1. Preparing the Examination and Treatment Area35
Preparing the Examination and Treatment Area

2. Learning Outcomes
35.1 Explain the medical assistant’s role in preparing the examination room.
35.2 Describe the layout and features of a typical examination room.
35.3 Describe steps to prevent the spread of infection in the examination room.
35.4 Explain how and when to disinfect examination room surfaces.

3. Learning Outcomes (cont.)
35.5 Describe the importance of such factors as temperature, lighting, and ventilation in the examination room.
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.
35.7 Explain how to eliminate hazards to physical safety in the examination room.

4. Introduction Preparation of the exam room and treatment area
Common layouts
Cleanliness and supplies
Comfort of room
Safety
Accessibility based on the Americans with Disabilities Act
Learning Outcome:
35.1 Explain the medical assistant’s role in preparing the examination room.

5. The Medical Assistant’s Role in Preparing the Examination Room
Maintain neatness and cleanliness of the room
Ensure that all supplies and equipment needed are present for the physician’s use
Make certain that potential safety hazards are eliminated
Learning Outcome:
35.1 Explain the medical assistant’s role in preparing the examination room.

6. The Medical Assistant’s Role in Preparing the Examination Room (cont.)
Main concerns are
Safety
Comfort
Learning Outcome:
35.1 Explain the medical assistant’s role in preparing the examination room.
Efficiency

7. Apply Your Knowledge Correct!
What are three tasks the medical assistant should do to prepare the examination room?
ANSWER: The medical assistant should
Maintain neatness and cleanliness of the room
Ensure that all supplies and equipment needed are present for the physician’s use
Make certain that potential safety hazards are eliminated
Correct!

8. The Examination Room The area where the physician:
Observes the patient
Listens to patient symptoms
Performs a general physical examination to confirm health or diagnose a medical problem
Learning Outcome:
35.2 Describe the layout and features of a typical examination room.

9. The Examination Room (cont.)
Number and size of rooms
Depends on the number of physicians in the medical practice
Average size room is 8 × 12 ft
Rooms should be large enough for patient, physician, and medical assistant, yet small enough to have supplies within reach
Learning Outcome:
35.2 Describe the layout and features of a typical examination room.
Ideally, each doctor in a medical office should have at least two exam rooms.
Medical assistant prepares one room while doctor examines patient in the other.

10. Exam Room Furnishings Should be arranged for:
Efficiency
Patient comfort
Physician convenience
Items commonly found in examination rooms
Learning Outcome:
35.2 Describe the layout and features of a typical examination room.
Key equipment found in exam room
Examining table
Sink
Countertop
Writing surface
Shelves, cupboards, drawers for routine supplies
One or more chairs
A rolling stool
Weight scale
Biohazard container
Wastebasket with lid
Puncture-proof containers
Wall brackets
High-intensity lamp

11. Special Features The 1990 Americans with Disabilities Act (ADA)
Requires “reasonable accommodations”
Compliance requires that medical office be accessible to patients with disabilities
Accessibility – the ease with which people can move in and out of a space
Learning Outcome:
35.2 Describe the layout and features of a typical examination room.

12. Special Features Doorway must be at least 36 inches wide ADA
Guidelines
Doorway must be at least 36 inches wide
Grab bars in lavatories
Door-opening hardware can be grasped with one hand and does not require twisting of the wrist to use
Clearance space in rooms and hallways at least 60 inches wide
Learning Outcome:
35.2 Describe the layout and features of a typical examination room.
Door closers must be adjusted to allow entry and exit time
Slip-resistant floors

13. Right! Apply Your Knowledge
When arranging an examination room, what three things should you consider?
ANSWER: You need to consider efficiency, patient comfort, and physician convenience when arranging an examination room.
Right!

14. Cleanliness in the Examination Room
Strict housekeeping standards
Adherence to government guidelines
Infection control
Make hand washing a priority
Keep examining table clean
Disinfect all work surfaces
Learning Outcomes:
35.3 Describe steps to prevent the spread of infection in the examination room.
35.4 Explain how and when to disinfect examination room surfaces.
People with a variety of contagious diseases visit medical offices every day.
Potential for spread of infection is higher in medical offices than in most other places.
You must be especially careful to follow infection-control procedures.

15. Cleanliness in the Exam Room (cont.)
Clean hands – first step in preventing infection transmission
Wash hands
At the beginning of the day
Before and after contact with each patient
Before and after using gloves
Before and after eating
After coughing or blowing your nose
Before handling clean or sterile equipment
Before leaving for the day
Learning Outcome:
35.3 Describe steps to prevent the spread of infection in the examination room.
After washing hands, use clean paper towel to handle faucets or doorknobs.

16. Cleanliness in the Exam Room (cont.)
Examining table
Change the disposable paper covering the examination table after each use
Dispose of paper coverings soiled by body fluids in a biohazardous waste container
Also place soiled linens and pillowcases in biohazard-labeled bags.
Learning Outcomes:
35.3 Describe steps to prevent the spread of infection in the examination room.
35.4 Explain how and when to disinfect examination room surfaces.
Lubricant: Water-soluble gel used during exam of the rectum or vaginal cavity.
Roll up paper covering quickly and carefully to avoid stirring up dust and microorganisms that can spread infection.

17. Cleanliness in the Exam Room (cont.)
Surfaces
10% bleach solution or product approved by the EPA
Disinfect work surfaces if visibly contaminated and at end of shift
Sink and countertops
Examination table
Patient lavatory
Storage
Store biohazardous specimens properly
Store testing kits properly
Learning Outcomes:
35.3 Describe steps to prevent the spread of infection in the examination room.
35.4 Explain how and when to disinfect examination room surfaces.

18. Cleanliness in the Exam Room (cont.)
Putting the room in order
Straighten room between patients
Boosts patient confidence in efficiency and abilities of medical personnel
Housekeeping
Janitorial services for after-hours cleaning
Monitor for lapses in cleanliness
Medical assistant may do some housekeeping chores
Learning Outcomes:
35.3 Describe steps to prevent the spread of infection in the examination room.
35.4 Explain how and when to disinfect examination room surfaces.
Putting the room in order
Put rolling stool in its place
Push in the examining-table step
Return supplies to containers
Secure prescription pads and samples that may have been left out

19. Apply Your Knowledge
Good Job!
A medical assistant at a busy pediatrician office notices a foul odor in two of the patient examination rooms. After careful inspection, the medical assistant finds soiled diapers in the biohazardous containers of both rooms. How would you handle this situation?
ANSWER: The first priority is to remove the source of odor, then to decontaminate the area. It may also help to designate a separate location in the office for soiled diapers so that parents will know how to dispose of them. Many pediatrician offices have a system in place to prevent such odors in treatment room areas.

20. Room Temperature, Lighting, and Ventilation
Maintain examination room temperature at about 72°F
Eliminate drafts from windows and doors
Temperature
Learning Outcome:
35.5 Describe the importance of such factors as temperature, lighting, and ventilation in the examination room.
A warm room can help an anxious patient relax.

21. Room Temperature, Lighting, and Ventilation (cont.)
Good lighting needed
Accurate diagnoses
Perform medical procedures
Read orders and instructions
Prevent accidents
Lighting
Learning Outcome:
35.5 Describe the importance of such factors as temperature, lighting, and ventilation in the examination room.
If room has exam lamp with movable arm, be sure the arm is positioned appropriately.
Replace all burned-out light bulbs as soon as possible.

22. Room Temperature, Lighting, and Ventilation (cont.)
Examination area should smell clean and fresh
Eliminate source of odors
If opening windows, monitor room temperature
Room deodorizer or spray
Ventilation
Learning Outcome:
35.5 Describe the importance of such factors as temperature, lighting, and ventilation in the examination room.

23. Excellent! Apply Your Knowledge
Why is it important to have good lighting in the examination room?
ANSWER: Good lighting is needed for making accurate diagnoses, performing medical procedures, reading orders and instructions, and preventing accidents.
Excellent!

24. Medical Instruments and Supplies
Tasks to maintain instruments and supplies
Order and stock all needed supplies
Sanitize, disinfect, and/or sterilize instruments as needed
Instruments and supplies should be placed within easy reach for the physician
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.

25. Instruments for a General Physical Exam
Purpose
Anoscope
Used to open the anus for examination
Examination light
Provides additional lighting
Laryngeal mirror
Reflects inside of mouth and throat
Nasal speculum
Used to enlarge the opening of the nose
Ophthalmoscope
Used to examine the inner eye surfaces
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.
Most instruments are either fine-grade stainless steel or disposable. Some stainless steel instruments have disposable parts.
Discard disposable instruments and supplies according to OSHA guidelines.

26. Instruments for a General Physical Exam (cont.)
Purpose
Otoscope
Used to examine the inner ear
Penlight
Small flashlight used to view a small area
Reflex hammer
Used to check patient’s reflexes
Sphygmomanometer
Used to measure blood pressure
Stethoscope
Used to listen to body sounds
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.

27. Instruments for a General Physical Exam (cont.)
Purpose
Tape measure
Used to measure size or development of an area
Thermometer
Used to measure body temperature
Tuning fork
Used to test patients’ hearing
Vaginal speculum
Used to enlarge the vagina for specimens from cervix and vagina
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.

28. Instruments for a General Physical Exam (cont.)
Inspecting and maintaining instruments
Be sure instruments are in good working order
Arranging instruments
Keep instruments in same location, either:
Mounted on wall
Out on countertop
Set on a clean towel or tray
Preparing instruments
Some instruments require warming
Cleaning instruments
Place used instruments in a container and always handle carefully
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.
Wash your hands before handling instruments.
If instruments are sterile, you must also wear sterile gloves.
Cleaning instruments: Use approved procedures for sanitizing, disinfecting, and sterilizing reusable instruments and equipment.

29. Supplies for a General Physical Exam
Curettes
Cervical scraper
Cotton balls
Disposable needles
Disposable syringes
Cotton-tipped applicators
Glass slides
Sterile and clean gloves
Paper tissues
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.
Specimen containers
Gauze, dressings, and bandages
Occult blood test slides
Tongue depressors

30. Consumable Supplies Supplies that are used up
Fixative – chemical spray used for preserving a specimen
Isopropyl alcohol
Lubricant – a water-soluble gel
Be sure patients do not have access to
Prescription blanks
Drugs
Needles
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.

31. Medical Instruments and Supplies (cont.)
Storing supplies in cabinets and drawers
Label so items can be easily located
Routinely straighten and clean
Restocking supplies
Reorder when the first half of a box, tube, or bottle has been used
Learning Outcome:
35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.
Information needed for tracking supplies
Types of supplies your office uses
Quantities of each type of supply you use in a given amount of time
Frequency with which you must reorder particular supplies
Names of various suppliers, along with the amount of time it takes to receive your orders

32. Apply Your Knowledge Good Choices!
A medical assistant is preparing the treatment room for a local ENT specialist. Which of the following instruments might be used in this office to assess patient ear, nose, and throat functioning?
ANSWER:
stethoscope
nasal speculum
reflex hammer
otoscope
penlight
laryngeal mirror
ophthalmoscope
tape measure
sphygmomanometer
tuning fork
anoscope
*penlight
*nasal speculum
*laryngeal mirror
*tuning fork
*ophthalmoscope
*otoscope
Good Choices!

33. Physical Safety in the Exam Room
Floor
Wipe up spills immediately
Pick up dropped items
Be sure carpets and rugs are intact
Cabinets and drawers
Keep closed
Prevents injury
Supplies not exposed to patients
Learning Outcome:
35.7 Explain how to eliminate hazards to physical safety in the examination room.
Destroy and dispose of medications that are accidentally dropped on the floor.

34. Physical Safety in the Exam Room (cont.)
Furniture
No rough edges or sharp corners
Pull from service and check with supervisor
Cords and cables
Taped or fastened down
Replace if worn
Learning Outcome:
35.7 Explain how to eliminate hazards to physical safety in the examination room.

35. Special Safety Precautions
Children
Keep medication and dangerous items out of reach
Toys should be washable and safe
Be sure toys do not have any sharp surfaces
Patients with disabilities
Fall precautions
Safe flooring and handrails
Learning Outcome:
35.7 Explain how to eliminate hazards to physical safety in the examination room.
Children
Keep toys and books picked up when they are not in use.
Sanitize and disinfect toys after sick children play with them.
Check toys periodically for sharp edges.
Disabled patients
Do not leave severely disabled patients alone in an exam room.
Check office guidelines regarding appropriate chaperones

36. Fire Safety Fire Prevention
Store and dispose of hazardous substances correctly
Post “No Smoking” signs in office areas
Check electrical cords, plugs, and outlets
Have functional smoke detectors
Learning Outcome:
35.7 Explain how to eliminate hazards to physical safety in the examination room.
In case of fire, be prepared to
Use fire safety equipment
Evacuate the building safely

37. Fire Safety (cont.) In case of fire Using safety equipment
Fire extinguisher – “PASS” system
Have a safe evacuation route
Locate fire alarms, fire doors, and fire escapes
Stage fire drills
Learning Outcome:
35.7 Explain how to eliminate hazards to physical safety in the examination room.
PASS system
Pull the pin
Aim at base of fire
Squeeze trigger
Sweep side to side

38. Impressive! Apply Your Knowledge
The medical assistant has received the recently ordered office cleaning supplies. When unpacking the cleaning solutions for storage, he finds two new disinfectant solutions that he is unfamiliar with. How should the medical assistant handle this?
Impressive!
ANSWER:
Store the solutions with the other cleaning solutions in the usual cabinet.
Lock the new solution up in a separate cabinet.
Read the label carefully and check the MSDS information before storing the liquids.

39. In Summary
35.1 It is the medical assistant’s responsibility to ensure that the examination room is neat, clean, and appropriately stocked.
35.2 A typical examination room is about 8 by 12 feet, large enough to accommodate the physician, the patient, and one assistant. Instruments and equipment in the room should be easily accessible.

40. In Summary (cont.)
35.3 Steps involved in preventing the spread of infection in the examination room include covering the examination table with a paper cover and changing the cover between each patient. It is also important to disinfect all surfaces that come in contact with blood or body fluids after each patient, and at the beginning and end of the day.

41. In Summary (cont.)
35.4 Examination room surfaces should be disinfected after an examination or treatment during which surfaces have become visibly contaminated, immediately following accidental blood or body fluid spills or splatter, and at the end of the medical assistant’s work shift It is important that patients feel comfortable in the examination room. A room that is comfortably warm, well lit, and properly ventilated will help the patient feel comfortable during the examination.

42. In Summary (cont.)
35.6 A variety of instruments and supplies are used in a general physical examination. To ensure that the examination room always has the necessary instruments and supplies, the medical assistant should order and stock all supplies needed for examinations and treatment procedures, keep the instruments sanitized, disinfected, or sterilized and in working order, and place all instruments and supplies where the doctor can easily reach them.

43. In Summary (cont.)
35.7 To eliminate hazards to physical safety in the examination room, the medical assistant should be alert for any physical hazards in the area, including spills, dropped objects, open cabinet doors, damaged furniture, or improperly secured cords and cables.

44. End of Chapter 35
Safety is something that happens between your ears, not something you hold in your hands.
~ Jeff Cooper