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LBNL AAAHC Accreditation Experience and Medical Surveillance Quality Improvement Peter D. Lichty, MD MOH FACOEM Site Oc

Financial Disclaimer. Part 1

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LBNL AAAHC Accreditation Experience and Medical Surveillance Quality Improvement Peter D. Lichty, MD MOH FACOEM Site Oc

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    2. Financial Disclaimer Part 1 – AAAHC experience – No financial or commercial interest. Part 2 – Medical Surveillance exam summary– No financial or commercial interest.

    3. Terminal Objectives Understand AAAHC process Understand actual lessons learned from LBNL accreditation. Review full gamut of medical surveillance exams under OSHA, ANSI laser, AAALAC, DOE regulations. Take home table of exam components.

    4. Topics (AKA “Enabling objectives”) Clinic quality and accreditation AAAHC process LBNL experience with AAAHC Medical Surveillance and Occupational Mandates Sequence of surveillance process Critical details of a surveillance program

    5. How do you know clinics are good? Physician imposter: Osei, Joseph 10/27/2008 Ft Worth Star Telegram TX Co-owner and president of Excel Occupational Clinics in Ft. Worth. Osei has 24 prior convictions, 10 of them felonies, in NY, CO, VT, and NM. Physician imposter: Barnes, Gerald AKA Gerald Barnbaum 4/17/1997 NY Times. Took over CA doc identity twice; practiced occupational health Endoscopy clinic 2007: hepatitis C virus (HCV) transmission likely resulted from reuse of syringes on individual patients and use of single-use medication vials on multiple patients at the clinic.

    7. DOE Clinics with AAAHC Accreditation Berkeley Brookhaven Hanford Livermore Oak Ridge Pantex Sandia Y-12

    9. Standards Organized by chapter in the Accreditation Handbook. 8 Core Standards Patient rights, governance, clinical records, professional improvement, etc. 19 Adjunct standards (8 apply at LBNL) Selected based on scope of services offered. Ours include Occ Med, anesthesia, teaching, surgical services, CLIA-waived lab tests, etc.

    12. Why Didn’t I Think of That? Translator services for non-English speaking employees. Log system for sterilizer quality control Credentialing of clinical skills for RNs. Systematic quality control on clinic notes. Standardize chart organization. Site tours for contract medical staff.

    13. DOE Connection “Technical Assurance” mandate difficult for medical departments. No on-site expertise. Oversight by non-physicians Continuous quality improvement. Comprehensive standards.

    14. Changing Gears – Medical Surveillance Bread and butter occupational medicine activity. NIOSH and OSHA regulations from 1970’s. Still confusion about what is required by OSHA. Reducing exposures has reduced exams. This talk – summarize req’ts in one place.

    15. Medical Surveillance Mastersheet Goal: Document every required exam and what it takes to do it right. Sources of requirements: OSHA medical surveillance (applies to DOE via 10 CFR 851). Baseline, periodic, termination, and post-incident. American National Standards Institute – laser AAALAC – Animal researcher and handler exams, a condition of funding.

    16. A to Z for each exam Who puts employees into exam group? Usually IH, but might be the clinic or supervisor. What information must be provided to occupational health? This varies: Job duties (Construction Lead) Type of respirator, type of work.(Respirator) Accident circumstances (Biological Exposure)

    17. The Medical Exam itself Waiting period before exam can be done. Exam components for each group. Do they have to do this? Voluntary exams Mandatory Offer Mandatory Required Documented consent for testing. “Magic Words” for results letter.

    18. Exam Components Mandated versus best practice. Type and frequency of exam Declination documentation Exam records Exam results

    19. Questions?

    20. More Questions?

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