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The Elements of Premises Risk Management

By Cliff Rapp, LHRM, Vice President of Risk Management, FPIC

Professional liability companies also encounter claims involving premises risks. These are usually not high dollar loss cases, but are frequent in number. One example is a slip or fall within examination rooms or waiting areas. Someone should be assigned to go through the office at least twice a year to look at the office with a critical eye to detect possible safety risks to the patients and staff members. As with medical risk management the goal is to prevent an event from ever happening in the first place.

A particular list of items to check include the following:

  • Are floors clean and nonskid? Are any carpet seams fraying, or does carpet need restretching to eliminate bulges, which can be tripped over?
  • Are equipment, boxes, supplies, etc., out of the way of foot traffic?
  • Are chairs and furniture stable, sturdy, and without sharp edges or splinters?
  • Are stairs, handrails, and steps safe and sturdy?
  • Is your office wheelchair accessible?
  • Are hallways free of obstacles?
  • Are there loose tiles on the ceiling or anything on the walls that can fall off and injure patients?
  • Are pieces of art safely suspended/attached to the wall?
  • Does your office present unsuspected risks for visually or hearing-impaired patients?
  • Are prescription blanks left in exam rooms?
  • Are outdated drugs and supplies checked and rotated?
  • Are chemical solutions, and undiluted and diluted medications clearly labeled?

When treating children it is important to keep sharp instruments and swallowable objects out of possible reach of children. In addition drug samples should be kept in closed closets and out of reach of children.

In case of power failure, it is important to have backup lighting. During office surgery, you would not want to interrupt a procedure due to lack of light. Battery pack auxiliary lighting is a good investment.

Set up a system to track the number of times an instrument is used. Also check sterilization methods at appropriate recommended intervals.

Avoid having staff drive patients home or to the hospital. Involvement in an automobile accident is an added risk. If necessary, call an ambulance.

Emergency Risk Management Plan

Are you and your staff prepared to handle an emergency situation? Physicians performing any invasive procedures in a non-hospital setting should review and comply with all state regulations with respect to facilities, equipment, and staff required for performing certain procedures. Even the most benign procedures conducted in your office may be considered office surgery by your state laws. Please review all state laws on performing office surgery or the use of anesthesia in your office to determine emergency equipment requirements.

The following is a list of criteria your office should have in place for a patient emergency situation:

  • Is emergency equipment/crash cart available in the office?
  • Is your clinical staff trained on how to use the emergency equipment/crash cart?
  • Does all your staff know the location of your emergency equipment/crash cart?
  • Is staff trained and certified in CPR?
  • Is the crash cart purged and updated regularly according to an established schedule? Do you record cart checks?
  • Does your office have a written emergency plan:
  • Who will call 911?
  • Who will start CPR?
  • Who will notify the doctor?
  • Who will get the emergency equipment/crash cart?
  • Who will call the hospital ER?
  • Who will watch for the EMTs?
  • Who will notify the patient’s family?

Your office should have a fire drill plan and posted evacuation route(s). Practice fire drills throughout the year. The following is a list of fire emergency suggestions for your office:

  • Does all your staff know the locations of the fire extinguishers?
  • Is your office equipped with smoke detectors? Is this equipment checked on a regular basis?
  • Are fire drills conducted in your office?
  • Does all your office staff know the locations of the emergency exits in your office?
  • Who will notify all the patients in the treatment rooms about the emergency and help escort the patients out of the building?
  • Who will call your answering service to notify them of the emergency?
  • Who will notify all your staff?
  • Who will take a copy of the schedule and check that all patients who had appointments at the time of the fire got out safely?
  • Who will get a printout from the computer of the patients scheduled for appointments and notifies them of the emergency?
  • Who will notify other physicians who are away from the office of the emergency and tell them not to come to the office?
  • Who will call the fire department?

Every office should be prepared for any form of an emergency situation (e.g., patient emergency, fire, and a natural disaster). Your office should have a plan for each one of these emergencies.