Treatment of Corneal Abrasions
Dear Colleagues:
| OMIC wishes to bring to your attention an important discussion regarding treatment of simple corneal abrasions with topical anesthetic.The American College of Emergency Physicians (ACEP) recently published guidelines regarding the treatment of simple corneal abrasions, in which it concluded that “…for only simple corneal abrasions, as diagnosed and treated in accordance with the full protocol described herein, it appears safe to prescribe or otherwise provide a commercial topical anesthetic (i.e., proparacaine, tetracaine, oxybuprocaine) for use up to every 30 minutes as needed during the first 24 hours after presentation, as long as no more than 1.5 to 2 mL total (an expected 24-hour supply) is dispensed and any remainder is discarded after 24 hours.” [1]
In a response[2], the American Academy of Ophthalmology respectfully disagreed with the ACEP recommendations and conclusions, citing a lack of robust supporting data. It further noted that a 2023 Cochrane study on the use of topical anesthetics for corneal abrasion concluded that there was little evidence to predict the safety and efficacy of such treatment. In conclusion, the AAO opined that to insure patient safety, more rigorous scientific studies that include ophthalmologists are needed before guidelines can be issued. You may wish to consider the following treatment guidelines presented in a February 2024 EyeNet Cornea Clinical Update article, “Topical Anesthetics: The Latest on Use for Corneal Abrasions,” which offers a “three As” mnemonic device when treating corneal abrasions in the emergency department[3]:
We hope that this information will be helpful to you. Sincerely, Robert S. Gold Michael Tigani, MD Andrew Iwach, MD ______________________________ |
Telephone Screening
April 8, 2024
Dear OMIC Insureds:
You rely on your staff to screen countless calls from patients each day. Having your employees ask patients the correct questions when they call to report a problem or seek advice will ensure calls are being handled appropriately. The materials in OMIC’s Telephone Screening Toolkit should be used as a guide to develop and implement a screening protocol for your practice. OMIC suggests the following recommendations to promote both the continuity and defensibility of telephone care:
- Exercise the same care when treating a patient over the telephone as you would during an office visit.
- Gather the information necessary to assess the situation and determine the treatment plan.
- Communicate the assessment and plan to the patient.
- Document the encounter and your decision-making process in the medical record.
- Develop written protocols for telephone screening and treatment that are specific to your patient population, subspecialty, and staff.
- Supervise staff members who screen calls. In addition to developing and approving written protocols, the supervision should include:
- Training and verification of competency.
- Answering questions from staff members unsure of how to handle specific calls.
- Regular review of how calls are handled and documented (e.g., patient complaint, type of appointment, staff advice, etc.), and
- periodic review of the screening protocols themselves.
If you have questions, contact us for confidential risk management advice at riskmanagement@omic.com or call us at 1-800-562-6642 and enter 4 for Risk Management.
Sincerely,
Amy Braswell
OMIC Risk Management Specialist
Weight Loss Drugs
March 7, 2024
Dear OMIC Insureds:
We bring this topic to your attention due to the rise in the use of glucagon-like peptide-1 (GLP-1) receptor agonists which are used for the treatment of Type 2 diabetes and for weight loss. GLP-1 agonists slow down the movement of food from the stomach into the small intestine, which can lead to an increased risk of regurgitation and pulmonary aspiration during surgery. The American Society of Anesthesiologists (ASA) consensus-based guidance is to hold GLP-1 agonists the day of the procedure for those patients taking a daily dose and hold for one week for patients taking a weekly dose. The current ASA fasting guidelines have not changed for patients taking this medication. ASA.
The risk management guidance is similar to the recommendations when holding medications prior to surgery when you are not the prescribing provider. For diabetic patients, we recommend you discuss with the prescribing provider and document the discussion and decision concerning the timing of discontinuing GLP-1 agonists pre-procedure to ensure no adverse effects, which could include hyperglycemia. This should also be discussed with the patient, documented, and included in pre-procedure and discharge instructions to ensure understanding of the risks and reasons for your hold recommendations and when to restart of the medication. In addition, rare side effects from these drugs can result in worsening diabetes-related retinopathy. Cleveland Clinic
If you have questions, contact us for confidential risk management advice at riskmanagement@omic.com or call us at 1-800-562-6642 and enter 4 for Risk Management.
Sincerely,
Jeannette Domask, MPH, CPHRM
OMIC Risk Manager
Terminating Patients for Financial Reasons
February 7, 2024
Dear OMIC Insureds:
Hindsight is 20/20. What did we learn this past year? Patients who have high-deductible medical plans or are undergoing expensive treatment, such as intravitreal injections, may incur high unpaid balances due to delayed payments by the patient and third party payers. Some patients delay or avoid medical care altogether rather than resolve their financial obligations. Such delays may result in worsening or even loss of vision.
We’re often asked about the risks of terminating care for financial reasons. OMIC recommends the following:
- Ensure that acute conditions are stabilized, or that another ophthalmologist has agreed to take over care.
- Send the patient the 30-day notice warning of termination if payment is not received.
- Send the letter certified, and by regular mail as well, in case the patient is not home or refuses to sign for the certified letter.
Patients who delay medical care present a specific set of risks. Our risk management recommendations for terminating the physician-patient-relationship provide step-by-step instructions for you and your staff and sample letters to assist in the process.
If you have questions, contact us for confidential risk management advice at riskmanagement@omic.com or call us at 1-800-562-6642 and enter 4 for Risk Management.
Sincerely,
Hans K. Bruhn, MHS
OMIC Risk Manager
Leaving Practice
January 10, 2024
Dear OMIC Insureds:
Ophthalmologists leave practices for many reasons, including illness, retirement, changes in employment status, and personal or family needs. Both the individual ophthalmologist and the practice need to take steps in order to promote continuity of care, prevent allegations of abandonment, and ensure that all involved ophthalmologists have access to the medical records in the event the care is ever called into question.
The leaving practice toolkit addresses the risks posed when an ophthalmologist retires or leaves a practice.
If you have questions, contact us for confidential risk management advice at riskmanagement@omic.com or call us at 1-800-562-6642 and enter 4 for Risk Management.
Sincerely,
Michelle Pineda, MBA
OMIC Risk Management
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