Dry Eye Dx and Tx

The Value of Staff Education

By Charles W. Ficco, OD

As the American population gets older, we will see an exponential increase in the number of new dry eye patients. With our contact lens patients getting older, it is imperative that we aggressively treat ocular surface disease to maintain our patients' ocular health. But with chair time as valuable as gold, how can we accomplish this effectively? The answer: our staff.

Pearls for Staff Training

In our practice, our technical staff is like a finely tuned instrument expected to hit every note perfectly, every time. And they do just that. The key in making this happen is education. We spend a great deal of time keeping our staff up to date on new conditions, diagnostic procedures, and treatments. Here are some pearls to help you educate your staff on ocular surface disease and get you started on the path to a better-run practice:

• Train appointment makers and telephone personnel to ask the right questions when making appointments for new patients. Have them ask patients to bring in the medications and drops that they are currently using. Send out patient questionnaires and history forms or ask patients to download them from your website to be completed before they arrive.

• Have appointment makers get both vision and medical insurance information and pre-certification. Also have them inform patients about the ocular medical examination they will receive as well as the vision examination.

• Ask technicians to elaborate on the medical history questionnaire, especially on the names and dosage frequency of ocular medications and eye drops.

• We include the History of Present Illness (HPI) in our exam form. It has specific questions about blur, fluctuating vision, foreign body sensation, tearing, etc.

• Tailor the Ocular Surface Disease Index questions to fit your exam form.

• Design a separate “special testing” form that includes all of the ancillary testing procedures you will need, i.e., tear osmolarity, Shirmer's test, punctal plugs, etc. Use this as an instruction sheet so technicians know exactly what you expect. Include an evaluation and report section on the back for insurance purposes.

• Designate a specific room or area where special testing is done.

• Designate a specific technician each day to perform special tests to free up other staff members for other patients.

• Educate all of the staff on warm compresses and lid hygiene. This will free you up to see other patients and will allow staff to answer questions over the phone.

• Educate all of the staff on proper medicine dosage and instructions—but take time to educate patients yourself on initial diagnosis. This will reinforce your staff's expertise, and it is important to the patients.

• Make good exam notes and train your staff to read your instructions for the next follow-up exam. For example, if you want to see the patient stained with lissamine green at the next visit, write it out and the staff can let you know at the follow up when the patient is ready.

• Most importantly, advise both staff and patients that ocular surface disease, specifically dry eye syndrome, is a chronic condition that will need numerous follow-up appointments.

Create a Staff of “Experts”

Ocular surface disease conditions are the most common medical problems we will see in our practices. We should train ourselves to be the “experts” in these diseases because we are in the best position to be able to take care of our patients' needs. Similarly, we also need to train our staff members to be “experts” in these conditions. This is a monstrous practice builder. Our patients, our staff, and we practitioners will benefit from the education we all share. CLS