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Thread: Preventing Medical Errors - Need help developing a course

  1. #1
    sub specie aeternitatis Pete Hanlin's Avatar
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    Preventing Medical Errors - Need help developing a course

    Hi Everybody!

    The state of Florida is soon going to be requiring a two hour course on "Preventing Mistakes" in medical records of patients. Every medical profession that is licensed (including Opticianry) will be required to include the course in their list of courses required for renewing a license.

    Subsequently, I'll be writing a two hour course on how to avoid mistakes as an optician (contacts or glasses). The content outline for the course is one of the vaguest things I've ever seen, so it appears any course author is going to have almost carte blanche. I'd appreciate some general thoughts on the kinds of things to include in the course. I plan on having a section on how to "properly" write an Rx, and perhaps some time spent on how to tell contact lens care systems apart... I could use some ideas to fill up the 110 minutes though!

    Thanks!
    Pete Hanlin, ABOM
    Sr. Director Professional Solutions
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

  2. #2
    Bad address email on file stephanie's Avatar
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    Confused

    Hmmm curious subject Pete. How DO you avoid making mistakes? I think in any business there are going to be errors it is inevitable. If you are a human being you will mess something up occasionally. In my particular case we are so extremely busy almost always that it is definately a good possibility that a mistake will occur. Maybe if we had more time to concentrate on people we would have the time to think about what we are doing before we do it. Unfortunately I think a lot of places are that way.

    Steph

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    Master OptiBoarder Joann Raytar's Avatar
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    Are you talking about things like comparing the new Rx to the old one and verifying any odd changes and what data would be included on an Rx card?

  4. #4
    sub specie aeternitatis Pete Hanlin's Avatar
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    Actually, the course is mandatory for all healthcare professions licensed in Florida. As I said, the content guidelines are very general, so I am assuming they are intending to have a course that shows doctors how to keep records and how to avoid mistakes in prescribing drugs and treatments.

    I have a feeling Opticianry sort of just got "swept in" to this requirement, and I'm scratching my head over how I'm going to spend two hours talking about how to make sure we don't make an error when transposing from plus to minus cyl or something!
    :D

    Anyway, I'm just looking for any "opportunities" for errors that occur to you...
    Pete Hanlin, ABOM
    Sr. Director Professional Solutions
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

  5. #5
    Master OptiBoarder Joann Raytar's Avatar
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    When you inspect a lens for layout or a mounted lens before dispensing always compare it to the original doctors Rx, not just your Rx card.

  6. #6
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Pete,
    How about taking the time to review past records, if available, to compare Rx changes. On occasion, I can spot the cataract the patient forgot to tell me about or it can give me the opportunity to ask about medications taken or not taken. I've even spotted the missed prism correction or unusual power changes that may indicate an error in the written rx. You may also want to cover documentation of conversations about products and the ever-popular UV log book. I was advised to keep that one by another Optician who had a patient file a complaint that she had been charged for UV that wasn't there. The log book said differently and when questioned, the patient had taken her glasses somwhere else to have the tint adjusted and the tint and UV had been almost entirely bleached out. Just some thoughts early in the morning...

  7. #7
    Master OptiBoarder Cindy Hamlin's Avatar
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    Ditto On Judy's Remarks!

    I, too, have been saved by pulling the patients old records. I think as we have become more automated (computerized) we forget to check the file!
    ~Cindy

    "If you can't be a good example, then you'll just have to be a horrible warning." -Catherine Aird-

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    Master OptiBoarder MVEYES's Avatar
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    Post Interpreting medical record information

    Pete,

    How often has anyone who works in an ophthalmology or optometry office had to interpret information from a patients chart? In our situation this happens daily. Why not run through several cases of reading information from these charts and understanding terminology and abbreviations of our profession.

    Jerry Sherman :idea:

  9. #9
    Master OptiBoarder Joann Raytar's Avatar
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    MVEYES,

    That's a good idea! Knowing how to find VA's is especially helpful.

  10. #10
    sub specie aeternitatis Pete Hanlin's Avatar
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    Why not run through several cases of reading information from these charts and understanding terminology and abbreviations of our profession.
    Actually, I have a one hour class called "A Little Bit of S.O.A.P." that covers exam forms and how opticians can glean info from them. However, that is an excellent idea, because a lot of the errors we have in the optical could be prevented if the patient's medical records were looked at before ordering eyewear!

    Actually, with that idea, I think I can probably fill the two hours... About 50 minutes talking about patient records, 15 minutes on how to properly copy a patient's Rx (in Florida, there are several key items that are required, plus it will give me the opportunity to preach about using three digit numbers when writing an Rx ;) ). The balance of the time can be spent on keeping contact lens solutions straight.

    Thanks guys and gals!
    Pete Hanlin, ABOM
    Sr. Director Professional Solutions
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

  11. #11
    Master OptiBoarder MVEYES's Avatar
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    Smilie This course should be ABO certified

    We need more courses like this. I hear so many complaints about our CE being the same old stuff. This course could take many turns from patient chart information to understanding legal restrictions of our scope of practice.

    Jerry Sherman

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    Pete:

    I am very bad about leaving things off spectacle orders, like, P.D.'s, type seg., etc. I sometimes blame this on being a one-man office and doing spectacles, prosthetic eyes, and contact lenses. But in truth I am just senile or half-whatever.

    Obviously, this often costs me some money, occasionally serious money.

    I have often concidered decopageing on my dispensing table a check-list like pilots use asking myself did you: "Write down seg.ht, tint, bifocal type, and listing everything that might be required."

    Obviously I can't do this as my patients would know right away in a one man show who the dummy was.

    But you might includ something like this in your course.

    Chip

  13. #13
    Forever Liz's Dad Steve Machol's Avatar
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    Actually Chip, a checklist can show the patient that you are extremely thorough and cautious when it comes to their vision care. I think it's a great idea myself!


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    Bad address email on file stephanie's Avatar
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    Wink

    Actually Chip I agree with Steve on this one. I think a check list would be a great idea for remembering things. They have them on the back of some of the bills we send in...did you remember to sign your check, write your account number etc...I don't look at it as dumb at all rather as efficient. I have a bad habit at work for forgetting a pt is supposed to have a visual field. I love just throwing their chart in the box and forgetting all about them only to have someone come tell me a half hour later uhhh Steph that man was a visual field. It actually makes me mad at myself as it sometimes gets us behind since we have to go back and do a test that would have already been done if I were not brain dead. What I do is take a sticky note and write great big HVF on it and I don't forget them if it is on there. Of course I believe the pts are ususally very happy that you have forgotten to give them that test the LOVE so much....LOL!!

    Steph

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    Master OptiBoarder MVEYES's Avatar
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    Confused Do any of you have friends that are Lawyers?

    Hi Everyone,

    Do any of you have friends who are lawyers that could give you information about the legal woes that you could face in a lawsuit because of poor records? What liabilities do we face and what could be the penalties for our roles in misinterpretation of data or poor record keeping?

    Jerry Sherman

  16. #16
    Master OptiBoarder MVEYES's Avatar
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    Post Talking about records

    Does anyone have reliable information on the HIPPA regulations put out by the Federal government? I heard that violations could amount to $150,000. Our ophthalmology office has been gathering information from the hospital in seminars that address this issue.

    :bbg: Jerry Sherman

  17. #17
    sub specie aeternitatis Pete Hanlin's Avatar
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    What liabilities do we face and what could be the penalties for our roles in misinterpretation of data or poor record keeping?
    As it stands, most Opticians work under the auspices of ODs and/or MDs. In most cases, this means that the real exposure for any incompetence is on the doctor.

    However, you raise an excellent point that most DOCTORS don't seem to "get." Especially when billing services to Medicare, there are all kinds of requirements for keeping records. One of the most common errors I see is "Routine Visit" written in the Chief Complaint section of the exam form. With those two words, you have just made the visit non-submittable to HCFA- regardless of what medical problems are found during the course of the visit.

    Of course, this is just the tip of the iceburg. HCFA also requires tons of information on the exam form that isn't included in most OD offices around the country. As to what exposure offices may face? It is now more a question of when than if they will face scrutiny. During the Clinton Administration, the number TWO job of the FBI became the investigation of HCFA providers. What they found was that for every dollar spent on investigations, $28 was returned in the resultant fines and penalties. Now THIS is a business the government wants to be in. I believe every OD has been audited in some states, and it looks like this will become a trend in all the states.

    Sound scary? Good! Just because you recieve a check from HCFA for a submitted service doesn't mean they agreed with the charge. Any day, a government representative can walk into your office and request 10 records or so. If documentation problems are found in any of those records, they can request tons more. The "adjustments" on what you "should" have been paid can run into the tens of thousands of dollars (not to mention penalties for fraud if exams have been improperly coded).

    Anyway, just a warning. Keep records. Keep them accurately, in detail, and keep them organized.
    Pete Hanlin, ABOM
    Sr. Director Professional Solutions
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Master OptiBoarder MVEYES's Avatar
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    Lightbulb Pete,

    Are you going to incorporate any duty to warn info in this course? Also are you going to include what should be charted concerning the info given the patient about eyewear as well as contacts?

    Jerry
    PS Pete I like your avatar
    Last edited by MVEYES; 01-19-2002 at 03:19 PM.

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    Bad address email on file optigoddess's Avatar
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    Chip, the office I work for now is computerized and our program REFUSES to let us forget pd's, seg heights etc....HOWEVER, we were once on paper files. We had a couple of great opticians who sometimes "spaced out" some vital things...(pd's, segs, etc). What I did to help them over come this was to take the paper work orders and hilight with a marker the areas that just had to be included....this helped a lot! Maybe worth a try?

    Karen

  20. #20
    Bad address email on file optigoddess's Avatar
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    Post Speaking of Records & Duty to Warn....

    Some posts have brought up the importance of good, thorough recordkeepings while others have brought up Duty To Warn. Is anyone using the form (or one similar) that is on the Eye Protection Council's website? It is a Patient Questionnaire that brings up a lot of good questions to jog people's mind regarding the need for safety eyewear (as it's not always EMPLOYMENT related). At the end of the form, there is a waiver if they choose to not get eye protection but have been made aware that there are options to help them.

    I found this thru the Optiboards "optical links" - Titmus....then links....then eye protection council.

    Just a thought....

    karen

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    Dear Steve & Stephanie:

    I didn't mean that a check~list was a bad thing. I obviously need one badly. But, I think that if I were to have one decopagueed on my dispensing table (where I really should have it) I am afraid that my patient/customers will realize how dumb I really am. So I have to weigh: Do only t he ones that are victum to my errors and omitions or ALL of them know I have this problem?

    If I could figure out some way to be the only one to see this (a hologram maybe) I would put something like:

    "O.K. you dummy, did you take the P.D., bifocal type, seg.ht, ect. before you let the patient get away?:"

    :finger: Strange a it may seem, my own incompetence irritates me more than that of others.

    Chip

    And Pete: I hope that lovely blinking eye isn't yours.

  22. #22
    Master OptiBoarder MVEYES's Avatar
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    Question Karen,

    I think it is a good idea to put on the patient's record that you explained duty to warn. It is tough to remember back a year when your patient comes in with a black eye and says "Why did'nt you tell me that these would break if I fell?"

    Jerry

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    Master OptiBoarder MVEYES's Avatar
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    Question Advise

    Hi everyone,

    Has anyone talked about what you should not say to a patient and when do you refer? Back in the exam room there are lots of questions. You need to know the scope of your practice. Even unintentional remarks can lead to trouble.


    Jerry

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