Tuesday, June 9, 2020

SUGGESTED SAFETY GUIDELINES FOR MEDICAL OFFICES

Copyright © 2020- IntermediaWorx Inc. Educational Publications & NY Cancer Resource Alliance


As essential health and medical service providers, our community looks to us to set the standards when it comes to implementing safety measures, risk prevention strategies and sanitizing efforts.  We are all in the same fight to control the spread of pathogens and to preserve the health of our patients and our staff.  These same priorities align with our commitment to share these top recommended protocols for HEALTH & SAFETY which we assembled from a wide survey of safety‐minded colleagues. We urge you to review and consider these safety measures for your office.  Only together can we continue 'flattening the curve' and win this global health crisis- one office at a time!


1) BY APPOINTMENT ONLY:    As private practices are now beginning to re-open on a cautiously limited and adjusted schedule, communicate with your patients that you are officially open for in-person patient care and your new office hours. Adjusted scheduling allows you to better spread out all appointments for better crowd control and allows your staff time to disinfect and clean between patients. Also, emphasize NO WALK-INS.

2) TEMPERATURE CHECKS AT THE DOOR: More and more businesses and professional practices are now requiring temporal temperature checks at the door as an essential public safety measure.  The doorway is a major point of contact with the public at large- and one of your first lines of defense, starting with temperature screenings. Also, you can suggest all patients to check their temperature prior to traveling to your office - and stay home if they have above 100 degree reading (recommendation by the CDC). 

3) PATIENTS ANNOUNCE THEMSELVES UPON ARRIVAL: When the patient reaches your facility for their appointment, request that they announce themselves via phone from outside. This gives your staff a chance to adjust in case the office is backed up- or if you can see them earlier. If possible, encourage patients to wait outside the building until their time is ready.

4) THE "NEW" WAITING ROOM: More and more doctors’ offices are now reducing the number of seats, and others are even eliminating their waiting rooms altogether.  Waiting rooms have been recognized as a potential ground for sharing bacteria and viral pathogens.  Reducing the wait capacity to the least number of patients (ONE or TWO max) is crowd-control and supports social distancing. 

5) (NEW) REMOVE MAGAZINES & NEWSPAPERS: Take away any materials in the waiting room that may land on a patient's hands.  Reading material is a potential breeding ground for traveled viruses from others.

6) MASKS & OTHER PPE: The current law of “NO MASK = NO SERVICE” applies to all indoor professional or commercial settings where masks (nose & mouth covering) are required AT ALL TIMES. And when working with patients under treatment, make sure to wear clinical-grade protective gear such as gloves, protective gowns and face shields as standard precaution. 

7) HAND SANITIZING: Regular hand-washing 
(20 seconds) is highly advised for reducing contamination from pathogens both for the public and your staff. In addition, your office should have visible & easy access to hand sanitizers in every room especially for all office occupants. 

8) REDUCE IN-PERSON TALKING: As viruses are widely recognized to be transported by one’s BREATH and atomized saliva, a major part of Prevention means limiting verbal exchange between patients and medical staff to the absolute essential minimum. A safe alternative is discussing anything administrative BY PHONE prior to the appointment.   

9)  PAPERLESS OFFICE:  Another means of reducing person-to-person contact and minimizing physical engagement with patients. Transmitting and receiving patient forms and payment processing via email before the visit is a proven and safe office solution (PAPERLESS OFFICE) that streamlines workflow and reduces patient time spent in the office. 

10) TELEMEDICINE: A sustainable tech option that is spiking in popularity, TeleMedicine is a nationally billable alternative to the (now risky) face-to-face consultation and post-procedure doctors’ visit.  Digital and video communication with patients is an intelligent use of our existing web & video technology.  Telemedicne supports the elimination of the patient's travel time and is a completely SAFE preventive measure from any possible exposure from a waiting room or public contact.



11) OFFICE DISINFECTING REGIMEN: Stock up on disinfectant wipes and sprays for your staff’s daily maintenance.  Upgrade your office cleaning routine to include a regular hospital-grade sanitizing regimen.  This includes use of industrial rated anti-microbial products. Offices and hospitals can hire outside disinfecting companies to come in and conduct disinfecting services. Research the many available products and sanitizing vendors in your area. Also, explore the many new disinfecting technologies (their efficacy and pros and cons) - including liquid sprays, electrostatic applications, UV-C (Ultraviolet) Lamps and Negative Air Ionizing Filters.  [CDC also recommends increasing the frequency of disinfecting surfaces.]


12) (NEW) QUESTIONNAIRE / PATIENT'S CURRENT CONDITION
Sometimes, clerical measures can be a preventive tool.  Many doctors offices are requiring patients to fill out and sign a form asking about the patient's health condition and history with Covid-19. By their signature, they are attesting legally to the validity of their responses, committing them on record as to their level of risk to others and to themselves.

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CORONAVIRUS UPDATES FROM NIOSH/CDC





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TALK ABOUT SAFETY... See what other docs are saying

NO-TOUCH TECHNIQUE
“Without a doubt, this pandemic has awakened much change in the way we do just about anything, and thinking SAFETY is a big part of that! Our patients appreciate our converting to an ONLINE platform for all patient registration forms... once we went completely digital,  you have a true “no touch” and "no talking"  technique where patients walk directly in to an exam room and no stopping at the front desk and no MA’s or techs needed.  It’s a direct walk into treatment then out the door.”  
– Dr. Stephen Chagares, Breast Cancer Surgeon- NJ (drchagares.com)


A TIMELY REVOLUTION IN METHODS
“- I’ve always felt that there are many areas in patient care that could use an upgrade... this  pandemic made us re-evaluate every part of our work process for better safety and cost efficiency. This  includes our current resources like TeleMedicine- where remote consults and digital file have become such a blessing as it saves patients travel time and $$ while keeping everyone safe from unnecessary risk and exposure." 
Dr.Robert  L. Bard, Cancer Diagnostic Imaging- NYC (Cancerscan.com | TelemedScans.com)



LEADING BY EXAMPLE
"It is imperative to institute good safety measures in medical office settings as we begin to navigate this COVID-19 pandemic and help guide the country through the reopening phases.  As healthcare professionals- it is our duty to set the example for others to follow.  We can provide a framework and high standards of health and safety ideas that can be mirrored in all office settings, stores, schools , banks and other industries." 
- Juanita Mora, MD, Volunteer National Spokesperson, American Lung Association


PREVENTIVE ADJUSTMENTS
“The landscape for treatment has changed…Patient visits are spaced so that no one is in the waiting room. Patients  must wear a mask upon entrance and throughout the course of the visit and so does the caregiver or attendant. After each visit, the room is wiped down with appropriate sanitizers; careful to not overdo it which might cause respiratory problems. Common surfaces (doorknobs etc) are also wiped” 
– Dr. Richard Kushner, Podiatrist - NYC


PATIENT CONFIDENCE
"It is critical that every patient “touch point” is educational and science based. Examples include; the first email sent out announcing your practice re-opening, the screening questions that are asked prior to the patient’s first visit,  the patient’s greeting/screening at your entrance, the handwashing station, the waiting and patient areas. Take the time to make sure your staff is comfortable with the procedures implemented."
Dr. Carol Stillman Physical Therapist and owner of Sutton Place Physical and Aquatic Therapy.


SMART SYSTEM UPGRADE
"Promoting SAFETY GUIDELINES in any health practice (especially during this Pandemic) is everyone's duty in our community-- where we all need to do our part to help minimize the risk of contamination. Policies like checking temperatures at the door and having maintaining sanitizers and PPE's for the staff gives the patients peace of mind knowing they are walking into a safety conscious office.  It's an opportunity for providers to lead by example!" 
 Jessica GlynnLicensed clinical social worker/psychotherapist- NYC (jagtheracoach.com)  

For  the  latest  CDC updates,  additional  information  and  safety  recommendations  for  your  medical  office,  visit:  PREVENTION101.ORG and review our CDC SAFETY LINKS.  This list of suggested Safety Guidelines for healthcare offices  is published by The Advocacy for Professional Safety‐ a branch of the NY Cancer Resource Alliance and IntermediaWorx  Educational Publishing. (c) Copyright, 2020‐ All Rights Reserved. 
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VIDEO EXTRA:
"The Power of Prevention of Covid-19 is in YOUR HANDS"
Source: MD Anderson Cancer Center

You have the power to reduce your risk of infection by washing your hands often. Watch how a blacklight reveals what improper hand washing can leave behind. According to Dr. Christina Le-Short of MD Anderson Cancer Center, "Cancer patients are at greater risk of developing complications from respiratory viruses... Effective hand-washing is your best defense against germs that cause the flu or Covid-19".

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A WORD FROM THE TOP
As the country aims at opening more and more areas of business, the concern for safety is at its highest.  Commercial business and health centers alike are following the many safety protocols recommended by city, state and federal leaders with the hopes of quelling the threat of a Covid recurrence, bringing us all back to another shut-down.

In a NY State press conference on 5/12, Governor Andrew Cuomo presented his goals for reopening lower New York with safety conditions, starting with a push to maintain social distancing and valuing the importance of continued face covering.  "Out of respect to you," he started, "I wear this mask.  The mask says I respect the nurses and the doctors who killed themselves through this virus to save other people- all essential workers who get up every day to do their job so I can stay safe... it's not about ME-- it's about WE!" ( see complete video LINK)

A recent CDC report about Screening Patients for COVID-19 at Intake stated, "If there is widespread community transmission of COVID-19, facilities can consider instituting active temperature monitoring by having a staff member check the patient’s temperature immediately upon arrival at the door and when the patient is first asked about symptoms".  (ref. link: CDC Screening PatientsIn addition,  masks, social distancing and disinfecting work areas are part of this new critical infrastructure.  (See complete CDC Interim Guidance)

In addition, the NYS Dept of Health also published Covid-19 Guidance for Medical Providers about infection control.   "...When engaging a client (patient), staff should use alcohol-based sanitizer with at least 60% alcohol prior to entering the home and should wear a face mask, if available.  Staff should attempt to keep at least six (6) feet away-- [and] should also remind everyone to practice appropriate hand hygiene and to avoid touching their face".  From a May 2020 update, the DOH also encourages Telemedicine and TeleHealth technologies whenever possible. (link).- Also see Managed Care Organization Contracting and Surveillance Relief.  (DOH link

Also see: Senator Biaggi’s 6/4 COVID-19 Update: NYC has Zero Confirmed COVID-19 Deaths for first time since March 11




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