May 14, 2020 — In the face of Covid-19, there is much that needs to be addressed in caring for patients before they even get into the exam room. Here, we dive into eight points to consider. 
The American Optometric Association (AOA) President Barbara Horn, O.D., calls this “a new phase.” That is, “the process to return to providing routine, along with urgent and emergency, care." 

The key, she adds, “is to provide the care patients are seeking in a safe and healthy environment.” That care starts at your front door. Literally. 

Is it open or are you keeping it closed? According to the AOA, you need to decide for yourself if your door is to be locked to limit entrants, or propped open to reduce the door handle being touched and to increase the exchange of fresh air.

And, speaking of air, Independent Doctors of Optometry (IDOC) reminds offices to increase ventilation rates as you reopen.

These points underscore how much needs to be addressed in caring for patients before they even get into the exam room. Here, we look at some of those touch points. 

TEXT ME. Does an associate text when it’s time to enter the building, and does he or she go outside to take the patient’s temperature and make sure they haven’t been exposed to anyone with Covid-19 in the past month?

Alan Glazier, O.D., a leading industry consultant and owner of Shady Grove Eye & Vision Care in Rockville, MD, says his practice will do just that when it reopens later this month.

PRACTICE MAKES...• Trial Run: If, like Dr. Glazier, you haven’t opened quite yet, consider following his pre-opening training suggestion. “We’re doing a dry run with our staff before we open. That way we can find glitches and constraints in our process, and it will make things run smoother and more safely.”

• Train: Especially when it comes to PPE, both train and then obtain employee signoff. For more guidance on this, go to: osha.gov/laws-regs/regulations/standardnumber/1910/1910.132.
 
COMMUNICATIONS “VEHICLES”• Go Online: What else is involved in communicating before the exam? If possible, stresses the AOA, explain your new sequence to patients ahead of time so they know what to expect. And, what about paperwork? At Dr. Glazier’s office, “All forms and paperwork—insurance, ID cards, etc.—will all be done prior to the visit.”

• Drive-Up: Also, let patients know ahead of time if you’re asking them to text or call from their cars, for example, and if they will be given any outstanding forms to complete in the car or be prescreened there by a staff member.
What if they need a pen? “We’ll only use pens one time,” says Dr. Glazier, “and then sanitize them all at the end of the day.”
 
IN-OFFICE PROTECTION
• Plus-Ones: Communicate ahead of time that unless the patient is a minor or caregiver, only the patient is allowed into the facility, and, especially, the exam room. Anyone else should wait in the car or elsewhere outside of the office.

• PPE: Explain that everyone aged 10 and up has to wear a face mask (cloth or disposable) when entering your office space. And, back that up with signage.

• Cleaning: Immediately upon arrival, provide hand sanitizer for the patient to use, along with gloves and a face mask if they don’t have an adequate PPE with them. If you also ask them to wash their hands as part of your protocol, tell them to dry them with a paper towel as opposed to an air dryer.
As for office cleaning, provide checklists for staff to follow. IDOC guidelines include a reminder to include sometimes-overlooked surfaces like light switches in your ongoing cleaning and sanitizing, and to make sure all trash cans are no-touch designs. For more detail on cleaning (as well as reopening), The Vision Council is a great resource (thevisioncouncil.org/members/reopening-guidance).

• Ready Resources: While you’ve hopefully already tapped resources from the AOA, the Centers for Disease Control and Prevention, etc., another excellent source is your buying group or alliance. Healthy Eyes Advantage (HEA) and IDOC definitely stand out in terms of resources available to help make sure your reopening is safe for patients and ECPs alike.

Be consistent AND firm in your policies. As practices that have already opened report, some patients will push. And push. —Stephanie K. De Long