SDS Accreditation Update
Are your physicians in your program familiar with emergency protocols?
Take steps to ensure they can answer surveyors' questions
The accreditation survey was going well when the surveyor turned to the medical director and asked, "What would you do if the surgery center received a bomb threat or if a fire broke out right now?"
To the administrator's horror, the physician replied, "Are you kidding me? I'm out of here!"
This incidence demonstrates the importance of making sure your orientation of physicians and allied health professionals to the emergency plans of your outpatient surgery program is thorough and is taken seriously. Even if every member of your staff is prepared for emergencies, the presence of a certified registered nurse anesthetist (CRNA) or surgeon who is unprepared can leave you short-staffed in an emergency because one of your staff members has to "take care of" the unprepared people, points out Anne Dean Schilling, RN, BSN, consultant with The ADA Group, a DeLand, FL-based firm that specializes in ambulatory surgery center development and regulatory compliance.
The emergency procedure orientation for physicians and allied health professionals needs to be more than a checklist that is read quickly, marked, and put into a file, Dean Schilling says. "The orientation should be scheduled for a specific time and should cover the same items covered in the surgery program staff orientation to emergency procedures," she says.
Surgeons, physician assistants, anesthesiologists, and CRNAs are busy and might not perform the majority of their cases at your program, but they should make time for the orientation if they want privileges, says Dean Schilling. "One administrator was frustrated that a surgeon had scheduled and canceled his orientation three times," she says. When asked how to handle the situation, Dean Schilling suggested that the administrator tell the physician, "If you don't come to learn how to handle evacuations in case of fire, you will be the last one evacuated." While this wording seems harsh, Dean Schilling points out that the safety of patients must come first and surgery program staff members need to know that everyone working in the operating room is able to help, rather than hinder, activities during an emergency.
The key to getting buy-in and participation in orientation procedures up front is to make it clear in your credentialing requirements that privileges will not be granted until orientation is complete, suggests Dean Schilling. "Your medical director and the anesthesiologists have to buy into this process, and they have to understand that it affects patient safety as well as your accreditation status," she adds.
Be positive, but firm
When presenting the orientation requirement, be sure to keep it positive, says Dean Schilling.
"Start out by saying that the physician or CRNA will enjoy working at your program and that your facility promotes a strong safety culture," she says. Explain that orientation to emergency procedures is part of the safety program and ask when it is most convenient for them to attend an orientation, she adds.
One-on-one orientations are best, but if you are starting a relationship with a new anesthesiology group and you need to orient several CRNAs or anesthesiologists, a small group of two to three can work well, says Dean Schilling. "Be sure to cover basic emergency information such as codes, location and operation of defibrillators, evacuation procedures, and emergency exits," she recommends.
Give everyone a list of your facility's codes, advises Nancy Burnes, RN, operating room supervisor at Premier Surgical Center in Boise, ID. Some facilities print codes on the back of staff ID badges. Codes are different from facility to facility, so you need to point out that your Code Yellow may be different from another facility's Code Yellow, or you may not use "Yellow" at all, she says.
The orientation process at Burnes' facility includes reading a three-page document that discusses the emergency information that applies to all allied health professionals and completing a checklist that demonstrates understanding of the material. "Everyone has to complete this orientation before they perform the first case, and we have them redo it once a year," she says.
The competency assessment includes a demonstration of the proper use of the facility's defibrillators as well as the location of fire pulls, fire extinguishers, and crash carts, Burnes adds. (For other items included on checklist, see box.)
One of the ways that Dean Schilling suggests orienting people to emergency items is a scavenger hunt. "Give people a list of items such as the fire blanket, fire extinguishers, emergency exits, and fire pulls," she says. "This is a fun way for them to demonstrate competency."
Be sure that your physicians and allied health professionals do participate in emergency drills, she recommends. "Every outpatient surgery program is required to conduct quarterly fire or disaster drills for accreditation organizations and for Medicare," Dean Schilling says. "At the end of the year, all staff in the facility should have participated in at least one of the drills, but the definition of staff is not limited to nursing staff," she points out. Physicians, CRNAs, physician assistants, or any other clinical professional in the center should be included in at least one drill, Dean Schilling says.
Make sure that your drills cover more than just fire emergencies, she warns. "There are so many other types of emergencies for which staff members need to prepare that concentrating only on fires or weather emergencies will not prepare everyone," Dean Schilling says. Staff members, physicians, and ancillary health professionals need to know how to react to workplace violence, a biological threat, or a power outage, she points out. Be sure that the role of ancillary staff is defined so that everyone knows what to do, Dean Schilling adds.
Ensuring a complete emergency preparedness orientation for physicians and ancillary health professionals is challenging, Dean Schilling admits. "This needs to be more than a paperwork process. It must be a thorough process of teaching and learning," she says. "Board members are often supportive of efforts to orient physicians when they realize how physician preparedness for emergencies can avoid potential liability related to patient harm."
Sources
For more information about orientation for physicians and ancillary health professionals, contact:
- Nancy Burnes, RN, Operating Room Supervisor, Premier Surgical Center, Boise, ID. Telephone: (208) 377-3937. E-mail: [email protected].
- Anne Dean Schilling, RN, BSN, Consultant, The ADA Group, 911 E. Minnesota Ave., DeLand, FL 32724. Telephone: (386) 956-1817. E-mail: [email protected]. Web: www.theadagroup.com.
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