WELCOMEThe webinar will start shortly…

By Amy McLain, RN, BSN

Senior Risk Management & Patient Safety Specialist

Cooperative of American Physicians

Medical Assistant Liability:Their Vital Role and Sources of Risk

Webinar Learning Objectives

1. Understand the definition of a medical

assistant and what kind of training is required

to be an MA

2. Understand the MA’s scope of practice in the

medical office

3. Understand who can supervise the MA and how

4. Identify areas of risk associated with MAs

5. Identify ways to improve patient safety and

reduce medical liability risk

Laws Governing Medical Assistants

• California Business and

Professions Code

Sections 2069-2071

• California Code of

Regulations Title 16,

Article 2, section 1366-

1366.4

• California Health and

Safety Code Section

1204

Definition of a Medical Assistant

An unlicensed individual who performs basic

administrative, clerical, and technical

supportive services under the supervision of a

licensed physician, podiatrist, physician

assistant, nurse practitioner, or nurse

midwife.

On the Job Training

• Physician determines the content of MA

training

• A MA can be trained by a licensed physician

or podiatrist, RN, LVN, NP, PA, or a

qualified MA acting under the direction of a

licensed physician or podiatrist

• Written, signed, dated documentation of

training must be kept by employer

MA training MA

A “qualified medical assistant” is a medical assistant who is:

1. Is certified by a medical assistant certifying organization approved by the MBC (see slide 7), or

2. Holds a credential to teach in a medical assistant training program at a community college, or

3. Is authorized to teach medical assistants in a private postsecondary institution accredited by an accreditation agency recognized by the United States Department of Health or approved by the Bureau for Private Postsecondary Education.

Formal Education

• A secondary, postsecondary, or adult education program in a public school authorized by the Department of Education

• A community college program

• A postsecondary institution accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP.org) and the Accrediting Bureau of Health Education Schools (ABHES.org)

Certification

Board Approved Medical Assistant Certifying Organizations

American Association of Medical Assistants 20 N. Wacker Drive, #1575 Chicago, IL 60606-2963 http://www.aama-ntl.org

(312) 424-3100

American Medical Technologists 710 Higgins Road Park Ridge, IL 60068 http://www.amt1.com

(847) 823-5169

California Certifying Board of Medical Assistants P.O. Box 462 Placerville, CA 95667 http://www.ccbma.org

(866) 622-2262 or (530) 622-1850

Multiskilled Medical Certification Institute, Inc. P.O. Box 17 7007 College Boulevard Overland Park, KS 66211 http://www.mmciinc.com/

(888) 625-8408 or (913) 754-3287

Scope of Practice

• Clerical, administrative, and technical

support within an office or clinic setting -

not an inpatient setting

• Cannot diagnose, treat, or perform invasive

tasks or those requiring assessment

• Cannot be used to

replace a highly

skilled licensed

professional—MAs are

not nurses

Warning!

Physicians can be charged with aiding and

abetting the unlicensed practice of medicine.

Supervision

• An MA must always work under the direct

supervision of a licensed physician or

designated supervisor before performing

non-invasive technical support services of

any kind.

• A physician or designated supervisor

MUST BE physically present in the

treatment facility during the performance

of those procedures by an MA.

MA can…

Additional Training Required

• Medication (IM, SQ, Intradermal)

• Inhalation meds

• Venipuncture

• Skin puncture

• Skin tests

� A minimum of 10 clock hours with 10

satisfactory performances demonstrated

� Training includes: A&P, equipment choice,

technique, ER procedures, follow-up, law

MA can …(not complete list)

• Assist patients in ambulation

and transfers

• Prepare patients for

examinations and procedures,

including positioning, draping,

shaving, and disinfecting

treatment sites; and prepare

patients for gait analysis

testing

• Collect & record patient data

• Provide patients information

and instructions

MA can …(not inclusive list)

• Collect, by non-invasive

techniques, and preserve

specimens for testing, including

urine, sputum, semen, and stool

• Swab the throat in order to

preserve the specimen in a throat

culture

• Draw blood for tests, including

finger sticks and venipuncture

• Measure, describe, record, and

report skin test reaction

MA can …(not inclusive list)

• Apply and remove bandages and

dressings to superficial incisions

or lacerations

• Apply orthopedic appliances,

such as knee immobilizers,

envelope slings, orthotics, and

similar devices

• Obtain impressions for orthotics,

padding and custom-molded

shoes; select and adjust crutches

to patient; and instruct patient

in proper use of crutches

MA can perform…(not inclusive list)

• Simple laboratory and screening tests

customarily performed in a medical office

• Hearing tests under direct supervision

• Ear lavage to remove impacted cerumen

• Electrocardiogram, electroencephalogram,

• Spirometry pulmonary function testing

MA can administer…(not inclusive list)

• Oxygen to a patient via mask or

nasal cannula

• Allergy skin tests

• Fetal non-stress tests

• First aid or cardiopulmonary

resuscitation in an emergency

• Cut the nails of otherwise healthy

patients

• Remove sutures or staples from

superficial incisions and lacerations

MA can …(not inclusive list)

• Administer flu shots, allergy shots, and

other vaccines, and narcotic injections

• Administer medication

• Call in refills to pharmacy under direct

supervision

Case Study #1 :

No One Told the Doctor !

• A 3½ year-old with strabismus and ptosis

underwent repairs of both by an

ophthalmologist.

• Maxitrol (steroid) eye drops were ordered

for one week followed by ongoing Normal

Saline Solution eye drops.

• An MA renewed the Maxitrol without the

physician’s knowledge for 15 months!

• The patient was subsequently diagnosed

with totally opaque cataract, cataract

removed with lens implant resulting in

lifelong disability & need for glasses.

Case Study #1 :

No One Told the Doctor !

No refill guidelines

Lack of supervision

Ineffective communication

Not in MA’s Scope of Practice (not inclusive list)

• Placing the needle or starting and

disconnecting the infusion tube of an IV

• Administering medications or injections into

the IV line

• Charting the pupillary responses

• Inserting or remove a urine catheter

• Injecting collagen

• Using lasers to remove hair, wrinkles,

scars, moles or other blemishes

• Administering chemotherapy

• Independently performing telephone triage

Not in MA’s Scope of Practice (not inclusive list)

• Perform chemical peels or microdermabrasion

• Apply orthopedic splints, casts, or Unna boot

• Interpret results of skin tests, spirometry, lab

tests, or pregnancy tests

• Determine that a test is needed

• Perform sclerotherapy

• Collect nasopharyngeal swabs

• Cauterize wounds

• Perform physical therapy

• Draw up, mix, or administer any anesthetics

Case Study #2: Paying a Heavy Price to Look Good

• A 67 year-old woman, 10 days post-facelift,

presented for CO2 laser treatments at a

medi-spa.

• A back-office assistant/nursing student withdrew

7cc of Epinephrine, instead of Lidocaine with

Epi, and gave unlabeled syringe to the MD.

• The patient coded in office, 911 was called and

the patient was transferred to the ER.

• Her injury was diagnosed as

respiratory distress and a

“chemically induced heart

attack”.

Case Study #2:

Paying a Heavy Price to Look Good

Lack of training

Not in MA scope

of practice

Lack of supervision

Violation of medication protocol

2016 CAP Closed Claims Medical

Assistant Data Study

Common Medication Errors

1. Violation of safe medication administration

practices

2. Improper technique/administration

3. Refill errors

4. Mislabeled medications

Case Study #3:

Kenalog

• A 31-year-old female who was being treated for an insect bite received a Kenalog injection in her right upper arm by an MA.

• The patient later complained of right arm weakness, as well as a palpable lump, a tingling sensation, and pain at the injection site.

• It was determined that the drug leaked out into the patient’s surrounding adipose tissue, causing necrosis and dimpling.

• The patient needed fat grafting..

Case Study #3:

Kenalog

Lack of training

Lack of supervision

Preventing Medication Errors

� Training and Competency

� Policies and procedure

�Identify refill guidelines for staff

�Limit types of meds

�Symptoms that require a physician

visit

�Drugs that may not be renewed

�Document ALL refills

� Control access

� Allergy alerts

Preventing Medication Errors

� Store “look-alike, sound-alike” drugs

separately

� Correctly label syringes and storage

containers

� Give medication to only one patient at a

time

� Limit distractions

� Single-dose vials vs Multi-dose vials

� A supervisor must verify medication before

administration

Safe Medication Administration

2016 CAP Closed Claims Medical

Assistant Data Study

Preventing Falls

� Assist with ambulation

� Have a family member sit/stand by patient

� Have patient lie down on exam table

� Use reclining chairs with arm rests

� Ensure pathways are free of obstructions

� Staff monitor patient

Office Systems: Recall And Tracking

Medication Errors 49%

Office Systems Errors 12%

Scope of Practice 5%

Improper Performance 7%

Misconduct 2%

Failure to Monitor 25%

2006-2014

• Diagnostics/referrals reports

• Chronically ill, complex

patients

• High risk (OB, Cardiac, CA)

• Health maintenance,

screenings, immunizations

• Age-appropriate screenings

• No-shows

Office Systems: Recall & Tracking

Communication Failures

“The single biggest problem in

communication is the illusion

that it has taken place.”

- George Bernard Shaw

Communication Failures

• Distractions & Interruptions

• Workload & Fatigue

• Punitive Culture/Steep Hierarchy

• Production pressures

• Unclear roles and responsibilities

• Absence of clearly defined process

• EHR limitations

• Assumptions

• Documentation

Effective Communication Strategies

� Complete medical record documentation

� Identify critical information to be relayed

to MD

� Provide written education materials to

patients

� Encourage questions and consultation

� Listen

� Confirm understanding

� Avoid assumptions

� Avoid jargon

Improvement Opportunities

• What types of critical

information do you

communicate in your

practice?

• Where could this

communication break

down?

• What safeguards can you

implement to prevent

breakdown?

Understanding Error

Policies and Procedure

Training

Supervision

Office Systems of

Patient

INJURY

Effective Communication

Scope of Practice

Patient

SAFETYSAFETYSAFETYSAFETYRisks

Thinking Like a Risk Manager

• What’s in the best interests of Patient Safety?

• What could possibly go wrong?

• What improvements can we make?

Resources

• CAAHEP.org

• ABHES.org

• www.capphysicians.com

• Risk E-Notes

• CAPsules

• Risk Management Institute (Members only)

• www.mbc.ca.gov

• FAQ

• Approved certification organizations

Open Q&A Session

• Any Questions??

• Additional questions/comments, email:

• AMcLain@CAPPhysicians.com

• RiskManagement@CAPPhysicians.com