Ch. 26 Daily Operations and Safety

Reasons to maintain inventory

• Tax consequences: Larger pieces of equipment depreciate over 5 years, but smaller pieces can be deducted as an expense for the current year.

• Theft or damage

• Sufficient supply

Equipment inventory

• A way to track individual equipment

• Purchase and supplier information

• Warranty information (e.g., start and end date, warranty coverage)

• Location and unique facility number for all equipment (Larger facilities place stickers with unique numbers on the items for tracking purposes.)

Supply inventory

1. The item’s name

2. Any specific size used and order number, if available

3. The usual supplier

4. The cost per a standard quantity (e.g., $3.50 per 100), if known

5. The type of units (e.g., each, box, package [pkg], case)

6. The quantity or number to order

Reorder point

Maintaining an inventory also helps identify when an item needs to be replenished to prevent a shortage. To identify the reorder point, determine the number of items used in a day or a week and the delivery time of an order.

How to receive a delivery

Once a shipment of supplies is received, the MA places the items in the storage room, reconciles the order with the items received, notifies the supplier if any items are missing or if the package slip is incorrect, and submits the forms to accounts payable for repayment.

Physician authorization of order

Certain supplies can only be ordered with the authorization of the physician, such as for controlled substances, medications, needles, and certain sterile solutions.

Logging equipment maintenance

• Equipment information

• Manufacturer information

• Date of purchase

• Warranty information (e.g., start and end dates, warranty coverage)

• Service provider contact information

• Information about the maintenance activities

Monitoring equipment for function and readiness

• Check equipment for any problems.

• Look for frayed wires, bent or damaged instruments, and machines with improper functioning.

• Dust or wipe the office machines regularly.

• Replace the batteries, fluids, paper, or toner as required.

• Document the maintenance of the piece of equipment in a log.

Factors for replacing equipment

• Age of the piece of equipment

• Cost of the new piece of equipment

• How often the equipment is used (i.e., daily, weekly, monthly, rarely)

• If the manufacturer still produces parts for repair

• Any features that have been added to newer models of the equipment

Use of emergency equipment

• Ensure readiness of the use of emergency equipment, and check emergency equipment at least monthly.

• Check the emergency box or crash cart by using a checklist that helps indicate if any contents are missing.

• Check oxygen tanks. If the oxygen level falls, refill the tanks.

• Check the expiration dates of emergency medications.

Steps for routine equipment maintenance

• Ensure there is no fraying by checking all electrical cords and plugs.

• Check for cracks, dents, or other damage to the equipment.

• Check for cracks, faded numbers, letters, or other impairment on keyboards or keypads.

• Wipe or dust pieces of equipment as per the manufacturer’s directions.

• Check or change batteries, fluid, toner, or other essential components.

Service contracts

an agreement in which the service provider offers repair calls after the expiration of the manufacturer’s warranty for a particular piece of equipment.

Service calls

Maintaining a record of service calls, including the reason for the call, the response from the technician, details about the service charge, and any follow-up requirements is essential to understanding the product and keeping good track of equipment.

Patient and employee safety

• Maintain equipment and perform safety inspections regularly.

• Provide training to employees on how to stay safe in the workplace.

• Build open lines of communication so that any errors and accidents can be reported easily without fearing their repercussions.

• Regularly analyze all incidents that occur on the premises, including the “near misses,” to ensure all systems are in their appropriate place.

• The most effective tool to prevent accidents or injuries is to make people aware of the hazards and create a culture in which every employee must respond to potentially harmful situations.

Safe work practices

• Measures to manage spills of blood, body fluids, or chemicals.

• Measures to prevent infection.

• Procedures for handling and disposing of hazardous materials.

Safety checklist

Every corner of the office must be checked for sufficient lighting, clear walkways, proper storage of supplies, and proper disposal of biohazard waste. The storage areas of compressed gases, medications, and chemicals must also be checked.

Safety sign, symbol, and label regulations

• Print the signs identified and place at the appropriate place. A sign for authorized personnel only should be placed outside the room entry is restricted.

• Educate patients and colleagues about the signs and the need for complying with it.

Immediate danger signs

Signs with red on the upper panel and black lettering and a white background.

Caution signs

Signs with either yellow lettering on a black background or black lettering on a yellow background. 

Exit signs

Signs that are white with red lettering, not less than 6 inches high and 3/4 inch wide.

Biohazard warning signs

Signs with explanatory text, typically red and orange.

Radiation symbol signs

Signs with a radiation symbol and text to indicate X-ray equipment or other forms of radiation. It includes a red circle crossed by a diagonal line.

Eye wash station signs

Signs or labels with green background representing the activity of eye washing.

Body mechanics

the field that involves using the correct muscles to maintain appropriate balance and posture that helps achieve tasks more efficiently and safely, without strain or stress on the muscles and joints.

Mechanics while standing

• Wear low-heeled shoes that are comfortable and offer good support.

• Maintain the head erect at the midline of the body, keep the back as straight as possible

• Flex the knees slightly with the feet pointing forward. This position gives a broad base of support and improves balance.

Mechanics while sitting

• Sit in a chair with a rigid back.

• Sit firmly with the back and buttocks supported by the back of the chair. Distribute the body weight evenly over the buttocks and thighs.

• Keep the feet flat on the floor and the knees level with the hips.

• Use a footstool to raise one knee to reduce strain on the back when sitting for a prolonged time.

Mechanics while lifting

• Bend the body at the knees and hips while lifting the object.

• Grab the object firmly with both hands.

• Keep the back straight and lift the object slowly with the leg muscles.

• Hold the object close to the body at waist level.

• Turn by pivoting the whole body and not by twisting.

• Lower the object slowly; bend from the knees so that leg muscles can do the work.

Immediate opening tasks

1. Deactivating the alarm system in the office

2. Turning on the lights

3. Calling the service to indicate the office is open

4. Unlocking the door through which patients and visitors enter

5. Unlocking file cabinets, medication cabinets, and medical record files

Non-immediate opening tasks

1. Checking and adjusting the temperature

2. Turning on all of the office equipment that will be used during the day

3. Turning on the machines that are used daily, such as computers, printers, etc.

4. Checking the telephone, ensuring it is set to the daytime setting, and retrieving all the messages on the answering service or electronic mailbox

5. Counting and recording the amount in the cash drawer

6. Checking the office for safety hazards such as frayed wires, items blocking corridors or walkways, etc.

7. Arranging the waiting room

8. Making sure the exam rooms are cleaned and stocked with supplies

9. Preparing biohazard waste containers

10. Checking the autoclave and turning it on

Preparing for the day’s activities

• Organize the day’s activities by checking patient appointments and provider schedules.

• Use a tickler file or electronic tasks system to set up reminders about daily activities.

Preparing patient charts

• Prepare patient records before the patient arrives by pulling up the information in the electronic health record on the computer.

• Arrange paper charts for the provider, if the facility uses both electronic and paper-based records.

• Print and place copies of the appointment schedule at designated locations, such as at the physician’s desk, reception desk, and medical assistant’s desk.

• Place the paper medical records at the front desk, if the facility uses both electronic and paper-based records. The MA may also print out pages from the electronic health record to place at the front desk.

Closing duties

1. Ensure the examination room is clean and contains all supplies.

2. Start the autoclave so that supplies can dry overnight.

3. Prepare and print the patient schedule for the next day.

4. Ensure computers are turned off and users are logged out of the electronic health system in case the system needs to run updates overnight.

5. Print and attach charge slips to each patient’s medical record, if the facility uses both electronic and paper-based records.

6. Make sure all cabinets containing medical records are locked.

7. Place any money received during the day in a safe place or deposit in the bank, and balance the cash drawer.

8. Activate the telephone-answering device and night system for the office’s telephones.

9. Turn off all electrical appliances that may pose a fire hazard.

10. Lock the door through which patients enter, and turn off the lights.

11. Activate the alarm and ensure the door is locked.

Patient check-in

• Maintain confidentiality.

• Obtain information about new patients.

• Ensure acknowledgment of the receipt of notice of privacy practice by patients.

• Verify insurance and obtain authorizations.

• Verify managed care referral using the Internet and a referral form from the referring physician, and by the patient completing a referral form from the referring physician.

• Verify billing information for established patients.

• Accept copayments.

Temp and ventilation control

• Adjust the temperature to a comfortable level as patients who are ill may be sensitive to cold.

• Maintain a temperature of 70–72° F in the reception area and 68–70° F in the exam and treatment rooms.

Cleaning cabinets and drawers

• Check the labels of supplies for expiration dates.

• Discard outdated supplies.

• Make a list of supplies that need to be ordered or restocked.

• Ensure proper disposal of outdated supplies.

General cleaning

• Ensure that the reception and waiting rooms, administrative space, physicians’ offices, and examination and treatment rooms are kept clean.

• Check and empty the waste containers and recycling containers daily.

• Ensure proper dusting and cleaning of restrooms, polishing of furniture and other accessories, and cleaning of glass at the reception area.