2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35 Preparing the Examination and Treatment Area

3. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-2 Learning Outcomes 35.1Explain the medical assistant’s role in preparing the examination room. 35.2Describe the layout and features of a typical examination room. 35.3Describe steps to prevent the spread of infection in the examination room. 35.4Explain how and when to disinfect examination room surfaces.

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-3 Learning Outcomes (cont.) 35.5Describe the importance of such factors as temperature, lighting, and ventilation in the examination room. 35.6Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them. 35.7Explain how to eliminate hazards to physical safety in the examination room.

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-4 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

6. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-5 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

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-6 The Medical Assistant’s Role in Preparing the Examination Room (cont.) Main concerns are

8. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-7 Apply Your Knowledge 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

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-8 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

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-9 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

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-10 Exam Room Furnishings Should be arranged for: –Efficiency –Patient comfort –Physician convenience Items commonly found in examination rooms  One or more chairs  A rolling stool  Weight scale  Biohazard container  Wastebasket with lid  Puncture-proof containers  Wall brackets  High-intensity lamp

12. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-11 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

13. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-12 Special Features Doorway must be at least 36 inches wide Clearance space in rooms and hallways at least 60 inches wide Slip-resistant floors Door-opening hardware can be grasped with one hand and does not require twisting of the wrist to use Door closers must be adjusted to allow entry and exit time Grab bars in lavatories ADA Guidelines

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-13 Apply Your Knowledge ANSWER: You need to consider efficiency, patient comfort, and physician convenience when arranging an examination room. When arranging an examination room, what three things should you consider? Right!

15. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-14 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

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-15 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

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-16 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.

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-17 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

19. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-18 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

20. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-19 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. Apply Your Knowledge Good Job!

21. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-20 Room Temperature, Lighting, and Ventilation Maintain examination room temperature at about 72°F Eliminate drafts from windows and doors

22. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-21 Room Temperature, Lighting, and Ventilation (cont.) Good lighting needed –Accurate diagnoses –Perform medical procedures –Read orders and instructions –Prevent accidents

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-22 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

24. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-23 Apply Your Knowledge ANSWER: Good lighting is needed for making accurate diagnoses, performing medical procedures, reading orders and instructions, and preventing accidents. Why is it important to have good lighting in the examination room? Excellent!

25. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-24 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

26. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-25 InstrumentPurpose AnoscopeUsed to open the anus for examination Examination lightProvides additional lighting Laryngeal mirrorReflects inside of mouth and throat Nasal speculumUsed to enlarge the opening of the nose OphthalmoscopeUsed to examine the inner eye surfaces Instruments for a General Physical Exam

27. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-26 InstrumentPurpose OtoscopeUsed to examine the inner ear PenlightSmall flashlight used to view a small area Reflex hammerUsed to check patient’s reflexes SphygmomanometerUsed to measure blood pressure StethoscopeUsed to listen to body sounds Instruments for a General Physical Exam (cont.)

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-27 InstrumentPurpose Tape measureUsed to measure size or development of an area ThermometerUsed to measure body temperature Tuning forkUsed to test patients’ hearing Vaginal speculumUsed to enlarge the vagina for specimens from cervix and vagina Instruments for a General Physical Exam (cont.)

29. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-28 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

30. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-29 Cervical scraperCotton balls Cotton-tipped applicators Curettes Disposable needlesDisposable syringes Gauze, dressings, and bandages Glass slides Sterile and clean gloves Paper tissues Occult blood test slides Specimen containers Tongue depressors Supplies for a General Physical Exam

31. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-30 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

32. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-31 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

33. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-32 stethoscope nasal speculum reflex hammer otoscope penlight laryngeal mirror ophthalmoscope tape measure sphygmomanometer tuning fork anoscope Apply Your Knowledge 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? *nasal speculum *otoscope *penlight *laryngeal mirror *ophthalmoscope *tuning fork ANSWER: Good Choices!

34. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-33 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

35. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-34 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

36. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-35 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

37. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-36 Fire Safety Store and dispose of hazardous substances correctly Post “No Smoking” signs in office areas Check electrical cords, plugs, and outlets Have functional smoke detectors Fire Prevention

38. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-37 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

39. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-38 A.Store the solutions with the other cleaning solutions in the usual cabinet. B.Lock the new solution up in a separate cabinet. C.Read the label carefully and check the MSDS information before storing the liquids. 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? Apply Your Knowledge ANSWER: Impressive!

40. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-39 In Summary 35.1It is the medical assistant’s responsibility to ensure that the examination room is neat, clean, and appropriately stocked. 35.2A 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.

41. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-40 In Summary (cont.) 35.3Steps 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.

42. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-41 In Summary (cont.) 35.4Examination 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. 35.5It 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.

43. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-42 In Summary (cont.) 35.6A 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.

44. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-43 In Summary (cont.) 35.7To 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.

45. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 35-44 Safety is something that happens between your ears, not something you hold in your hands. ~ Jeff Cooper End of Chapter 35