Preparing the Patient for Retinopathy
Jenny Gaffney & Jean Macpherson
How To Confirm Patients Identity?
• Print out daily clinic list
• Call patients from waiting room as per clinic
list in time order.
• Ask for appointment letter and check
details once more against list and computer
in the privacy of the screening room
What Do We Check
• Patients full name
• Address / contact telephone number
• CHI number
• Preferred location of screening
Why Do We Check Personal Details?
• Ensures captured images corresponds to
• Ensures continuity of care and correct
delivery of results or onward referral.
• Avoids legal implications of results going to
wrong patient thus maintaining patient
Adverse Factors Influencing The Screening Visit
• Mental status e.g. dementia or learning
• Physical status e.g. amputee
• Level of co-operation
• Communication problems.
Affect on Screening Programme
• Inaccurate recording of Visual Acuities.
• Difficulty in accessing equipment resulting in
poor image quality.
• Increase in number of inadequate quality
images resulting in more slit lamp referrals.
• This all leads to a drain on clinic resources.
Solutions To Screening Difficulties
• Detailed explanation of procedure.
• Carer or relative accompanying patient.
• Use of alternative VA testing charts.
• Double or additional appointments.
• Variable height adjusting chairs for
Solutions To Screening Difficulties
• Use of interpreters or sign language expert.
• Written explanations.
• Possible “trial run”.
• Ensure 2 members of staff in attendance.
• Record any additional help or aids required
for future visits.
Importance Of Privacy
• Achieves optimum co-operation.
• Avoids embarrassment, patient may not
have good reading skills.
• Maintains confidentiality of personal
details with reassurance that no
information is divulged.
Informing Patient About The Screening
• Patients attending for first visits receive an information
leaflet called “Diabetes and Eye Care in NHS
• On commencement of screening process allow
adequate time for questions.
• Additional information leaflets are available in the
• Attendance for screening is perceived to be implied
Obstacles To Understanding The
• Age, young and old.
• Mental health problems, dementia or
• English not first language
Consequences Of Misunderstandings
• Storage of inaccurate demographic details.
• Inaccurate visual acuity test leading to
inappropriate past or future comparisons.
• Possible high incidence of inadequate quality
• Patients driving to an appointment and
needing mydriasis resulting in a wasted
• Consent is required to carrying out any
• Referrals are initially made by the GP and
appointment letters are sent inviting them to
• Attending a screening appointment means the
patient has given implied consent.
• There is no facility on the software for recording of
• It is the patients right to decline to
be a part of the screening
Possible Reasons For Opting Out
• Fear of the unknown procedure and the
• Patients attending ophthalmology.
• Regular visits to opticians
• Other health problems
• Total loss of vision
Method For Opting Out
• This has to be formalised by the patients GP
after discussion about the possible risks
• The GP must record their decision in the notes
and both parties should sign a disclaimer
• GP must complete a webform on SCI-DC
• This last for 3 years and must be reviewed.
• It is the patients right to rejoin the
screening programme at any time if
they so wish.
Storage Of Confidential Information
• With the fast development of IT The Caldicott
Report of 1997 highlighted weaknesses in the
storage of confidential information.
• Guardians were appointed to make
recommendation for safety and storage of
• In Scotland the Confidentiality & Security and
Advisory Group for Scotland 2002 provided
information on the law, patients rights and
standards for confidentially.
Storage Of Electronic Information
• Information may only be accessed by
use of appropriate individual passwords
( at least 2 ).
• All information must be firewall
• If computer is left unattended “log off”.
• All information must be kept in a locked
cabinet in a locked room.
• Patients information or details must not be
left unattended at any time.
• Must be destroyed as per local protocol
when no longer required.
Access Of Information
• Only information pertaining to on going care is
available to fellow health care workers “need
to Know basis”.
• Patients may have access to certain medical
records in accordance with the Data
Protection Act of 1988.
• Providing information to unauthorised people
can have legal and disciplinary implications.
• Waiting times • Offer explanation
• Location, easy access • If possible offer
for disabled alternative site
• Car parking facilities • Offer another site
• Busy telephone lines • Advise patients when
lines are less busy
• If possible defuse situation immediately at a local
• If patients insists on making a complaint they
must be given an information leaflet on what
steps to take.
• Staff must inform line manager and complete a
Datix incident form.
• Staff training