Small Mistakes, Huge Disasters
By Perry Nickelston, DC, FMS, SFMA
"Mistakes are the portal to discovery." — James Joyce
Profound words of wisdom indeed. You will also find that learning from other people's mistakes saves a lot of time in the discov-ery process.Making mistakes is how we gain experience. Typically, the most successful people have made the most mistakes.
In today's economy you can't afford to make careless mistakes. As a doctor, mistakes can make you liable for malpractice. As an entrepreneur, mistakes make you vulnerable to decreased profits. Oftentimes, it is the mistakes you make out of complacency in poli-cies and procedures that come back to haunt you. Be painstaking in your quest to be the best and stay true to a system of professional standards.
A hammer in the hands of someone without the skills to use it properly can be a dangerous tool. Even a skilled craftsman can get hurt if they are careless in the application of their craft. It only takes a split second for things to go wrong. Just because something seems simple and easy, doesn't mean it can't be harmful. Taking routine treatment procedures for granted will make you susceptible to costly mistakes. Unattended or improp-erly used medical equipment can be dangerous. Follow the suggestions below along with the safety checklist for common equipment found in practices, and you will be on the fast track to discovery.
Powered Treatment Tables
Things can go horribly wrong when curious patients start touching the table and pushing buttons. Even worse, children might be in the room and accidents inherently happen. All you need is for a table to come crashing down on a child [as recently happened in a chiropractic practice, causing the child's death]. There are dangers of pinching fingers or even severed limbs.
Do not drop your guard for a single moment. Put the safety switch on when you are not in the room. Many doctors have tables in an upright position ready for the patients to stand on and then lower for treatment. If so, make the safety lock mechanism an absolute priority.
Stick a Post-It note or reminder somewhere in the room to always remind you to engage the safety switch. On busy office days, it can get chaotic and you might forget. Post a professionally-made sign inside each room warning patients not to touch the medical equipment. This is a great secondary back-up reminder for you, and in the event of a liability claim, you have proof that you took the time and energy to engage preventative risk procedures.
Electrical Muscle Stimulation
Check your pads on a regular basis to ensure proper contact. Do not exceed the life of the pads beyond recommended applications or you risk a painful electrical arc. EMS is most often an unattended modality and you do not want an electrical arc to occur when patients are alone and vulnerable. Don't be so gung-ho to crank up the power on the device. More is not always better. Better is better. If using EMS in conjunction with heat or ice modalities, ensure there is proper padding to prevent skin damage. Blistering or ice burns often occur when combined with electrical muscle stimulation due to the inherent superficial analgesic effects of the modal-ity. Stay with the patient for a moment before you leave the room unattended to make sure they are comfortable. This helps establish the trust relationship when the patient gets a true sense of how much you care.
In addition, document instrument settings so you are not haphazardly administering therapy, and so you have benchmarks for im-provement.
Ointments and Gels
Many people are hypersensitive or allergic to pain relieving ointments. Always ask the patient if they have allergies or sensitivities to creams, gels or ointments. Massage and man-ual therapy creams should also be evaluated for potential allergic ingredients. Read application directions carefully on any topical treatment modality. Applying pain-relief modalities in conjunction with heat or ice might be contraindicated due to increased skin sensitivity. Never assume you can apply the same therapy or treatment to each patient.
Explain to each patient what you want to apply, the reasoning behind it and what they should expect. Note resultant skin irritations and patient response to any topical application. You might find that some patients do not like to have gels or ointments applied during therapy. If so, respect their wishes.
There is a fine line between giving patients what they want and giving them what they need. This is where your expertise comes into play in balancing this variable for patients to reach their end goal.
Heat Packs and Ice
When using heat or ice, ensure there is an adequate buffer zone between skin and modality. Seems simple enough, right? Wrong. It's often the simplest of procedures that cause the biggest problems. It is very easy to get an ice or heat burn if applied improperly. Put a timer in each room as backup to assure the modality is not on for too long. Patients will often not say anything if a treatment is uncomfortable or even painful, thinking that some discomfort is normal if they want to get better. So, always ask the patient if they are uncomfortable.
When giving instructions for using heat or ice at home, walk the patient through the process step-by-step. Never presume they know how to apply ice or heat correctly. You might be held liable for what a patient does improperly at home with this simple mo-dality if you did not take the necessary time to review application procedures.
Patients often fall into the, "more is better" category in regards to heat and ice. How many times have you heard patients ask what they should use first, heat or ice? It's never a bad time to review the 72-hour rule of ice and heat application.
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