Why are practices and clinics not addressing the need for laser safety?
In visiting facilities throughout the United States, I have found what is missing is the necessary training and the resources to develop a laser safety program.
Many are unaware of the laws governing medical laser usage. Some, if not many, rely on information from the laser systems salesperson. Although many sales representatives are diligent about safety and instruct office personnel in the proper measures and precautions, their job is to sell equipment, not to implement safety programs.
LET’S GET STARTED
To start your implementation of laser safety, obtain the document called American National Standards Institute (ANSI) Z136.3. Appoint a laser safety officer (LSO). The LSO can be the plastic surgeon, nurse, office manager, or other appropriate staffperson who has comprehensive training in medical laser safety.
The LSO will be responsible for implementing all safety guidelines, coordinating training, and maintaining patient and staff safety on all new and existing lasers and procedures. The LSO will also need to develop and implement a series of policies and procedures for the facility.
These procedures include the following:
- Establish a laser committee, including laser physicians, nursing, administration, biomedical engineering, legal or risk management, and LSO;
- Define the LSO’s position and duties;
- Outline the guidelines for physician laser privileges;
- Describe medical surveillance;
- Educate personnel;
- Document your practice’s laser therapy; and
- Create a handbook providing specifics for each treatment area.
If you want to bring in a consultant to train an LSO or whomever you have designated as the appropriate safety officer, the cost can be around $1,000 to $2,000 and take 1 day.
Some professional societies, including the American Society for Laser Medicine and Surgery, say you should have an annual in-service for laser physics and safety in order to stay current. Those courses run from $500 to $1,000, depending on the course level and content.
It is important to implement training courses and procedures. One can never predict an incident or surprise inspection. If legal action is optioned due to injury, then you may have increased your exposure by lack of preparation.
I have been subjected to a regulatory inspection that included checking policy and procedures, patient documentation, safety measures, and documented training of laser personnel.
Having everything in order and easily accessible upon request gave the perception of a quality-run facility, and the inspector was not compelled to dig any deeper. The inspector also asked that the nurse verbally explain exactly how a procedure is performed, in order to ensure that all safety measures are taken from the time patients enter the facility until they depart it.
LASER USAGE LAWS
These laws are valid in several states or are due to be enacted into law in the future. Other states are collecting data with the intention of tightening their standards. Education levels of personnel who deliver laser energy to tissue and the types of procedures being performed by nonphysicians are also under examination.
See also “What’s the Skinny on Plasma Resurfacing?” by Dan Yamini, MD, FACS, in the December 2007 issue of PSP.
Many issues can be debated at the state and national level: Who can perform laser procedures? Are laser procedures considered the practice of medicine? Does a physician need to be on site? How soon can a physician be consulted? What is the appropriate response time to a laser incident by the physician?
Regardless of the extent laws and standards change, the future should hold a high standard of education and professionalism. Having a well-documented, planned, and implemented laser program is essential.
We owe it to patients and staff to provide the safest environment possible.
John E. Hoopman, LSO, is the assistant director of the Laser Safety Program at Southwestern Medical Center in Dallas. He can be reached at (214) 648-2416.