FEATURE


Chances are, Reisch says, that these patients know how to take care of them- selves better than an ASC’s staff. “We try to foster independence. If they can move themselves over from their wheelchair to the preoperative litter, we will let them. For those patients who cannot, we pro- vide a Hoyer lift.” Pay special attention to potential safety risks associated with paralyzed patients, Reisch says. “If you have a quadriplegic patient, you have to worry about involuntary muscle spasms. Keep these patients in a safe environment so they cannot injure themselves.” If you are performing a surgery where they can stay on the litter for the procedure, make sure the safety strap is in place, the siderail is up and pillows are pro- tecting any extremities that are not in the operative field. “Make sure to pad any part of their body that could be spastic,” she says. “Also make sure all bony prominences are protected.” Coordinating this care requires strong communication between care- givers, she emphasizes. “When we learn a paralyzed patient is scheduled for sur- gery, it is all hands on deck. We make sure we have enough staff to safely pro- vide care and the right equipment ready. As the patient moves from one area of the ASC to another, important informa- tion is shared at handoff to ensure we understand the patient’s specific needs and can continue meeting them.” Even if your ASC rarely treats para- lyzed patients, Hamilton says training is vital to a positive patient and staff experience. “Cover your process for caring for paralyzed patients in orien- tation and annual training. Make sure to include how staff should properly transfer patients to avoid injuries, such as those to the back.” An ASC can buy some basic equipment, like gait belts and transfer boards, to help accommo- date these patients. Poor training of staff, even those not directly involved in the care of paralyzed patients, can come back to haunt an ASC, Breitenbach says. “If a


Do not assume you know what is best for these patients. Moving them around without speaking about their needs first could make them uncomfortable.”


—Devonna Hamilton, RN


person calls who needs a wheelchair and accessible exam table, and a front desk staff member says the ASC can- not accommodate this individual’s care and directs them to the hospital, this is potentially problematic. By telling the disabled person that the ASC cannot accommodate them, an ADA violation has been committed.”


Potential Liability If your ASC fails to meet ADA and/ or other disability discrimination laws, the ramifications can be significant, Breitenbach says. “The Civil Rights Division of the Department of Justice has the ability to enforce ADA; state and local offices can also enforce those laws. When they investigate and enter into a settlement agreement, there are essentially four types of relief.” First is injunctive relief, he says. “This is law enforcement’s way of saying do not do what you did again. Change your policies and procedures and provide appropriate training.” Second is the awarding of compen- satory damages to the affected individ- ual. “This is some amount of money to


compensate the individual because of the discrimination,” Breitenbach says. “In most of these cases, the patient has not sustained a physical injury. Rather, it is an emotional injury. Usually the amount of money awarded is under $100,000, but it ultimately depends on the allegations.”


The third type of relief is a civil pen- alty paid to the government. “If you can- not get this waived, it is usually around $25,000,” he says. The fourth is the government require- ment that the incident is made public. “The offending facility must issue a press release stating it has signed a con- sent decree acknowledging violation of ADA,” Breitenbach says. “The punish- ment is a publicity hit.”


As procedures continue to move into the outpatient setting, Hamilton says ASCs should expect to care for more paralyzed patients. “If you feel your ASC may not be prepared to pro- vide these individuals with the safe care and dignity they deserve, start taking the steps necessary to address these shortcomings.”


ASC FOCUS JUNE/JULY 2018 |www.ascfocus.org 13


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