NEEDLE! 3. If there is not a safety sheathing mechanism on the syringe, place the sharps into the biohazard container by holding the barrel of the syringe with the needle pointing away from you. Drop into biohazard sharps container. FOR GLASS MATERIALS: 1. Place all used glass slides into the sharps container by carefully holding the slide by the edges. 2. Broken glass tubes should be placed in the biohazard sharp’s container as well. Be sure to handle the broken biohazard glass material in a safe manner when placing it into the biohazard sharps container. 3. NEVER fill the sharps container past the fill line on the container. 4. NEVER shake the sharps container to make more room for sharps. 5. When the sharps container is filled to the fill line, snap the lid closed and place in the designated area for biohazard materials collections. 3.1.12 Properly label the biohazard material (e.g., bodily fluids, sharps). AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. The OSHA Bloodborne Pathogens Standard requires that containers and appliances containing biohazard materials be labeled with a biohazard warning label. The biohazard warning label must be fluorescent orange or orange red and must contain the biohazard symbol and the word BIOHAZARD in a contrasting color. Warning labels must be attached to the following containers of regulated waste: Containers of regular waste. Refrigerators and freezers used to store blood and OPIM Containers and bags used to store, transport, or ship blood or OPIM Reg bags or red containers can be substituted with biohazard warning labels. The labeling requirement is designed to alert employees to exposure, particularly in situations when the contents are not easily identified as blood or OPIM. 3.1.13 Properly handle and dispose of biohazard material. Hazardous Substances A hazardous substance is any chemical in the workplace that can cause harm. The Occupational Safety and Health Administration (OSHA) require that health care employees: Understand the risks when dealing with such substances and know how to handle them safely. Labeling is extremely important when handling any substance in the hazardous material area. Bags, barrels, cans, cylinders, drums, and storage tanks all need labels identifying handling instructions.0‘] Every hazardous substance has a material safety data sheet. It provides detailed information about the substance – general and emergency information. The following are symbols that will be familiar in a health care facility: Biohazard Symbol Poison Symbol Toxic Symbol AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. 3.02 Electrocardiography Testing 3.02.1 Prepare an ECG machine for testing (e.g., loading of ECG paper, patient data entry). Content Coming Soon… 3.02.2 Explain an ECG testing procedure to patients. Interpreting Waveforms The results of the electrocardiogram are printed on a special graph paper which travels through the electrocardiogram at a rate of about 25 millimeters per second. The graph paper has both horizontal and vertical lines which serve to divide the paper into squares that are 5 millimeters in width and height. The horizontal line measures time, while the vertical line measures amplitude or voltage. The isoelectric line is a term used to describe a straight line on the ECG strip with illustrates the resting state of the myocardial cells. The isoelectric line represents the beginning and ending point of the five major waves of the cardiac cycle. ECG LEADS VLL – Left leg between hip and ankle VRL – Right leg between hip and ankle VLA – Left upper arm VRA – Right upper arm Chest or Precordial Leads V1: Records electrical activity between the center of heart and the chest wall where V1 electrode is placed V2: Records electrical activity between the center of heart and the chest wall where V2 electrode is placed V3: Records electrical activity between the center of heart and the chest wall where V3 electrode is placed V4: Records electrical activity between the center of heart and the chest wall where V4 electrode is placed V5: Records electrical activity between the center of heart and the chest wall where V5 electrode is placed V6: Records electrical activity between the center of heart and the chest wall where V6 electrode is placed AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. Standard 12-lead ECG electrode placement 3.02.3 Prepare and position patients for ECG testing. Patient education is important when preparing the patient for an EKG. 1. Introduce yourself to the patient. Stress that privacy will be maintained. 2. Verify patient identification asking for two identifiers. 3. Explain the procedure in easy-to-understand terms for the patient. 4. Ask the patient if they have any questions or concerns about the EKG procedure. Speak calmly and professionally. 5. Information will be asked of the patient and entered into the EKG machine. 6. Explain the procedure as follows: a. You will remove all clothing and jewelry from your waist to your chin. You will be given a gown to put on without tying it in the back. b. Next, you will lie down on the exam table on your back. c. Gel tabs will be placed on your legs, then arms and then your chest. d. Next, small leads will be attached to the gel tabs. e. You will be instructed not to talk or move during the tracing. f. The technician will tell you when the tracing begins. g. The technician will tell you when the tracing is over. h. The technician will cover your chest area. I. Once the provider has approved of the EKG, if necessary, the leads and gel tabs will be removed, and you will be able to get dressed and leave. Answer any questions the patient may have after the EKG is finished. Remember, you CAN NOT interpret nor discuss the tracing in any way. That is outside of the medical assistant’s Scope of Practice. If asked, inform them that the provider will discuss the EKG with them. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. 3.02.4 Ensure proper placement of electrodes for an ECG. Content Coming Soon… 3.02.5 Obtain an ECG on patients. Conduction System of the Heart The heart consists of four layers: the pericardium, the layer or sac that surrounds the heart; the myocardium; the middle layer; the endocardium, the innermost layer and the epicardium which is the top layer. Located within the myocardium is the electrical conduction system. This is the system responsible for the regulation of the pumping action of the heart, as well as the conduction of the electrical impulses that causes the myocardium to contract. Cardiac depolarization and repolarization occur when these electrical impulses develop and spread through the myocardium. The rate and rhythm of the heart are controlled by pacemaker cells, an essential part of the conduction system. These cells, also known as cardiac muscle cells, can be characterized by any of the following terms: excitability, conductivity, contractility, and automaticity. Regulation of the heart rate, speed of electrical conduction and strength of contraction are influenced by the brain via the autonomic nervous system. The electrical flow through the heart is as follows: 1. Sinoatrial node (SA Node) – The Sino-atrial node begins the electrical activity of the heart. It is in the wall of the right atrium and generates an impulse that flows to the atrioventricular node. The SA node is also known as the natural pacemaker of the heart because it generates the heart's rhythmic contractions. 2. Atrioventricular node (AV node) - This node is located between the atria, just above the ventricles. After the impulse reaches the AV node, the atria contracts and the impulse is then sent to the Bundle of HIS. 3. Bundle of HIS – This structure, also known as atrioventricular, AV bundle, is located between the ventricles and splits into two branches, forming the right and left bundle branches, before sending the impulse to the Purkinje fibers. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  4. Purkinje fibers – These fibers are in the walls of the ventricles. As the impulse flows through the Purkinje fibers, it causes the ventricles to contract. 1. Instruct the patient to remove all clothing and jewelry from the waste on up and put a gown on. 2. Instruct patient to lie on back on exam table. 1. Ensure patient privacy. 3. Enter patient information into EKG machine. 4. Remove gown. 5. Remove chest hair if necessary and clean any area that may need it. 6. Place gel tabs on all areas then the leads. 7. Place gel tabs and leads on patient beginning with the calf/fleshy area of legs, VRL, VLL, and arms, VRA, VRA, in the fleshy area of the shoulder. 8. Place precordial tabs/leads as follows: i. V1 – 4th intercostal space to the right of the sternum. ii. V2 – 4th intercostal space to the left of the sternum. iii. V4 – 5th intercostal space on the right in line with the midclavicular area. iv. V3 – midway between V2 and V4. v. V6 – 5th intercostal space directly below the armpit/midaxillary line. vi. V5 – 5 intercostal spaces between V4 and V6. 9. Before beginning the recording, instruct patient to lie still without talking. 10. Begin recording. 11. End recording. 12. Cover patient. 13. Look at EKG tracing. 14. Check for artifacts. If noted, repeat tracing. 15. Cover patient. 16. If any anomalies are noted, give the reading to the provider, and wait for further instructions. 17. Once the provider approves the EKG, remove gel tabs and leads and instruct patient to dress. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. 18. Dismiss patient to reception desk for further information. 19. Document the procedure in EMR or paper chart. 3.02.6 Adjust an ECG testing procedure to patients with special considerations (e.g., elderly people, children, and people with special needs). Follow the procedure in section 3.02.05. Add the following: Be aware of the specific needs of the patient. For the elderly: 1. Be aware that their skin may be fragile so place the tab electrodes gently. When removing tabs, be careful to remove the tabs slowly and gently. 2. Assist the patient with lying down and rising if needed. For patients with limited cognitive abilities: 1. Show the patient the leads and the ‘sticky’ tab electrodes and let them touch them if this helps them to understand and allay their fears. 2. Explain each step of the procedure to the patient and their companion/parent. 3. Place tabs and leads in the recommended order. 4. Explain to the patient that it is particularly important that they lay still (as if they are sleeping for just a moment, if appropriate). 5. Record the EKG. 6. When finished, remove the leads and tabs. For children: 7. Show the patient the leads and the ‘sticky’ tab electrodes and let them touch them if this helps them to understand and allay their fears. 8. Explain each step of the procedure to the patient and their companion/parent. 9. Place tabs and leads in the recommended order. 10. Explain to the patient that it is particularly important that they lay still (as if they are sleeping for just a moment, if appropriate). 11. Record the EKG. 12. When finished, remove the leads and tabs. For patients with missing limbs: 1. For amputees with below the knee(s) amputations, place the tab/leads on the thigh near the hip. 2. For amputees with full leg amputation(s), place the leads on the lower abdomen. 3. For amputees with arm amputations, place the lead in the shoulder area. 3.02.7 Identify and troubleshoot common causes of artifacts and recording errors. Artifacts on the EKG tracing are erroneous lines/squiggles that are not part of the electrical conductivity of the heart and may interfere with the heart tracings. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. Below are some of the more common types of artifacts that may be found on an EKG tracing. POSSIBLE EKG ARTIFACTS and CORRECTIVE MEASURES Problem Possible Causes Solutions Wandering baseline Poor skin preparation Repeat skin preparation and lead placement Loose electrode Reapply electrode Improper electrode placement Reapply electrode Somatic interference Help the patient relax and be comfortable. May be caused by neuro-motor condition such as Parkinson’s Disease. Wait for the tremor to stop. Pickup of breathing movement Reposition electrode Tension on electrode Drape wires over patient’s lower abdominal area Flat line Detached /loose wire or cable Reattach wires and cables Crossed wires Check – replace broken Short circuit in wires equipment – reposition wires Check pulse, respirations, begin Cardiac arrest CPR Marks not part of Careless handling Handle carefully tracing Use of paper clips Use a rubber band Wet hands Ensure the hands are dry Uniform, small spikes AC interference Turn off/unplug other electrical equipment: remove patient’s watch; remove cell phones from room Improper electrode placement Reapply electrode Inadequate grounding Check and apply proper grounding Clean and reapply electrode Dirty electrode Large, erratic spikes Somatic interference Help patient relax; wait for tremor to subside Loose/dry electrode Reapply electrode; use new gel tab 3.02.8 Connect patients to a Holter monitor. * Procedure for Holter Monitor use: 1. Identify the patient and introduce yourself. 2. Verify the patient identification by asking for 2 identifiers. AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©.  3 Explain the procedure 4. Instruct the patient to remove all clothing above the waist including jewelry. Provide a drape as needed. 5. Wash your hands and put on gloves. 6. Assemble all needed equipment. 7. Clean chest of chest hair if needed per facility protocol. 8. Clean all electrode pads with alcohol and dry well with gauze. 9. Attach wires to the electrodes. Peel off the backing on electrodes. 10. Place electrodes at correct locations per manufacturer’s instructions. 11. Attach patient cable. 12. Insert a new battery and position the unit. 13. Tape wires, cables and electrodes as needed to avoid tension during patient movement. 14. Insert the microchip or cassette and turn on the unit. Watch for activity. 15. Indicate the start time in the patients EMR. 16. Instruct the patient on use of the monitor and writing in the journal. Write exactly what is happening at the specific time. 17. Schedule the return visit per protocol. Document the encounter in EMR. 18. Upon the patient’s return, wash hands, don gloves, remove all equipment , dispose of electrodes, and clean unit. 19. Wash hands. 20. Transfer data as necessary to EMR. 21. Document the encounter in EMR or in paper chart. 22. Dismiss patient to reception area. 3.03 Collecting Specimens and Diagnostic Testing AMCA Clinical Medical Assistant National Certification Exam (CMAC) Study Guide This document is the property of the American Medical Certification Association (AMCA). The document and any of its contents cannot be reproduced, shared, or disseminated for any reason without the written consent from the AMCA©. 3.03.1 Verify the details of requisitions. Content Coming Soon… 3.03.2 Establish if patients meet the requirements of specimen collection for the test ordered. The best way to establish if patients have met the requirements for specimen collection is to ask them if they followed the instructions they were given in the medical office. 3.03.3 Select the appropriate equipment for the purpose of testing and the type of patient. Blood Collection Equipment A tourniquet is a device used to make the veins easier to find for venipuncture. These non-latex bands usually measure ½ to 1 inch wide and 15 inches long. One use per band. Vacutainer tubes, the most used tubes for laboratory blood collection, are color coded based on the presence of any additives within the tube. Anticoagulants, clot activators, and preservatives are a few of the additives that may be present in the tube. Needles include straight needles and winged sets that are attached to a vacutainer barrel. Sizes include 21g, 22g, 24g, straight and 21g, 22g, 24g, 28g butterfly winged sets. Syringes may be used for special circumstances. Venipuncture To perform venipuncture, it is essential to have the following supplies on hand: Phlebotomy tray containing antiseptic, vacutainer barrels, vacutainer tubes, and needles o both straight and winged sets in varying gauges, syringes. Alcohol wipes Tourniquet Accurate specimen labels Disposable gloves Sharps container Gauze, 2x2