Medical Assistant (Part-Time)

Summary:

• Ultrasound
• Laboratory
• Patient Education
• Procedure Room
• Scrub room
• Recovery room
• Follow-up
• General duties

Ultrasound

An Ultrasound must be done on every patient before an abortion is performed. This is done to determine exactly how many weeks pregnant the patient is and to determine for the physician how they will perform the procedure. if the physician is male, one female member of the clinic staff must assist him in the ultrasound room The person performing the ultrasound does not have to be a physician but must have training from a reputable educational institute or from a licensed physician.

1.      Any charts with an ultrasound reading of 12.0 weeks and above must be taken to the front desk for approval.

2.      If needed, one clinical staff member should be in the lab during ultrasounds to run a pregnancy test after the ultrasound and ensure all consent forms are signed. Indications are as follows:

a.       Ultrasounds indicate "NV" (not visible) must run a 2-minute pregnancy test. Record results on the chart.

                                                              i.      If results are positive, counsel on early warnings and ectopic pregnancy and have the patient sign Early Warning consent.

                                                            ii.      If results are negative patient may NOT be pregnant. Advise the patient to seek a further evaluation with her own OB/GYN. Regardless of pregnancy test results or option selected, "Ectopic/Early Warning Consent” must be signed.

b.      Ultrasound indicated patient is 15.0 to 19.6 weeks patient's procedure may be a 2-day procedure. Laminaria will be inserted on day one. The patient will return on day two (at clinic time) to have the procedure. A completed "Laminaria Consent" must be signed by the patient.

3.      After each patient has completed their labs and, ultrasound a member of the clinical staff will check charts for completion of signatures, and medical information is complete.  

Laboratory

1.      Take the patient’s vital signs: blood pressure, temperature, respiration, pulse, and weight. Record values on the chart. Circle abnormal values in red and notify RN and MD. 

2.      Review demographics and medical history with the patient. 

a.       Ask the patient if they have any illnesses: i.e., Rheumatic Fever, DIC (disseminated intravascular coagulation), or hemophilia. 

b.      Ask if the patient has any food or drug allergies. If yes, flag the chart with “allergic” to the sticker; place the sticker on the left side of the chart. 

c.       Ask the patient if she is taking any medications. Ensure medications are documented on the chart and nothing is left blank.   

d.      Ask the patient if she would like a form of birth control such as a pill, vaginal insert, or Depo. Document on the chart under “Contraception” 

3.      Prick the patient’s finger. 

a.       Using a lancet, prick a finger and obtain blood in micro cuvette, and place it in hemoCue hb 201 machine to get hemoglobin count. Record the reading on the AB lab sheet in the hematocrit column for that patient. Circle abnormal values in red and notify RN of values under 10. 

b.      Place 1 drop of Anti-D on the glass slide and then 2-3 drops of blood on the same slide, place slide on RH View Box (light off), mix well, rock view box slowly back and forth a few times, let sit for a period no less than 5 minutes. Interpret results as follows: 

                                                              Agglutination= RH (positive) 

                                                              No Agglutination= RH – (negative) 

Record results on AB lab sheet in RH type column. If the patient is RH negative, give her the handout explaining what that means to her today and for any future pregnancies. Place Rh Negative sticker on the blood type section of the chart. 

Patient Education                     

1.      Patients will be counseled by trained clinical staff in a group setting. This will be done in the counseling room and should only take about 15 mins. When counseling is complete: 

a.       Ask patients if they have any questions and inform patients that a nurse is available for individual counseling should anyone require it at any time. 

b.      Review all post-op instructions with patients and make sure patients have all after-hours telephone numbers. Remind patients of the follow-up sheet in their take-home bags. 

Procedure Room 

The MA’s job in the operating room is to assure the patient is as comfortable as possible (hold her hand, talk to her throughout the procedure) operate the ultrasound machine and assist the physician. 

1.      Sterile tray set-up: 

a.       Open sterile instrument pack.

b.      Add betadine/hibicleanse to 2x2 gauze. 

c.       Place drawn-up lidocaine, cannula, and any other appropriate instruments or medications needed for that particular procedure onto the tray.

d.      Unfold the sterile wrap found inside the pack and place it on top of the tray with the sterile side down, covering the instruments.

e.       On top of the sterile wrap covering tray, place the appropriate size speculum and pair of sterile surgical gloves.

2.      Patient set-up: 

a.       Call the patient from the patient waiting room using the patient's first name.

b.      Have the patient come into the OR and have her set her basket on the floor near the door, undress from the waist down and put on a gown open end to the back.

c.       Have her sit bare-bottomed on the end of the exam table. When the doctor enters the room have the patient put their feet in the stirrups and slide to the bottom of the exam table. 

d.      Place a sterile tray on the mayo stand.

e.       Only MA will start the IVS, and ONLY the physician will administer the IV meds. 

f.        DO NOT leave patients alone when they are sedated.

Recovery 

1.      When a patient enters the recovery room, her vital signs must be taken and recorded on her chart every 15 minutes. 

2.      Post-op medications are to be given as instructed by the operating physician. 

3.      The patient will stay in the recovery room chair for no less than 30 minutes. This time can be as long as an hour or more if needed.  When the patient’s recovery time is up, you will instruct the patient to get dressed in the patient changing room. 

4.      After the patient has changed and returned to the recovery room, take and record vital signs, have the patient sign recovery discharge, give the patient her take-home bag, and walk the patient out to her support person.

Scrub Room

1.      Set up: 

a.       Fold and stack sterile sheets with 4x4 and 2x2 gauze for sterile pack set-up. 

b.      Tear tape and attach it to the cabinet for closure of sterile packs.

c.       Cut and date sterile indicator strips.

d.      Prepare bins for biohazard materials.

e.       Fill the sink with warm water and enzymatic solution.

f.        Fill the container with Cidex OPA solution.

g.       Fill the container with instrument lubricant and distilled water (for soaking instruments).

2.      Clear and clean trays:

a.       Rinse and get excess blood off instruments, empty instruments in enzymatic solution.

b.      Discard soiled materials as indicated by OSHA guidelines.

c.       Discard all needles in the sharps container.

d.      Scrub all instruments with a brush and rinse.

e.       Arrange and package instruments (8 dilators, 1 tenaculum, 1 curette, 1 sponge forceps) folded sterile wrap and date sterile indicator strip. Double wrapped, close, tape, date, and initial package.

3.      Autoclave instruments.

4.      Package all biohazards appropriately and freeze or store them for pick up by the biohazardous waste disposal company.

5.      Clean and stock room for the next shift.

Follow up visits

1.      Two to three-week follow-ups will be done on assigned days and times.

2.      Upon follow-up check-in, a two-minute pregnancy test will be run.

3.      The patient will be in the lab, take their vital signs, and record all vitals and pregnancy test results on the chart. Ask questions such as if she is having any abnormal bleeding, or signs of infection and have resumed sexual activity. Answer any questions or concerns.

4.      If the pregnancy test is positive notify the ultrasound tech for a repeat ultrasound.

5.      The patient is discharged afterward reviewing the ultrasound and discussing the next steps with the patient.

General Duties

1.      Pre-clinic duties

a.       Check autoclave

b.      Check laundry

c.       Take reagents out of the fridge

d.      Fold gowns and place them in baskets

e.       Set up the lab and run controls

f.        Stock ORs and set up rooms

g.       Set up recovery

h.      Prepare the scrub room (fold blue sheets)

i.        Make sure floors and carpets are clean and presentable

j.        Make sure bathrooms are clean and stocked

2.      Post-clinic duties

a.       Clean ORs

b.      Clean bathrooms

c.       Start laundry

d.      Start autoclave

e.       Empty and take out the trash

f.        Check inventory in areas you worked and inform the manager of any shortages

g.       Restock rooms

h.      Sweep, mop, and vacuum floors

i.        Deep clean including dusting floorboards, blinds, and windowsills (monthly).