Applies to: Dr. Darlington and McManus Techs, Assistants, Clinic Supervisors, Front Office Receptionists, Surgical Counselors, Front Office Leads
 
With the intention of ensuring that our post-operative cataract surgery patients enjoy the best possible comfort with the least possibility of post-operative inflammation, a change has been made to the post-operative steroid regimen.  Going forward, and beginning this week, the new steroid eye drop regimen will be as follows:
 
If Durezol: 1 drop 3 times for 21 days and then 1 drop once per day for 7 days, then D/C
If Pred Forte: 1 drop 3 times a day for 21 days, then 1 drop once per day for 7 days, then  D/C
 
Note:  IT will be updating the PO Patient instruction sheets to reflect this change.  The previous steroid regimen was:
 
If Durezol: 1 drop 3 times for 7 days and then I drop 2 times a day for 14 days, then D/C
If Pred Forte: 1 drop 3 times a day for 21 days, then D/C
 
There are no changes in terms of the antibiotic eye drops or the NSAID eye drops.

Applies to: Clinical, Clinic Leads, Front Office Leads, CEO, HR

Prior to leaving any office both technicians and assistants should be cleaning up their own rooms and their work areas.  Make sure that all machines are off, lights off, any papers cleaned up especially patient papers, etc.  We need to be considerate of the next team coming in the next day.  This is not the sole responsibility of the late tech. 

Applies to: Surgical Counselors, Front Office Leads, Clinic Leads, Jason K. Darlington, M.D.; Eric Straut, O.D.

There are a significant number of one week PO cataract surgery exams on his schedule that should be scheduled with Dr. Straut. 
 
Dr. Straut can see all patients for their one week PO cataract surgery appointment, except: 

• Those patients that Dr. Darlington specifically requests to examine personally;
• Patients referred by outside Optometrists;
• Patients referred by Dr. Michael Mandese – they should see Dr. Mandese for their one week PO visit, unless he is out of the office for the week;
• Patients who have had a multifocal or accommodate lens implant (ReStor, Tecnis Multifocal, Crystalens, or Trulign).

 
Patients who have had toric IOLs can be placed on Dr. Straut’s schedule, unless they were Optometric referrals.
 
(One week exams on patients referred by outside Doctors’ of Optometry typically see that doctor, but this refers to cases in which Dr. Darlington wants the patient seen here one additional time prior to the return to their family eye doctor).
 
If a patient refuses to see Dr. Straut for their one week PO appointment for any reason, email the particulars to the CEO, cc’ing Dr. Darlington, Scheduling Supervisor, Clinic Leads.
 
For clarification:
Cat, Cat/istent, YLC can be seen postop by our OD or referring OD.
Glaucoma, Cornea, Lid will need to see Dr. Darlington postop.

Applies to: Clinic Leads, Front Office Leads, Anterior Segment Assistants
 
Paracentesis is occasionally performed in the clinic.  It is not ever performed for diagnostic purposes but rather only for therapeutic purposes, to the best of the CEO’s knowledge.

Applies to: Clinical; Billing; Clinic Supervisors, Front Office Leads
 
Clinical Assistants and Billing Staff – Please note that the “Impressions”(Diagnosis) listed in the chart notes must correspond with the Diagnosis’ listed in the Operative Report for all procedures, including injections, of course.
 
If you are the Assistant for a procedure and you see that this is not the case, please immediately bring this to the attention of the physician so that he can correct it; if you are a member of the billing department and see this in the course of your duties, please request a review or an addendum of the note by the rendering physician and copy the Billing Lead, Clinic Leads, Scheduling Lead and CEO.

Applies to:  All Employees
 
In the event of a patient becoming injured while on TEI property, the most important thing is to make sure the patient is safe and further damage occurs.  While most of the falls are minor and need no further follow up, they can also be tragic and have poor or tragic results.  I want to make sure that everyone understands the correct process to follow if such an event should occur.  Please keep in mind this is not limited to falls, but to any time a patient becomes injured on our property.   It is important that all staff know what to do if this should happen.
 
STAY CALM.
Immediately see that the patient is stable.  
Quickly assess the situation to see if a doctor or other health care provider is needed. For the Melbourne location, remember that on Tuesdays, Wednesdays and Thursdays there is a likelihood that there are medical staff in the ASC who may be able to assist. 
If so, contact the doctor or other health care provider that is closest to the situation, advise them of the name, condition and location of the  patient. 
Depending on the condition of the patient, ask another employee to stay with the patient until you are able to seek additional help. 
If needed , contact 911 IMMEDIATELY, advising the 911 operator of the address, type of incident, current condition of patient, name of patient, and location of patient (i.e., 2nd floor, hallway X). 
DO NOT attempt to move a patient that is non-responsive or unable to move on their own as you could further injure the patient. 
It may be possible that bandages or compresses are needed.  Know where to locate them in each of your offices.
 
When the patient is stabilized, contact Human Resources for an incident report and let her know what has happened.  The incident report needs to be completed as accurately and quickly as possible after the incident so that key details are not  forgotten.  Please include any witnesses to the incident and secure their statement of what they witnessed or how they participated. 
 
Return the completed Incident Report to Human Resources.
 
If you have any questions, please do not hesitate contact Human Resources.

Applies to:  Jason K. Darlington, M.D. Techs & Assistants, Clinic Supervisors
 
SLT patients are to be expedited to eliminate wait time. After the SLT, they are to have the scheduled visual field while they are waiting for the IOP check.  There will be a 30 minute gap between the laser and testing.  
    
This applies only to Dr. Darlington’s patients as of this date.

Applies to:  Front Office Leads, Anterior Segment Assistants, Doctors, Clinic Leads
 
When filing out the Amniograft post cards please DO NOT USE the patient’s name.  You MUST use patient’s account # only.  Any use of their name is a HIPAA  violation since this information is on a post card which anyone handling the mail would have access to.

Applies to: Jason K. Darlington, M.D.; Anterior Segment Assistants; Billing, Marketing, Front Office Leads; Clinical Leads

In order that billing be correct, and in order for us to be in compliance, the following steps must be taken in all cases and without exception.
 
In order that YAG Cap procedures that are to be co-managed get filed appropriately from the start, three items need to be addressed:
 

1. The record needs to be appropriately documented under PLAN that the patient is to be co-managed.  Be specific in your note.  Example:   “Patient to see Dr. Lawrence Thomas for PO care and be co-managed at Optique Unique.”
2. The Superbill needs to be noted – “COMANAGED – 54 – Dr. L. Thomas.”
3. The usual co-management paperwork should be signed – both by the surgeon and the co-managing doctor, as well as the patient.   If the patient does not arrive with co-management paperwork from the referring/co-managing doctor,  this paperwork should be available in the exam rooms and signed by the surgeon and patient.  This should be placed in the outguide.  When it gets to billing, it should get to Louise to ensure that the document is countersigned by the co-managing doctor.  This paperwork must be kept on file.
4. If at checkout, the Superbill is noted that the patient is to be co-managed but there is no paperwork in the outguide, this must be brought back to the surgeon to be addressed by check out or the front desk supervisor.  (Front desk supervisors – review this carefully with all checkout staff.).
5. Clinical Supervisors – be certain that all assistants are fully clear as to their role and responsibilities relating to this matter.