Point of Care Risk Assessment (PCRA)
A Point of Care Risk Assessment (PCRA) is a clinical evaluation used by chiropractors to analyze factors in a patient interaction that may increase the risk of infection transmission. By performing this assessment, a practitioner determines the specific measures necessary to mitigate those risks. PCRA is a fundamental component of Infection Prevention and Control (IPC) as outlined in Standard of Practice 4.3 (Infection Prevention and Control).
A PCRA is a two-step process:
- Step 1: Assess the level of patient risk
- Step 2: Implement risk mitigation strategies
Step 1: Assessing the Level of Patient Risk
According to Alberta Health, a PCRA is based on the health professional’s clinical judgment—including their knowledge, skills, reasoning, and education—regarding a specific clinical situation. This assessment must always be conducted within the Scope of Practice for Chiropractors in Alberta.
While the management of infectious disease is not within the chiropractic scope of practice, practitioners will frequently treat patients who may have acquired an infection. Utilizing PCRA tools allows you to take appropriate actions to minimize exposure risks. It is required that a PCRA is completed prior to every patient interaction.
Determining the Level of Risk
Infection control is not a “one-size-fits-all” approach. Practitioners must use critical thinking on a case-by-case basis. Just as clinical decisions vary based on a patient’s physical assessment, infection control decisions vary based on patient-specific details.
Factors that may increase risk include:
- Environment: Spending extended time within 2 metres of a patient, working in poorly ventilated areas, or utilizing shared treatment spaces.
- Task: The likelihood of contact with surfaces or items contaminated with blood, body fluids, or respiratory secretions.
- Patient Factors: Advanced age, immunocompromised status, or a patient’s inconsistency to adhere to hand hygiene and respiratory etiquette.
- Symptom Presentation: The presence of respiratory secretions, frequent coughing, or sneezing.
The chiropractor’s own health status, the health of their staff, and the safety of other patients in the clinic must also be factored into this assessment.
Step 2: Risk Mitigation (AHS IPC Framework)
Once the risk level is determined, practitioners must implement strategies to mitigate those risks. Consistent with Alberta Health Services (AHS) Routine Practices, the following measures should be applied:
Administrative and Environmental Controls
These measures reduce risk before the clinical interaction begins:
- Screening: Identifying symptomatic patients before they enter the treatment area to determine if care should be deferred or if additional precautions are required.
- CCOA Directives: Following all current CCOA directives and provincial health guidelines regarding self-isolation for practitioners and staff who are symptomatic.
- Environmental Maintenance: Ensuring frequent cleaning of high-touch surfaces and maintaining adequate ventilation to reduce the concentration of pathogens.
Personal Protective Equipment (PPE)
PPE is used when other controls cannot fully mitigate the risk of exposure:
- Standard Precautions: Apply to all patients, including consistent hand hygiene and the use of gloves when contact with blood or body fluids is anticipated.
- Droplet/Contact Precautions: If a patient is coughing or sneezing, or if you will be within 2 metres of a symptomatic patient, a surgical mask and eye protection are appropriate.
- Patient Etiquette: Consider asking symptomatic patients to wear a mask. If a patient cannot tolerate PPE, consider delaying non-urgent care or providing instruction from a distance of at least 2 metres.
Final Considerations
As regulated health professionals, chiropractors have a responsibility to maintain public trust by minimizing risks to themselves, their staff, their patients, and the general public. By consistently applying the PCRA process, practitioners can safely manage the risks associated with various infectious agents in an endemic environment.