When Doctors of Chiropractic think of patient safety, they often think about maintaining safe office layouts or treatment plans. But it can also mean knowing what to do when a patient has a potential adverse reaction to care or is experiencing an emergency.
by Nicole Ingrando, D.C. in Patient Interactions on Wednesday, May 24, 2017
- A chiropractic assistant is performing manual therapies when the patient reports feeling dizzy, faint or lightheaded upon sitting up.
- The receptionist notices a patient nodding off in the reception area, walking clumsily to the front desk, or otherwise speaking, moving or acting in an erratic manner.
Where does the patient’s responsibility end and yours begin when it comes to patient safety?
A Team Approach Is Essential
As a starting point, it is crucial for the staff to know what to do. The entire team—from the front desk employees to the doctors—should be trained on patient safety.
Patient safety protocols should be in place so staff members know when to attend to the patient and when to advise the doctor. They must be able to recognize when a patient’s behavior is outside the norm. They should know when to calm the patient, secure the patient’s surroundings and call for emergency assistance.
Once notified of a potential patient emergency, the doctor should begin by checking the patient’s vitals:
- Are they within normal limits?
- Is the patient demonstrating labored or painful breathing?
- Has the patient become injured or is an existing injury a factor?
In the meantime, assess the patient’s state of mind and other factors:
- Have they felt this way before?
- Do they know where they are?
- Are they experiencing any visual disturbances or paresthesia?
- Have they eaten today?
- Is the patient a diabetic or taking any medication?
Having patient healthcare records easily accessible is also important. Staff can be directed to print the patient intake forms for the responding doctor. That way, you can review the patient’s previous medical history, which is especially important if he or she is not able to communicate normally. When in doubt, it is better to call 911 versus allowing patients to leave or drive themselves to the hospital.
Guiding the Patient
There are times, of course, when a patient will insist on leaving the office without support. There is only so much you can do to control the situation. However, having an office policy and safety protocol, ensuring everyone is trained on an ongoing basis and documenting thoroughly are key.
If the records detail the patient’s history and examination, and if informed consent remains ongoing, effective decision making should naturally follow. This will better enable you to deliver essential care to the patient.
Another important aspect of maintaining patient safety is effective communication and involvement. By using clear language that is tailored to the patient’s level of understanding, providing specific follow-up instructions, and involving patients in the decision-making process, you help them be active participants in their care and safety.
Safety Is a Multifaceted Approach
Patient safety is the number-one priority for chiropractic practices. There are many ways to “first do no harm.” Experienced practitioners and new graduates alike must establish safety policies and procedures for everyone in the office to follow.
How Safety is Applied in Dr. Ingrando’s Practice
Dr. Ingrando’s office has two individuals with experience in patient emergencies.
Dr. Aaron Proctor served as a combat Army medic before becoming a chiropractor. The office manager, Vinny Ingrando, spent 12 years as a firefighter and first responder in countless emergency situations. With their critical feedback, they have developed an internal protocol for handing difficult scenarios.
Dr. Proctor believes that doctors and staff should act based on facts at hand and not allow emotions (worrying about patient perceptions) to intervene with decision making. “If you can’t be reasonably sure that an underlying process is not presenting, then you must escalate the scope of testing and intervention outside the clinic.” In other words, the patient must go to the hospital.
Vinny Ingrando says it’s better to be safe than sorry. “If we call 911 and allow the ambulance to take the patient to the hospital, then the patient has a better chance of arriving safely, versus allowing a patient to leave or drive themselves there.”