Spot the safety hazards in this office—and yours

Ever think of the many ways a place of healing can be dangerous? Here's how to reduce the risk of injuries, lawsuits, and OSHA fines.

By Robert Lowes
Midwest Editor

An employee at an East Coast group practice was handling a bag of trash when something pricked her hand. A used needle in the bag had jabbed her. Fortunately, fears that she had contracted HIV or a strain of hepatitis proved unfounded.

Experiences like hers are all too common, though. In fact, exposure to blood-borne pathogens is one of the biggest hazards facing health care workers, says Robert Calway, a safety and risk-management expert with MedSafe, a consulting firm in Waltham, MA. In an effort to curb the spread of such pathogens, Congress passed the Needlestick Safety and Prevention Act last fall. As a result, the Occupational Safety & Health Administration (OSHA) plans to impose new rules on physicians, such as a requirement that they buy safer sharps and log all needlesticks. (The Bush administration put the regulations on hold, along with many others, but Calway predicts they'll take effect eventually.)

Patients, too, can fall victim to one of the numerous hazards endemic to medical offices. Several years ago, a 4-year-old boy was electrocuted in an internist's waiting room when he touched bare electrical wires on an aquarium. To be sure, the mother wasn't minding her son—she was arguing with a receptionist about her bill. "But the doctor never should have tolerated the bad wiring," Calway says.

If you care about your patients and employees, you'll muster the willpower to eliminate all those accidents just waiting to happen. As a bonus, you'll minimize the risk of getting slapped with a lawsuit or a fine; a whole gaggle of government agencies besides OSHA can punish you for a workplace hazard.

So how do you get your safety act together? Here are the steps that risk-management experts and practice administrators recommend you take:

• Champion a safety program. Employees won't take accident prevention seriously unless you do. "If physicians shrug their shoulders and think it's the office manager's business, the program will usually fail," Calway says.

• Appoint a safety coordinator. OSHA says your practice must devise programs to implement the agency's standards on blood-borne pathogens and hazard communication (for workers who are exposed to dangerous chemicals), and each initiative needs a leader. Your safety coordinator can fill those roles, as well as plan and execute other segments of your safety agenda.

Choose the right person for the job. Doctors are usually too busy to serve as safety coordinators, notes OSHA expert Ann Bachman at DoctorsManagement, a consulting company in Knoxville, TN. The office manager is a better candidate, but may not know enough about medicine to master some of the details—or teach others. Your best choice may be a veteran nurse.

• Assemble a safety committee. This group, which guides and assists the safety coordinator, should include a physician or two.

• Draft a safety manual. OSHA demands that you put your mandatory programs on blood-borne pathogens and chemical hazard communication in writing. Your safety manual also should discuss ergonomics, indoor air quality, tuberculosis precautions, radiation safety, general safety (such as electrical wiring and places where people may trip), out-of-control patients, and emergency planning (who does what when a fire breaks out, for example).

OSHA worries only about employees, but your manual must address patient well-being, too. To flesh out this topic, Robert Calway suggests borrowing safety standards from agencies that accredit physician offices, including those where surgery is performed. These agencies include the Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org ) and the Accreditation Association for Ambulatory Health Care (www.aaahc.org ). Another good source may be your malpractice carrier. Such insurers typically offer risk management advice.*

• Identify safety shortcomings. Sweep through the office, using a checklist based on your new manual. If you own your building, don't forget to scrutinize the parking lot and sidewalks, where patients could trip and fall.

Let an expert conduct the first inspection. Most likely, the company that insures you for general liability or workers' compensation will supply a safety pro free of charge. (For more on where to get help, see the box below.)

• Purge the perils. Take a day when the office is closed to start de-jinxing your practice—removing boxes that block a fire exit, putting covers on electrical outlets, mounting a loose fire extinguisher on the wall. Those are some of the easy fixes. For others, you may need a contractor—an electrician, for example, to install more outlets for the sake of fewer extension cords.

• Train staffers and doctors. Institute annual safety classes based on your manual. OSHA mandates this specifically for blood-borne pathogens and chemical hazard communication. You may want to ask a risk management expert to provide the initial training, and let your safety coordinator take over from there.

• Inspect your office again—and again. Maybe you eliminated all the dangers you caught in your first sweep, but new ones are bound to crop up. At the seven-physician Southeastern Urological Center in Tallahassee, the practice's safety coordinator tours the building each month with checklist in hand.

Let employees take turns making safety rounds, suggests Ann Bachman. "This can make real believers out of them," she says.

• Collect and analyze safety data. Don't rely just on inspections to ferret out potential mishaps. Encourage doctors and employees to file incident reports on any accident, near-accident, or safety violation that they encounter. Then review these at safety committee meetings.

"We look for systemic problems," says Philip Porter, CEO of the 58-physician Slocum-Dickson Medical Group in New Hartford, NY. "For instance, fainting after blood draws is our No. 1 cause of accidents, followed by falls in the parking lot due to weather conditions."

Practices that take these steps toward a safer office can reap economic rewards. Insurers may discount your premiums if you address accident prevention as part of a broader risk management program. Southeastern Urological Center received a 5 percent premium reduction from its building liability insurer after it got serious about safety, according to Susan Kizirian, the group's executive director.

The fact that your practice tries to keep patients and employees out of harm's way will help you if misfortune does strike, notes Robert Calway. "Courts respect good-faith efforts," he says. "If someone gets hurt and sues you, and you have a safety program, the settlement tends to be lower. OSHA feels the same way—it's likely to ease up on fines."

Monetary incentives aside, the most important reason for making your office safe is a moral one. You owe it to your patients and staff, and you don't want an injured child or a disabled employee on your conscience.

Just remember that making your office safe is not a one-time job. "You have to constantly stay on your toes, or things will fall into disarray," says Susan Kizirian. "Preventing accidents is like housekeeping. It's not fun, but it's necessary."

*For other services your malpractice insurer may provide, see "Malpractice Consult"in this issue.

How can you get hurt in a doctor's office? Let us count the ways

• If you block an emergency exit with boxes and equipment, you make it harder to escape in the event of fire.

• Paper towels out in the open collect bacteria. Stash them in a cabinet.

• Don't forget to turn off a coffee maker at day's end, or you may hear fire trucks that night.

• Don't throw sharps or any other infectious waste into a regular trash can.

• Don't put a centrifuge in the employee lounge—one accident, and bodily fluids will splatter on food. Keep this room free of all biologicals, hazardous chemicals, and medications.

• Open desk or file drawers cause many a staffer's downfall.

• Electrical cord snaked under rugs will fray, posing a fire hazard.

• Any toddler could stick his hand into a sharps container. Get it off the floor.

• Overloaded electrical outlets can start a blaze.

• Electrical outlets accessible to children invite electrocution.

• Clutter may translate into a broken hip.

• Children's toys can spread disease if they're not cleaned frequently.

• A coat tree, overloaded on one side, could topple on a patient. Rely on wall-mounted racks.

• If an unmounted fire extinguisher falls over and discharges, it could turn into an unguided missile.

• Bars of soap spread bacteria; use liquid soap instead.

• Expired drugs should be discarded.

• The door to the medicine cabinet should be locked. Use an electronic key-code lock instead of an actual key, which you can lose.

• Cleaning supplies don't belong in a bathroom accessible to patients—what if a toddler takes a sip of disinfectant?

• Don't use glass capillary tubes. They can break into skin-slicing shards. Plastic tubes are safer.

• Books and paper supplies stacked too close to water-sprinkler heads shrink the spray pattern. Leave an 18-inch gap.

• You risk a head injury storing heavy objects on top shelves.

• A sharps container filled to the brim is dangerous to use. When it's three-quarters full, get a new container.

Where to get help to make your office safer

You're not on your own when it comes to ridding your office of safety hazards and complying with pertinent government regulations. Plenty of companies and organizations can guide you every step of the way.

The Occupational Health & Safety Administration, though much maligned, tries to be helpful. Its Web site (www.osha.gov ) features many handbooks aimed at small businesses that you can download or order through the mail. To find them, click on the Small Business hyperlink under the Outreach heading. OSHA's Web site also lists state government agencies (www.osha.gov/oshdir/consult.html) that, in cooperation with the Feds, will dispatch a safety inspector to your office free of charge to identify problems. Violations found during this consultation won't result in a citation or penalty, but you're expected to correct the problems.

If OSHA makes you queasy, your workers' compensation or general liability insurer probably will be happy to perform an inspection as well as help assemble the rest of your safety program. Or you can hire a risk management company that specializes in health care. Large practice management consulting firms also field safety experts.

Don't forget to visit the Web site of your state medical society. Some societies offer manuals and workshops on complying with OSHA regulations and state laws that govern office safety.

If you want a bible on the subject, consider the 347-page Physician Office Safety Guide, published by ECRI, a health-services research agency in Plymouth Meeting, PA. You can buy the book from ECRI for $149 by calling 610-825-6000, extension 5888. The Medical Group Management Association in Englewood, CO, also sells the guide to members for $99.95; nonmembers pay $145.95. Call 877-275-6462, extension 888, or order from MGMA's online catalog at www.mgma.com. For other books and resources on safety, visit Healthcare Marketplace (www.hcmarketplace.com), an online store.

What to look for on safety rounds

Robert Lowes. Spot the safety hazards in this office--and yours.

Medical Economics

2001;9:77.