Does your support staff feel comfortable questioning you about an order that doesn’t seem right? Or are they reluctant to point out an error for fear of consequences? It can be difficult for a nurse or MA to approach allergists with a concern, but encouraging staff to have a questioning attitude will provide a safer environment for you, your staff and your patients.
A culture of safety is one which puts safety first, above everything else. A positive safety culture includes:
- An environment of openness and trust, where employees are free to discuss safety concerns without fear of blame.
- An environment that focuses on learning from mistakes – and putting processes in place to correct them.
From the ACAAI Risk and Compliance Toolkit, here are some steps you can take to create a culture of safety in your allergy practice:
Encourage identification of errors or near misses.
Identifying problems is the first step to fixing them. Encourage, rather than discourage associates from reporting errors, and let them know they won’t get in trouble when they do. Most of all, keep the “no blame” promise. You will likely learn about problems you didn’t know existed – which means you have an opportunity to fix them. Create a safety team to implement process changes to address identified problems, and report on safety successes and results at staff meetings. You may also want to consider an anonymous reporting option.
“Compile errors, de-identify them and use them as teaching tools,” recommends Tom Derrico, Vice-chair of the Practice Management Committee. “Review them with the staff periodically, discuss how they occurred and ask for discussion on how they can be prevented in the future. It can also be helpful when training new staff on the risks associated with clinical practice.”
Comply with USP 797 allergen extract mixing requirements.
The new USP 797 rules for mixing allergen extracts go into effect Nov. 1. Make sure your staff is properly trained, that compounding occurs in either an AECA or an ISO Class 5 PEC, and that you follow all documentation, cleaning, hygiene/garbing, BUD and labeling requirements. You can find all the resources you need to be compliant in the College’s Allergen Extract Mixing toolkit.
Create a “Quiet Zone” for drawing up allergy shots, vaccines and medications.
Drawing up allergy shots, vaccines and medications requires attention to detail and focus. Create an area in your office that is exclusively used for this purpose, where no interruptions are allowed. Post a “Quiet Zone” sign and put a colored mat on the floor to identify the area and educate all staff members that no one can be interrupted when they are in the quiet zone because they are engaging in a critical process.
Use the buddy system.
Require your clinical team to use the buddy system when drawing up allergy shots and vaccines. Have a buddy confirm the following are correct:
- Patient
- Order (i.e., confirm you haven’t ordered a flu vaccine for a patient who previously had one, and that the correct flu vaccine was ordered)
- Allergy shot or vaccine (i.e., the item to be administered matches the one ordered by the provider)
- Dose
- Product is not expired
“In our practice the patient does the final check before getting their allergy shots. They check the vials for name, DOB and dose. Each patient is given a dose sheet to keep and bring with them that they can check against,” said Alnoor Malick MD, FACAAI, Vice-chair of the Practice Management Committee. This helps ensure the patient understands their immunotherapy schedule and engages them in their care.
Do monthly facility checks.
Create a facility safety checklist and appoint a safety officer to walk through the office and sign off each month. Some items to check include:
- Do any medications, vaccines or rapid lab tests have expired dates?
- Are all unused electrical outlets filled with child safety plugs?
- Are there any tripping hazards (electrical cords, loose rugs, etc.)?
- Are all exam rooms properly stocked? Do they contain items that should not be there (sharps, medications, RX pads, etc.)?
- Are sharps and biohazardous waste being disposed of properly?
- Are all EXIT lights working, along with backup batteries?
- Are fire extinguishers properly charged and within code?
Creating a culture of safety requires a commitment from you and your staff. Make your safety journey a team effort, and you will find it pays off in terms of increased safety, employee engagement and reduced risk.
For more information on reducing practice risk, check out the College’s Risk and Compliance Toolkit.
