When you consider “office safety,” what comes to mind? Do you think only of clean walkways and locked drug cabinets? Do you believe that simply meeting the defined safety requirements under the Health Insurance Portability and Accountability Act (HIPAA) or the Occupational Safety and Health Act (OSHA) is sufficient? If so, perhaps you need to broaden your thinking a bit.

Any office safety plan should be designed to achieve the following three goals:

1. Minimize the risk of exposure to safety hazards by patients and employees
2. Minimize the practice’s risk of exposure to lawsuits and fines
3. Establish a framework for an ongoing office safety program (including checklists)

If the practice owns the office building, it is responsible for all maintenance and upkeep to ensure that the environment is safe for patients and staff. If the office space is leased, however, some of those responsibilities may belong to the landlord. In either case, office safety goes far beyond having well-lit corridors and meeting building code requirements.

For example, do you or a member of your staff regularly check the expiration dates on medication or emergency equipment such as oxygen tanks or crash carts? Have you actually checked that your sterilizer truly sterilizes?

Patient safety can also be affected by inaccurate or missing information, so communication and a clear understanding of responsibilities are key. The following questions can help you determine how well your office achieves this aspect of office safety:

• Where are patient charts stored? Who is responsible for pulling charts? Was the correct chart pulled or available when the patient was seen?
• Do you have an EMR that guarantees availability of the chart?
• How are patient charts updated? Who is responsible for checking to make sure information is updated before you see the patient? Were allergies and current medications updated?
• Do you submit prescriptions via computerized order entry or do you write them out? Is your handwriting legible? How many times has a pharmacy had to call to clarify one of your prescriptions?
• Do you have a follow-up system (a “tickler file”) for radiographs and laboratory tests that you have ordered?
• Is someone responsible for contacting patients who failed to keep an appointment?
• Does someone confirm the details of surgical scheduling such as the procedure, hospital or surgicenter, necessary assistants, special equipment, and surgical site (side, level, or approach)?

The safety plan
Each office should have a safety plan with written protocols that is reviewed on a regular basis. Although you and other physicians in the office need to be involved in the development of the plan, day-to-day supervision and implementation of the plan can be handled by others. The practice manager, a physician assistant, or a senior nurse may be the best person to monitor the medical procedures.

The following are among the issues that could be considered in developing the plan:

• How is adherence to the plan monitored? Are lapses reported to the physicians for remediation?
• Do the office staff cooperate in covering for each other and ensuring patient safety procedures?
• Are office safety procedures a topic at staff meetings? Are regular drills conducted to ensure that staff know what to do in an emergency?
• What is the procedure for correcting mistakes when they are identified? Are there provisions for training the staff to prevent recurrences?

The goals and objectives of any prototype individual office safety plan obviously cannot be applied to every practice. A plan for a 1- or 2-physician office may not be appropriate with one for an office with 30 or 40 surgeons. Most importantly, a cooperative environment that fosters a concern for patient safety and encourages the reporting of problems without assessing blame is necessary.

Alexander Pope, the 18th century English poet, stated “To err is human, to forgive, divine.” However, by the end of the 20th century, the Institute of Medicine stopped at “To Err Is Human.” In today’s litigious society, we, as physicians, must take steps to avoid errors of any kind. Fostering a culture of patient safety in our offices and creating an office safety plan will help ensure that unintended errors do not expose our patients to potential harm or us to liability.

Obviously, a single article cannot cover every aspect of patient safety in the office setting. I hope, however, that this article encourages you to begin thinking about it. Several resources are available to help in developing a safety plan for your office.

G. Klaud Miller, MD, is a member of the AAOS Patient Safety Committee. He can be reached at doc@jockdoc.net

Additional Resources:
Medical Office Survey on Patient Safety—An office survey regarding the culture of safety and medical offices that can serve as a lead-in to a more comprehensive plan.

Improving Patient Safety in Medical Offices—An extensive list of resources on numerous issues that affect a medical office; multiple resources on medical office safety issues and improvement of staff performance are included.

U.S. Department of Commerce Office Safety Inspection Checklist for Supervisors and Program Managers—A checklist for general office safety issues, not specifically for medical offices.

Canadian Centre for Occupational Health and Safety—A checklist for general office safety issues (not specifically for medical offices) from the Canadian equivalent of OSHA.