Research or the practice of medicine?
OMIC policyholders regularly contact our confidential Risk Management Hotline for help deciding if what they are doing is research or the practice of medicine. They may want to use a drug or device outside of clinical trials before it has been approved by the FDA, or off-label after approval. Some want to offer their patient a novel surgical technique. Research or Practice of Medicine provides useful guidance.
Idiopathic intracranial hypertension/Pseudotumor cerebri checklist
OMIC has settled 8 claims alleging failure to diagnose and treat idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri (PTC). These patients suffered significant vision loss. The claims show that ophthalmologists do not always recognize when the patient’s condition is an emergency and do not ensure timely follow up with other specialists.
OMIC Board Members Dr. Ronald Pelton and Dr. Robert Wiggins developed this Idiopathic intracranial hypertension checklist to use when evaluating patients with IIH. Checklists identify important aspects of the patient’s history, exam, and management that might be missed, particularly by practitioners who do not encounter these patients frequently in clinical practice. Place the completed checklist, or the information within it, in the medical record.
Patients with suspected IIH need prompt care. Use our sample forms to ensure timely follow up. The Referral Note for Patient explains who will make needed appointments and when care is needed, and Referral note to MD alerts other providers to your proposed diagnostic and management plan.
Intravitreal injection of Kenalog or Triesence
RECOMMENDATIONS: Kenalog and Triesence intravitreal injections
PREVENT WRONG EVENTS: Time out before Intravitreal Injections
Documentation of Ophthalmic Care
Documentation of Ophthalmic Care provides our key recommendations on how to make changes to the medical record, and how to document the diagnostic process, informed consent, procedures and complications, telephone calls, and noncompliance.
Management of acute retinal ischemia
Update 1/9/20
Acute ophthalmic conditions present diagnostic and management challenges. To assist in assessing patients with acute presentations, including retinal ischemia, OMIC Committee member Dr. Gaurav Shah and retina fellow Dr. Alex Boutini of Retina Consultants, Ltd (St. Louis, MO) developed an algorithm called Acute Ophthalmic Presentations. We thank them for allowing us to share this decision tree.
February 2019
We would like to draw your attention to new guidelines on the management of acute retinal ischemia that indicate an urgent need to change how ophthalmologists approach patients with this condition. We also discuss what to do if your community does not have the recommended resources.
According to the guidelines published recently in Ophthalmology, “acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Because the risk of stroke is maximum within the first few days after the onset of visual loss, prompt diagnosis and triage are mandatory. Eye care professionals must make a rapid and accurate diagnosis and recognize the need for timely expert intervention by immediately referring patients with acute retinal arterial ischemia to specialized stroke centers without attempting to perform any further testing themselves.”
If Your Community Does Not Have a Certified Stroke Center
The new guidelines suggest as an alternative immediately referring patients with TMVL, BRAO, or CRAO to observation units in Emergency Departments, or admitting them to hospitals.
- Determine what resources the nearest Emergency Department and hospitals have for evaluating patients with possible strokes.
- Explore the most efficient process for such patients. While a particular hospital might be closer, the patient may be better served by seeking care at a more distant facility with a predefined accelerated diagnostic protocol for such patients.
- Formulating a plan now on how to implement these guidelines will promote patient safety and reduce your liability exposure.
Call the OMIC Hotline for confidential advice on any risk management issue. We’re here to help!
Phone: 800-562-6642 (Press 4)
Email: riskmanagement@omic.com
