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CCMA 3.0 Focused Review
2023 Assessment Technologies Institute, L.L.C 1
# Patient Safety Within the Clinical Setting
The importance of safety in the ambulatory care setting cannot be underestimated. Make every effort to maximize the safety of patients and staff to prevent injury and avoid litigation. Planning for environmental emergencies, such as fires and natural disasters, is essential to protect human life. This involves identifying emergency policies and evacuation plans and having emergency equipment easily accessible.
In an emergency, pay particular attention to the safety of children, older adults, and patients requiring accommodations. Children are prone to falls and injuries involving sharp objects, choking on small items, or touching electrical outlets. When preparing the patient prior to being seen by the provider, take precautions to avoid a child falling from the examination table. Maintain visual and physical contact with patients until they return to their parent or guardian.
Patients may need assistance walking or getting onto an examination table. Some patients might also need supervision while waiting to be seen. Restrooms should be equipped with handrails and emergency alert buttons; if they are not available and there is a safety concern, someone should be with or near the patient.
For all patients, be alert for potential hazards and take measures to maximize patient safety. CCMA 3.0 Focused Review
> 2023 Assessment Technologies Institute, L.L.C 1
# Prepare Patient for Procedures
Patient Instruction
Preparing for the Examination
Prior to the patients arrival, review the patients medical record, including the completed history and physical examination, to make sure you understand the procedure and what supplies and equipment will be needed in the exam room. There are several tests and procedures that require specific patient preparation prior to the procedure, such as a colonoscopy or a fasting glucose test. Explain and review the needed preparation with the patient and verify that all instructions were followed before the procedure. If the patient did not complete necessary preparation or they have any questions, direct them to the health care provider. Confirm that an informed consent has been signed and is in the patients medical record.
Before entering an examination room that is occupied by a patient, always knock, announce yourself, and ask for permission to enter. Do not enter the room until the patient has expressed consent. This will help reassure patients that their privacy is respected.
Explain the procedure and the importance of the procedure in an empathetic, simple, and direct manner. Avoid using overly technical terms and encourage the patient to ask questions and to express any anxiety or concerns.
Ask patients to empty their bladder before undressing. If a urine sample is required, give complete and detailed instructions. Patient gowns and drapes should be provided for the patients comfort and privacy for all examinations. Explain to the patient which items of clothing should be removed for the exam and instruct them whether to put on the gown with the opening in the front or the back. For a problem-focused visit or exam, only some clothing items may need to be removed, such as all clothing above the waist. Assist patients with disrobing and with stepping up onto the examination table as needed. Ensure that gowns of all sizes are available for patients who are required to change clothing for an examination or a procedure. Inform patients where their personal clothing and belongings can be stored during the examination. Once the patient is ready, notify the health care provider.
After the procedure, assist the patient down from the examination table if needed. The patient may become lightheaded when sitting up if they were lying down for the procedure. Allow the patient privacy when getting dressed. Assist the patient with getting dressed as needed. CCMA 3.0 Focused Review
> 2023 Assessment Technologies Institute, L.L.C 2
Providing Patient Education
Provide the patient information about any follow-up appointments, additional exams, aftercare instructions, and referrals. Let the patient know when to expect results from lab, radiology, or any other diagnostic tests. Ask if the patient has any questions and direct appropriate questions to the health care provider to answer.
In some cases, it may be helpful to call the health care provider for advice on whether a situation is an emergency. If the provider is not immediately available, the patient may be recommended to call 911 or go to the nearest hospital. CCMA 3.0 Focused Review
> 2023 Assessment Technologies Institute, L.L.C 1
# Phlebotomy
Patient Preparation
Patient preparation instructions are essential for accurate test values. Fasting is the most common patient preparation instruction. If a patient is required to fast prior to a procedure, they need to be instructed not to eat or drink anything but water for a certain period of time prior to having their blood drawn. Most fasting blood tests require a 12-hour fast. Presence of certain substances in the blood can be affected by fluid intake and food. For example, patients should fast prior to having a lipid panel. If the patient ate a meal prior to having blood drawn, the test values would likely detect fats from the food and the results would indicate elevated lipid levels. Another possible patient preparation requirement is medication restrictions. Therefore, verify that all preparation guidelines were followed by the patient prior to all phlebotomy procedures. The laboratory directory will indicate if any patient preparation is required prior to blood collection. Patients must be asked upon arrival if they have completed the required preparations (if any). If they have not, the MA must explain to the patient that the procedure cannot be performed.
The MA should introduce themselves and approach each patient with a pleasant, warm demeanor. Some patients have little or no issue with the process of blood collection. Other patients have a great deal of anxiety when having blood drawn. In addition to performing the procedure correctly, make patients as comfortable as possible and be sensitive to their needs.
In preparation for the venipuncture, seat the patient in a comfortable, well-lit area. Position the patient with their arm extended out. If a phlebotomy chair with an extended arm rest is not available, have the patient make a fist with the opposite hand and place it behind the elbow of the arm being used for the procedure. This ensures the arm will stay straight and stable during the procedure. There could be difficulty when obtaining blood from children and infants. For pediatric patients, a support person could assist in holding the patients arm still to avoid injury. Effective communication and accurate skills are necessary when dealing with children.
Question patients about previous blood draws and what, if any, reactions they have had. This can prepare the MA for a possible adverse reaction to a phlebotomy procedure, allowing them to make adjustments or accommodations as needed. For example, if a patient reports that they often faint while having their blood drawn, have the patient in semi-Fowlers position or supine during the procedure to eliminate the risk of a fall. CCMA 3.0 Focused Review
> 2023 Assessment Technologies Institute, L.L.C 2
Explain the procedure and safety precautions to the patient. Be sensitive to verbal and nonverbal communication. If the patient is in obvious distress during the procedure, it may need to be stopped.