Anesthesia Liability
Retina specialist Dr. Michael Morley, anesthesiologist Dr. Karen Nanji, and OMIC Patient Safety Manager Anne Menke conducted a study of OMIC ophthalmic anesthesia claims from 2008 to 2018 that was published in the July 2020 issue of Ophthalmology.[1] Part 1 of this article presents some of the data from our study. Part 2 provides risk management recommendations and answers questions about liability for anesthesia care. OMIC hopes Anesthesia Liability contributes to the ongoing safety of ophthalmic anesthesia.
Use this consent form for Regional anesthesia block.
[1] Morley M, Menke AM, and Nanji KC. Ocular Anesthesia-Related Closed Claims from Ophthalmic Mutual Insurance Company 2008-2018. Ophthalmology 2020 Jul; 127(7):852-858. https://www.aaojournal.org/article/S0161-6420(19)32371-1/fulltext.
ROP: Intravitreal Anti-VEGF Injections Risk Management Recommendations
Revised in 2022 based on ICROP3 definition changes*
AntiVEGF for ROP Risk Management Recommendations
The American Academy of Pediatrics Section on Ophthalmology revised its Policy Statement (PS) [1] on ROP screening late last year. We revised the ophthalmologist’s obligations for follow-up when an infant is treated with anti-VEGF medication so that they are consistent with the new PS. 2019 Changes are in orange.
Follow infants closely until at least 65 weeks postmenstrual age (PMA).
At 65 weeks PMA, may end screening if either of these endpoints has been reached: 1) Full vascularization in close proximity to the ora serrata for 360° OR 2) The avascular retina has been successfully treated with laser (e.g., no skip areas).
Use professional judgment on continued monitoring in the following circumstances if no treatment endpoint has been reached at 65 weeks PMA: 1) Low-grade disease that is clearly and slowly improving, 2) Stage 1 disease that is unchanged for 2 months, 3) No disease, no ROP, but incomplete vascularization, or 4) Infant has a DNR order.
[1] Fierson WM. “Screening Examination of Premature Infants for Retinopathy of Prematurity.” Policy Statement (PS) issued by the American Academy of Pediatrics (AAP) Section on Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists. Originally issued in 1997 and updated in 2001, 2005, 2006, and 2018; current version published in Pediatrics (Volume 142, Number 6, 2018, at http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3061.
Laser consent form: http://www.omic.com/rop-laser-surgery/
Anti-VEGF consent form: http://www.omic.com/rop-anti-vegf-injection/
ROP Safety Net materials: https://www.omic.com/rop-safety-net/
*Chang MF, Quinn GE, Fielder AR, Wu WC, Zhao P, Zin A, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10):E51-E68. Available at: https://doi.org/10.1016/j.ophtha.2021.05.031 (Accessed: 3/10/22)
3rd Edition of “ROP: Creating a Safety Net” Published
OMIC ROP Safety Net revised in 2022 to reflect changes to International Classification of Retinopathy of Prematurity, Third Edition (ICROP3). In 2023 we added Telemedicine Protocols and Recommendations.
Click on the name of the document to access it.
Clinical Tables Revised with Changes Highlighted
ROP Risk Analysis
ROP Conditions of Coverage
ROP Risk Management Recommendations for AntiVEGF
ROP Tracking List
HOSPITAL ROP TOOLKITS
Hospital toolkit.Treat at hospital
Hospital toolkit.Transfer to treat
OFFICE ROP TOOLKIT
The Office toolkit has additional procedures, forms, and letters needed for outpatient care.
FORMS AND LETTERS
The following consent forms and letters are in the toolkits and procedures, but can also be accessed directly:
Consent: ROP Injection to Treat
Consent: ROP Laser Surgery to Treat
ROP-Remote-Digital-Fundus-Imaging-Telemedicine-Consent
Discharge letter
Missed appointment letter
Outpatient screening letter
Transfer for other care letter
Transfer to treat
ROP Protocol and Recommendations for Telemedicine
ROP Telemedicine 9.16.23
