Safety in the Outpatient Wound Care Clinic: A Generalized Checklist

CHECKLIST

Category

Checklist Items

Building Design & Maintenance Safety

• Refer to Title 3 of the Americans With Disabilities Act (ADA) to ensure compliance issues and confirm that all universal design standards set forth by the ADA are met.
• Schedule regular sanitation/cleaning routines conducted by in-house staff and/or an outside vendor.
• Ensure that enough staff coverage is assigned to conduct clinic business during all hours of operation.
• To help ensure quality, be Joint Commission “ready” by discussing plans for tissue tracking, locking up of medications, infection management, etc.
• Consult with your respective state’s department of health for regularly occurring window inspections.
• Indoor environmental quality: The Centers for Disease Control and Prevention (CDC) offers guidance on such aspects as dampness and mold in buildings, ventilation, chemicals and odors, construction and renovation projects, and health hazard evaluations. Visit www.cdc.gov/niosh/topics/indoorenv for more information.

Disaster Preparedness Safety

• The CDC offers a varied set of guidelines for healthcare officials to consider when preparing their facilities for potential natural disasters. Specific guidance is available for tornado cleanup and response; storm, flood, and hurricane response; extremely cold temperatures; earthquake cleanup and response; and fighting wildfires.¹ 

Emergency Safety

• The Federal Emergency Management Agency has published a step-by-step approach to emergency planning, response, and recovery for facilities of all sizes.²

Employee Safety 

• Distribute and post in the workstation the names and contact information for all medical staff, including emergency on-call providers.
• Provide basic orientation that educates on all policies and procedures related to the clinic, as well as any organizational standards that will be expected to be met at the time of hire for all staff members and clinicians.
• Schedule annual competency training for all staff members and clinicians.
• Provide ongoing education as needed.
• Be sure to delegate and designate staff responsibilities that adhere to the individual’s scope of practice.
• Healthcare workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in the workplace. The CDC provides guidance on this type of exposure.³ 
• Occupational violence remains a safety issue for any healthcare employee. The CDC and World Health Organization offer education and training on peer-related violence⁴ and patient-related violence.⁵
• Occupational hazards in hospitals and other healthcare settings include employee exposure to stress. Consult the CDC’s manual on this topic.⁶  

Fire Safety⁷

• Consult National Fire Protection Association (NFPA) codes No. 99 (Health Care Facilities Code⁸) and No. 101 (Life Safety Code^®9).
• Confirm that your wound clinic adheres to any fire-safety codes established within your respective municipality, and schedule routine fire drills with staff in the event of an emergency.
• Properly label all exits (including at least one emergency exit), and regularly inspect all rooms, doorways, hallways, etc. for potential hazards that could affect an emergency evacuation.
• Post and follow any building-related occupancy codes that must be complied with.

HIPAA Privacy & Security Safety

a) Generate a required remediation plan to address any security gaps identified during the risk assessment.

b) Require all employees to undergo HIPAA Privacy and HIPAA Security education/training at times of orientation and at least biannually thereafter (quarterly is advised).

c) Post a notice of privacy practices in conspicuous places throughout the clinic and on your website.

• Conduct a required security risk assessment:
• Establish clear policies for staff, vendors, and patients that are easily monitored and enforceable related to the use of mobile devices (eg, mobile phones and tablets) in the facility that could be used to capture and transmit protected health information (PHI).
• Train all staff members and vendors on facility-specific policies and procedures.
• Refrain from posting anything related to PHI on any social media platform and ensure that polices restrict staff, vendors, and patients from doing the same.
• Remind staff, vendors, and patients of any policies related to HIPAA by posting notices throughout the clinic (eg, patient rooms, waiting rooms, common areas) that clearly communicate the information and are easily visible.
• Ensure the facility’s electronic health record (EHR) software and any programs that contain PHI are secure through password protection/employee-specific sign-in credentials.
• Ensure that the EHR vendor is compliant with the HIPAA/HITECH regulations and that both parties have signed a business associate (BA) agreement.¹⁰
• Implement and train staff on protocol in the event of a PHI data breach (unauthorized access and/or use) of any kind. This includes contacting those individuals whose information is unlawfully accessed.
• Obtain confirmation (ie, signed and dated policy) from any BA permitted access to any PHI that acknowledges an understanding of the restrictions to that PHI (eg, cannot be sold or distributed to other parties).
• Establish and communicate clear standards that explain how patients can acquire electronic or hardcopy information related to PHI and advise them of how to safeguard their materials when leaving the clinic.
• Ensure that all staff members are aware of where all PHI information is stored in the event of a compliance review by the U.S. Department of Health and Human Services (HHS).
• Frequently refer to HHS for updates related to HIPAA’s privacy and security rules.
• Implement your internal audit program of your security and privacy program.

Hyperbaric Facility Safety

• Periodically review hyperbaric mishaps and consider the “lessons learned” from prior experiences in order to avoid repeating them.
• There are five basic safety issues: integrity of the pressure vessel, safe gas-handling practices, decompression safety, fire safety, and training.
• Clinical hyperbaric chambers and systems used for patient care in the United States must be constructed in accordance with the American Society of Mechanical Engineers’ standards for pressure vessels and pressure vessels for human occupancy (or an international equivalent).
• Each facility must appoint an onsite hyperbaric safety director to be responsible for all hyperbaric equipment and operational safety requirements established by Chapter 14 of the NFPA Code No. 99.⁸
• Qualified individuals in accordance with the American Society of Mechanical Engineers (or equivalent standards) will perform any modifications to the chamber(s).
• The fire department will want to know where all of the oxygen cylinders are in service or stored within your facility.
• Gas cylinders are periodically inspected and hydrostatically tested by the gas delivery service, and a date stamp of the original hydrostatic test is etched in the top of the cylinder.
• Special vigilance is required to ensure that no igniters enter the chamber.
• Oxygen percentage in multiplace chambers should be kept below 23.5%.
• The amount of burnable material must be limited. Paper products should be stored in metal containers when not in use.
• Signs should be posted in the vicinity of the chamber(s) and clothing stations to remind patients of forbidden items.
• Checklists should be used for daily operations. Patients should be briefed about items that are excluded from the chamber and reminded prior to each treatment.
• The staff must be trained, present, and vigilant in order to avoid mishaps. Each member of the staff should attend formal training.
• Physicians should attend introductory courses in hyperbaric medicine consisting of at least 40 academic hours before administering therapy.
• Each member of the hyperbaric staff must know how to properly decompress the patient and attendant, if applicable.

Patient Handling & Mobility Safety 

• Communicate with other departments (eg, nursing departments, care managers, hospitalists) to let staff know when the clinic is opening and the best way to arrange for referrals.
• Discuss procedural requests for the pharmacy with that staff.
• Discuss specific diagnostics you will need to order with radiology/imaging staff.
• The CDC provides resources on safe patient handling and mobility on topics ranging from patient handling ergonomics and safe patient handling standards to revised lifting guidance and related legislation.¹¹

Wheelchair Safety^12-14

• Finding one’s proper position is essential to safety when using a wheelchair. 
• Patients should use the casters to help maintain their balance and stability. 
• Patients can practice a variety of activities such as bending, reaching, and transferring in and out of their wheelchair. 
• It is best to practice and feel confident with all chair movements while someone is close by.
• Tipping and falling are the most common accidents wheelchair users encounter. Tipping can be caused by moving the wheelchair too quickly, unlocked brakes, and slippery/uneven surfaces. 
• The tipping lever should be secure when needed.
• The brakes should be locked before someone gets in or out of the chair. The power should be turned off of electric wheelchairs before transferring.
• Adjust or lift foot rests and arm rests if needed before transferring.
• Attach flashy items such as flashing taillights and flags to the wheelchair for night use. 
• Advise patients to avoid forcing the chair down or up staircases, slopes, and inclines.
• Replace the casters regularly. (If a side-to-side motion is occurring while going at high speeds, this is a sign of needed replacing.)
• Sandy surfaces and wet surfaces should be avoided as much as possible. 
• Wheelchairs should be inspected and serviced before travel. 
• Depending on how much the wheelchair is used, maintenance will be needed at least once per year. 
• Common parts that are replaced or serviced on a regular basis include batteries, joysticks, arm rest joints, safety seatbelts, arm rests, leg guards, central processing unit controller and cable, seat cushions, back support cushions, front wheel assembly, and rear wheel and motor assembly.
• Minimize the use of incontinence pads on top of the wheelchair cushion. They can decrease the pressure redistribution properties of some cushions and they may also cause the care recipient to slide, which can lead to more frequent repositioning being required.
• Keep all pathways travelled by the individual in a wheelchair clear and accessible, and remove throw rugs, clutter, and loose electrical cords.
• Arrange furniture to allow a clear path so the wheelchair can easily be moved and ensure there is a way to safely enter and exit the facility, preferably through an accessible entrance.
• Ensure the wheelchair will fit through office doorways.
• While in transit, wheelchair users must use a tie-down system to fasten the wheelchair to the floor of the vehicle.
• If the wheel locks, don’t move easily on a manual wheelchair; lubricate them until they can easily lock and unlock.
• Check the front and back wheels of a manual wheelchair to make sure they turn without sticking and that the bearings are not making any noises. A test to use to see if the wheelchair is properly aligned is to push it across a flat, smooth floor. If it does not move straight, the wheels are probably out of alignment or the bearings need replacing.

Infection Control¹⁵

• Promote a safety climate by developing policies that facilitate the implementation of infection-control measures.
• Perform hand hygiene by means of hand rubbing or handwashing. Hands should always be washed with soap and water, if hands are visibly soiled, or exposure to spore-forming organisms is proven or strongly suspected, and/or after using the restroom. For other indications, if resources permit, perform hand rubbing with an alcohol-based preparation.
• Ensure availability of handwashing facilities with clean running water.
• Ensure availability of hand-hygiene products (clean water, soap, single-use clean towels, alcohol-based hand rub). Alcohol-based hand rubs should ideally be available at the point of care.