Why every clinic needs a sound safety plan

Take-home: Having an emergency-response plan for the clinic is a must. Here are some tips to develop an effective safety plan.

Putting It In View By Dianna E. Graves, COMT, BS Ed

Let’s set the stage: You’re halfway through a long week. It’s a normal day, no sick calls, everyone’s where he or she should be, and the morning is half-over. Two of your physicians with high-patient volumes are through the bulk of their mornings, and lunch is only an hour and a half away.

Then someone calls out: “I need help-call a code!”

And the rest of the morning quickly goes into a vortex of motion, controlled chaos, and the impending aftermath.

I have been in this field 30-plus years and have experienced more curves in the day than I can recount. However, I have to say those three words-“Call a code!”-are the scariest words one can yell in a clinic. Similar to yelling “Fire!” in a darkened, packed movie theater.

If you’ve never had one in your clinic, a code is a universal word meaning that a patient is having a medical crisis involving no pulse or breathing. This isn’t a seizure or a vasovagal response episode.

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In other words, someone is most likely dying in your clinic. And you have little time to rally the team to get an emergency response in motion. Less than minutes!

The time for rallying the team should have been the months and years of continual training and re-training provided to them prior to this incident in times when it was calm. And then you did it again and again, routinely.

I think back to when I worked at the hospital. One fearful disruption to our world was the periodic JCAHO (the Joint Commission was formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]). This was a time to defend, articulate, postulate, and discuss your battle plan contingency for chaos.

“But, I have no chaos in my clinic. I have a peaceful clinic, mild-mannered doctors, and consistent staff and schedule. Just an everyday clinic,” you might be thinking.

NEXT: In the event of emergency

In the event of emergency

If you have people in your office, there is the potential for chaos, and the training needs to start at the top! No one is excused.

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For example: During a JCAHO review, one reviewer repeatedly asked the clinic staff the following: “When was the last time you had a fire drill?”

Staff would turn white and try to come up with the exact date. The answer the clinic gave was: “Whenever the alarm sounds that there is a potential fire in any part of the hospital, that is a fire drill!

When the alarm and emergency lights went off, we would mentally, then verbally, discuss what we would do if this were in our clinic. This occurred every time. And that was our drill.

If there were inclement weather during the day, we would discuss the following with the staff:

•  What would you do if this were a tornado?

• Where would you take the patients?

• What if they were on oxygen? Or couldn’t be moved from their wheelchairs?

As a manager, you need to develop a safety plan that should be based on the known, but more unfortunately, on the unknown and unscripted.

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You probably have disaster plans for computer crashes/viruses, multiple bank accounts and lines of credit for financial crashes or ups/downs, lawyers and financial advisers for the organizational future health, and an organizational flow chart of who are charge with their responsibilities and their duties. This is all part of having a sound business disaster plan.

How about a sound safety plan? (see “3 Tips for a Sound Safety Plan”)

NEXT: 3 tips for a sound safety plan

3 Tips for a Sound Safety Plan

Here are some emergency-readiness recommendations for the day chaos arrives in the clinic:

1.   Have a safety team. You, some technicians, front desk, and optical representation. You want some from each group. Meet at least quarterly and have an agenda. We have seven clinics so each clinic needs a plan based on the building and particulars of that site.

2.   Roll it out to the staff routinely. We have Spring Safety Week reviewing tornado and severe thunderstorm information, work and fire safety and general first aid. These include reading assignments, crossword puzzles and the favorite – a safety clinic scavenger hunt looking to fire extinguishers, alarms, oxygen tanks, etc. The physicians have even been known to be involved. In the summer, we discuss water safety, heat exhaustion and other summer problems. In the winter, we discuss driving safety, CO₂ and how it can affect our living areas and clinic safety again.

3.   CPR is mandatory to all technicians every other year. It is also made available to the front desk, as well as the optical staff. This is paid for by the clinic. Even though this is not required as a part of the technician’s certification process anymore, it should be part of the clinic protocol.

NEXT: Lending support

Lending support

Even with the best training and proactive scenarios and drills, a code not only is devastating for the patient, but it is especially devastating for the staff. And staff includes the physician.

When it happens, you need to go to the site of the code, even if you are non-medical. You need to be there for support of your staff, and the support, understanding, and shoulder after the event.

You know your staff and can evaluate their reactions during and after the code. This will be a very traumatic experience on them as well-even if they were just bystanders.

We worry about the first responders, but don’t forget the front desk or opticians that were helping with crowd control or being the link with precious information on the computer that the paramedics needed.

Realize the staff will do the best job they can with the training they have received. They will also need to decompress-to absorb what has happened and what they saw.

There will be some tears, and the need to talk it through, even if you are feeling they should move on. They are processing and bonding to help each other through the trauma they’ve experienced.

And you will need to re-assess. What did they do well? What needs work? The final step: Make sure they know they did a good job and gave the best they had.

After 30 years, what is my best advice to give when a code hits your clinic? When it’s over and you are looking at shocked faces? Be strong and supportive for them-be an ear and a shoulder. Hugs help-they are free-and they are the best way to help the staff heal to start another day.

Finally, be there! They need you!

Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Dianna Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.