SECTION 4: UA CLINIC DAILY OPERATIONS

Transcription

1 SECTION 4: UA CLINIC DAILY OPERATIONS Revision:

2 UA Hearing Clinic Daily Operations Clinic Preparation It is the responsibility of all individuals who work in the Audiology Clinics to leave the audiology suites, waiting room areas and all clinic areas in a clean and neat condition and to replace all equipment in the proper location following test procedures. No food or drinks are allowed in the clinic (except for water). Daily Listening Check of Equipment: Check Task Inspect all earphone tubes, cables and power cords for cracks, visible wiring. If when touching the audiometer you receive a shock or feel tingling in your fingers, this may indicate a short. DO NOT USE THE AUDIOMETER UNTIL THE ISSUE IS RESOLVED. Do exhaustive listening check with Insert Earphones Throughout the listening check, slide fingers down from phone to jack jiggling lightly especially around cord connections and listen for any static or intermittency. Do this for both earphones. Frequency Check With the HL dial at 50 db, check each frequency for purity of tones and to ensure no crosstalk. Channel 1: Listen to all pure tones (up in frequency one earphone, down in frequency other earphone). Then go to Channel 2 and listen to NBN (up in one earphone and down in the other). Make sure sound is going into correct ear. Linearity Check Channel 1: With the frequency at 1000 Hz, turn the HL dial from 0-70 db. Check for equal changes of loudness. Notice if there are audible clicks with the changes of the HL dial. Listen to both insert earphones and audiometer channels (pure tones in channel 1, narrow bands in channel 2). Microphone Check To check the microphone, press mic, set the dial to 50 db and listen to the examiner s voice in each earphone. Listen for humming, static, or excessive background noise. Be sure that the person talking is not peak clipping or it will sound distorted. Check other transducers Do linearity check using the bone vibrator. Listen for any static as you gently jiggle cord connections. Do linearity check using both right and left supra-aural earphones. Make sure sound is going to correct earphone. Listen for any static as you gently jiggle cord connections. Do linearity check of right and left speaker in soundfield. Make sure sound is going to correct speaker. Listen for any static or unwanted sounds. ***Note any problems you encountered and what needs to be done!** Revision:

3 Start-up and Preparation AM students are required to arrive 30 minutes early in order to: 1. Turn on ALL equipment; Complete listening checks; Untangle all cords in booth 2. Review charts: physical paper chart and Lytec Notes. Please review your files at least 24 hours in advance of an evaluation, as noted above as additional preparation may be necessary. Files are pulled each Friday for the following week and are located in the GBC clinic office. 3. Prepare tools, hearing aids, forms, etc. for appointments 4. If you will be doing an AE (audiologic evaluation) be sure to have on hand an audiogram (in case the computer goes down), pen, appropriate word recognition list (Mayo, Spanish, NuChips, WIPI, etc.), manuals and recorded materials if necessary. 5. If you will be doing an HAE (hearing aid evaluation/consultation/selection/order), research hearing aid options and (if possible) select a hearing aid no later than one day before the evaluation. Gather impression material and tools, an otoscope, earmold and/or hearing aid order forms and model hearing aids just prior to the appointment. 6. If you will be doing a hearing aid fitting and assessment, ensure that the patient s aid(s) are available. A listening check should be performed on all new hearing aids at least one day prior to the fitting appointment. All hearing aids back from repair should have a listening check and be electroacoustically evaluated to ensure they meet ANSI standards at least one day prior to the appointment. Additionally, enter the patient s data into NOAH and complete pre-fitting adjustment using simulated real ear data. Gather the hearing aid(s), batteries, earmold(s), scissors, tubing stretcher and screwdriver just prior to the appointment. Check to make sure the medical clearance form has been obtained. *Complete the laminated check-list* PM students are required to arrive at least 15 minutes early to review files and prepare for appointments. Clinic Shutdown Following clinic, all students are expected to: 1. Complete a chartnote in Lytec (C) 2. Ensure the face sheet is up-to-date and accurate (F) 3. Enter a recall appointment if needed (R) 4. C,F,R (post appointment client specific duties) should be documented as completed for your supervisor in the manner they request. C = Chart note. This is the appointment summary note that you will write in Lytec. F = Face Sheet. All patients who wear hearing aids/cochlear implants should have an up to date face sheet in their physical chart. R = Recall Appointment. A recall appointment for6 month/annual hearing aid checks should be made at the time of the appointment (before adding an additional recall, the student should ensure that an appointment is not already entered to eliminate duplicate mailings). Revision:

4 NOTE: 5. Straighten booths (untangle headphone wires please!) and clinic area. 6. Clean video-otoscope specula, impression syringes, toys and work area, in accordance with the infection control policy. (Standard otoscope specula and foam insert-phone ear tips are thrown away after a single use.) 7. Turn off all equipment unless clinic will be held later that day in the same area. 8. Turn off all lights! EACH CLINICIAN is responsible for cleaning up after her/his own clinics DON T ASSUME THAT SOMEONE ELSE WILL DO IT! THESE GUIDELINES ARE FOR ALL PERSONS UTILIZING THE HEARING CLINIC EQUIPMENT FOR ANY REASON! If more than one person has clinic at a time, please workout amongst yourselves who will be responsible for which duties. Specific Clinical Documentation Requirements A. Formal reports 1. Formal reports must be written for patient contacts related to but not limited to: i. Audiologic evaluation, including Auditory Processing Assessment if applicable ii. Hearing aid evaluation/selection for new patients iii. OR other appointments at the direction of your clinical supervisor 2. Formal reports should include but not be limited to the following report elements: i. Headings 1. Patient name 2. Date of birth 3. Date of evaluation 4. Audiometer 5. Names of examiner and supervising audiologist 6. Name of referral ii. Background Information 1. Medical History 2. Patient/caregiver reports of communicative difficulties and their progression over time 3. Previous Audiologic Results 4. SAC/SOAC data 5. History of tinnitus and/or dizziness iii. Test results iv. Summary of test results and their significance relative to: 1. Medical history and patient concerns 2. Recommendations (Plan) for follow-up and rehabilitation v. Names and signatures of examiner and supervising audiologist vi. Names of individuals to receive copies of the formal report B. Clinical notes 1. Clinical notes must be entered in Lytec for ANY patient contact including but not limited to: Revision:

5 i. Hearing aid trouble shooting and repairs ii. Consultations regarding hearing aid maintenance, care and proper use. iii. Consultations by telephone, mail (electronic or traditional) and in person must be noted iv. Notes should include three basic categories: 1. Purpose of Visit 2. Assessment/ Summary of Session 3. Recommendations/Plan v. Notes related to hearing aid trouble shooting and repair should include but not be limited to: 1. make of hearing aid 2. serial number of hearing aid 3. model and style of hearing aid 4. ear hearing aid is used in 5. nature of problem as described by patient 6. type of action taken to repair hearing aid 7. result of action taken for repair 8. results of real ear and hearing aid test box (electroacoustic analysis) testing 9. printouts from real ear testing and electroacoustic analysis (taped to a white blank piece of paper and copied if printer paper is heat-sensitive) clearly showing the appropriate identification of patient, hearing aid, etc. 10. statement regarding patient s subjective opinion of benefit from action taken 11. recommendations for follow-up 2. Clinical notes for consultations regarding proper use, care and maintenance of hearing aids should include but not be limited to: i. Concerns and complaints as made by patient ii. Action taken to address patient concerns and complaints iii. Statement regarding the patient s subjective opinion of benefit obtained from action taken iv. Recommendations for follow-up Medicare Documentation Requirements For patients who are utilizing Medicare, there are the following documentation requirements. This information must be included in their Lytec note and printed report if applicable: A. Referring provider B. Reason for appointment. Medically necessary reasons include the following: 1. Evaluation of suspected change in hearing, tinnitus, or balance; 2. Evaluation of the cause of disorders of hearing, tinnitus, or balance; 3. Determination of the effect of medication, surgery, or other treatment; 4. Reevaluation to follow-up changes in hearing, tinnitus, or balance that may be caused by established diagnoses that place the patient at probable risk for a change in status including, but not limited to: otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Meniére s disease, Revision:

6 sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions; 5. Failure of a screening test (although the screening test is not covered); 6. Diagnostic analysis of cochlear or brainstem implant and programming; and 7. Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices. C. Current medications, or a note that a comprehensive list is on file D. Indication of tobacco use; if the patient uses tobacco, a note that they were given info on resources for tobacco cessation E. Procedures done and their outcomes F. Clinical assessment of the findings G. Recommendations H. Name of the provider, their qualifications (indicated by degree and certification, if applicable), signature, and date of service. For further information, please visit the following websites: FAQs/#1 Revision:

7 Closing Out Appointments At the end of each appointment, the student will indicate that the appointment has been completed in the following manner: CLOSING OUT A CLIENT The schedule can be used to see if a client is ready, but it can also be used to complete a client once the appointment is done. The following instructions will guide you through the process. Please complete your clinical notes prior to closing out the client in the schedule. Log into Lytec Click on Scheduling. Click on Schedule Apppointments. Make sure the Calendar is highlighted. This will show the calendar on the right side of the screen. Click on the date you want to complete. Revision:

8 The status should say complete at the end of the day. If your client cancelled or no showed, that should also be changed accordingly. Double click on the client you need to complete. Click on arrow to show list. Choose one of the following: Complete, Canceled, Missed (No show) or Rescheduled. Click OK. If you have a canceled or missed appointment, it would be important to communicate that with the clinical support staff. The clinical support staff will check a patient in and the schedule will say waiting once the paperwork is completed and the client is ready for the appointment. The clinical staff has been instructed to utilize the procedures that are being developed to create good communication between them and the providers. Revision:

9 Report Writing Timeliness and Guidelines Policy Statement: The University of Arizona Hearing Clinic is committed to quickly providing appropriate written communication to our patients and other caregivers. Our students play a vital role in this process. As such, their timeliness has a direct impact on their clinic grade. 1. Please refer to the Sample Reports and Lytec note instructions specific to your clinical supervisor on the D2L website and confer with your instructor regarding specific report format to use. It is important to note that full reports will no longer routinely be sent to patients. As a result, at the time of the exam, the clinician should provide the client with a copy of the audiogram to take with them. On this audiogram, please write See full report in the comment. Full reports can be provided upon request and authorization. 2. Follow the HIPPA guidelines for writing reports (i.e. clinical computer lab is the only acceptable location to write reports). 3. Be sure audiograms are recopied/printed thoroughly and neatly. List inserts or earphones depending on transducer used for air conduction testing. Include tests employed and procedures used (if unconventional). List recorded or MLV method for speech testing. If a routine test is not completed for some reason, report DNT or CNT and the reason if appropriate (i.e., DNT re-eval; CNT patient fatigue). 4. Compute and enter pure tone average. 5. Fill out a Tracking Form to accompany your report. The tracking form will include the patient s name, date (of appointment), last name of instructor and student clinician name. On the form, indicate the date you give the hard copy of the report to your supervisor. Your supervisor will put an entry on the form when he/she returns it for revisions, etc. Responsibilities of the Student: 1. Files are not to be taken out of the building. 2. Students will turn in to their clinical instructor FIRST DRAFT reports within TWO BUSINESS DAYS. These will be placed in the patient s chart, in the instructors clinic box, and will include: a. Double-spaced draft report, b. Appropriate HIPPA tracking form, and c. Written chart-notes. 3. Students will make revisions and/or respond to any subsequent clinical instructor request within ONE BUSINESS DAY of receipt. 4. Students will notify their clinical instructors when it is likely that they will write or revise a report late. 5. After your supervisor has OK d the final draft (within TWO BUSINESS DAYS), you will send (aka Spongebob) the file to the secretary and place the folder in the to be typed area in the clinic office. The secretary will put the final copy in your file in the GBC workroom for proofing. 6. Read the final draft VERY carefully! If there are no further revisions, sign your name in pen in the space provided on the report and on the audiogram and put the file in your instructor s clinic box for final proofing. Revision:

10 7. If there are corrections to be made, mark any corrections with a pencil and make an indication in the margin opposite the error so that it will be readily spotted by the secretary. The secretary will put the final copy in your file. Follow step 5 following your final proofing. Responsibilities of the Clinical Instructor: 1. Clinical instructors will return to the student revised first-draft report, with revisions, within TWO BUSINESS DAYS. (Exceptions may occur due to supervisor travel/vacation time). 2. Clinical Instructors will make subsequent revisions and/or respond to any student request within TWO BUSINESS DAYS, when possible within one business day. Late Report Submission Policy Students: It is understood that, due to unforeseen academic and personal conflicts, reports (first drafts and/or revisions) may occasionally be turned in late. Nevertheless, 90% of all reports must have moved through the process according to the standards above. If fewer than 90% of the reports are on time, a student will receive an AUTOMATIC grade reduction as follows: 90% on time performance No grade reduction 85 to 89% ON-TIME: Reduction of 1 grade level 80 to 84% ON-TIME: Reduction of 2 grade levels 75 to 79% ON-TIME: Reduction of 3 grade levels Less than 75% ON-TIME: Student may be barred from further clinic placement You are expected to notify the instructor when a report will be late. But permission, or acceptance of an excuse, should not be interpreted as removal of that report from the policy. ALL late reports, irrespective of excuse, will be considered toward the 90% on-time criterion. No report can be more than four days late for any reason. Such a transgression could result in an immediate reduction in the clinic grade. Reports turned in at the end of a semester must be processed according to these same standards (following the last day of clinic) or there will be an automatic lowering of the clinic grade for that semester. Students remain responsible for them until they are through the editing process and on to typing. Instructors will then sign the final draft on the student s behalf if necessary. Revision: