Lecture Clinical procedures for medical assisting (4/e): Chapter 4 – Booth, Whicker, Wyman

Chapter 4 - Preparing the exam and treatment areas. In this chapter you will learn about the common layouts of examination rooms; keeping the rooms clean and stocked with instruments, disposable, and consumable supplies; maintaining the comfort of the room; and making the room safe for patients and coworkers. You will also be introduced to the requirements for accessibility established by the Americans With Disabilities Act.

Preparing the Exam

and Treatment

Learning Outcomes

4.1 Explain the medical assistant’s role in

preparing the examination room.

4.2 Describe the layout and features of a typical

examination room.

4.3 Describe steps to prevent the spread of

infection in the examination room.

4.4 Explain how and when to disinfect

examination room surfaces.

Learning Outcomes (cont.)

4.5 Describe the importance of such factors as

temperature, lighting, and ventilation in the examination room

4.6 Identify instruments and supplies used in a

general physical examination, and tell how to arrange and prepare them.

4.7 Explain how to eliminate hazards to physical

safety in the examination room

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

Examination Room (cont.)

• Main concerns are

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

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

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

Exam Room Furnishings

• Should be arranged for:

– Efficiency

– Patient comfort

– Physician convenience

• Items commonly found in examination rooms

 One or more chairs

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

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

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!

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

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

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.

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

• Storage

– Store biohazardous specimens properly– Store testing kits properly

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

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

• Maintain examination room temperature at

about 72°F

• Eliminate drafts from windows and doors

Ventilation (cont.)

• Examination area should smell

clean and fresh

• Eliminate source of odors

• If opening windows, monitor

room temperature

• Room deodorizer or spray

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!

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

Instrument 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

Exam

Instrument 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

Exam (cont.)

Instrument 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

Exam (cont.)

• Arranging instruments

– Keep instruments in same location, either:

• Mounted on wall

• Out on countertop

• Preparing instruments

– Some instruments require warming

• Cleaning instruments

– Place used instruments in a container and always handle carefully

Cervical scraper Cotton balls

Cotton-tipped applicators

Curettes Disposable needles Disposable 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

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

Medical Instruments and Supplies (cont.)

• Restocking supplies

– Reorder when the first half of a box, tube, or bottle has been used

nasal speculum

reflex hammer

penlight laryngeal mirror ophthalmoscope

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

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

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

Special Safety Precautions

• Children

– Keep medication

and dangerous items out of reach – Toys should be

washable and safe – Be sure toys do not

• Patients with disabilities

– Fall precautions – Safe flooring and handrails

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

A Store the solutions with the other cleaning solutions in

the usual cabinet

B Lock the new solution up in a separate cabinet

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

In Summary

4.1 It is the medical assistant’s responsibility to ensure

that the examination room is neat, clean, and appropriately stocked

4.2 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

In Summary (cont.)

4.3 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

In Summary (cont.)

4.4 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

4.5 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

In Summary (cont.)

4.6 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

In Summary (cont.)

4.7 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

Safety is something that  happens between your  ears, not something you 

hold in your hands.

~ Jeff Cooper

End of Chapter 4