F rom 2005 to 2007, NCMIC reported that 5.1% of chiropractic malpractice claims stemmed from burns to the patient. Clearly, this is a result of passive care modality use, often due to assistants with little or no training. Current concerns surrounding chiropractic office employee training escalated from what is known as "incident to" and the interests of third-party payers being billed for services performed by office employees without documented training. Even more important, however, are the concerns of the Federation of Chiropractic Licensing Boards surrounding patient protection, safety, and office liability. Reducing Risk through Communication As a CA, you are an important line of defense to reduce vicarious liability in the office. One of your best weapons is communication, both the way you communicate with your DC and the way that you communicate with the patient. Please use the following quick tips as crucial reminders for patient care: Sticky Pads. Chiropractic assistants should as sure that the adhesive on disposable sticky pads is indeed still intact before applying them to the patient. Pads are expensive, but don't worry about the cost of the pads and getting mileage out of them ratherthan disposing of them when necessary for the protection of the patient. TIP: Remind your DC that pads should be promptly disposed of when the adhesive becomes torn, cracked, or no longer sticky. Keep your DC in formed as to your needs for supplies and about how many uses you get out of products. Hot Packs. Be sure that you use ample layers of toweling for hydrocollator packs. Moist heat can penetrate quickly and be underestimated. On a similar note, never let the patient lie on top of a pack. The pack should be on top of the patient so that the patient's body weight won't cause intensified heat and burns. Ultrasound. Remember to use ample amounts of gel/medium on the ultrasound head to reduce the patient's burn risk and to protect the equip ment head. Systemic Disease. The DC should be cogni zant of systemic disease in a patient, specifically diabetes, peripheral vascular disease, or neurop athies, and should share that information with the CA. Remember that these individuals may have loss of sensation and may not be able to give feedback if their skin is burning. Therefore, avoid these treatments with these patients or monitor them very carefully. 5. Communication. Chiropractic assistants should be encouraged to communicate with patients. It's a prudent practice that patients are asked and told several key communications when under a passive care modality. Decide with your DC which questions you should ask regularly. If you get a positive response, you should not hesitate to bring in the doctor before proceeding. Sample questioning may include but should not be limited to: Do you have a pacemaker or metal implants? Are you pregnant? Do you have decreased sensation anywhere on your body/neuropathies? Are you diabetic? How is your feeling/sense of touch? Most importantly, CAs should tell each patient on every visit to alert them immediately if the patient feels any discomfort or burning sensation at any time during a passive modality treatment. It is not normal to feel pain during the procedure. Reducing Risk through Training At this juncture, not all states require training for chiropractic assistants. However, with the creation of the CCCA application/testing process through the FCLB, we may begin to see changes to increase patient safety through state board criteria or even via third-party payer criteria. Whether it is required by law or not, though, trained employees bring with them a multitude of benefits: The importance of your role in the office is validated. It promotes credibility within our profession. It provides greater assurance to patients that those caring for them have training. It reduces office liability. It brings confidence and expertise to the job you perform. To remain current and fresh with procedures, CAs should complete some type of training every two years. Training for new employees is paramount, but refresher courses for seasoned employees are also important, whether they earn a formal certification or not. How to Proceed Tell your DC that you'd like to go through training. Online training programs in particular make high-quality training affordable and convenient, and can be done outside of office time. At www.CCCAonline. com learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study. We have highly satisfied learners from all over the United States. DCs will often pay for employees to train. Full price for training is an affordable $339 for the entire 24-hour program. However, www.CCCAonline.com also has special discount programs available for COCSA state association members, participating colleges, and other organizations. Ask your state association for your specific discount code. Not a member? If you are reading this article through The Chiropractic Assistant magazine, you can still enjoy a discount. Use AMCHIRO as your discount code during the reg- istration process for a $15 discount off the regular price of the program. This is the program that gives back to the profession. Learners can expect text, images/schematics, dynamic video lectures, and robust customized experiential interactivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disrupting the office. Questions? Visit our website or send us an e-mail at: [email protected] Laurie Mueller, DC served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000-2010; served as the ACC post-graduate subcommittee chair for six years; peer-reviewed for the Research Agenda Conference; and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solution, and subsidiary www.CCCAonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
