1. Unit 304 Preparing the Patient for Retinopathy Screening By Jenny Gaffney & Jean Macpherson

2. 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

3. What Do We Check Patients full name Address / contact telephone number D.O.B. CHI number Preferred location of screening

4. Why Do We Check Personal Details? Ensures captured images corresponds to correct patient. Ensures continuity of care and correct delivery of results or onward referral. Avoids legal implications of results going to wrong patient thus maintaining patient confidentially.

5. Adverse Factors Influencing The Screening Visit Age Mental status e.g. dementia or learning difficulties Physical status e.g. amputee Level of co-operation Communication problems.

6. 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.

7. 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 accessibility problems.

8. 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.

9. 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.

10. Informing Patient About The Screening Process Patients attending for first visits receive an information leaflet called “Diabetes and Eye Care in NHS Scotland” On commencement of screening process allow adequate time for questions. Additional information leaflets are available in the waiting area. Attendance for screening is perceived to be implied consent.

11. Obstacles To Understanding The Screening Process Age, young and old. Mental health problems, dementia or learning difficulties English not first language Deafness

12. 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 images. Patients driving to an appointment and needing mydriasis resulting in a wasted appointment.

13. Obtaining Consent Consent is required to carrying out any procedure. Referrals are initially made by the GP and appointment letters are sent inviting them to attend Attending a screening appointment means the patient has given implied consent. There is no facility on the software for recording of consent.

14. “Opting Out” It is the patients right to decline to be a part of the screening programme.

15. Possible Reasons For Opting Out Fear of the unknown procedure and the subsequent results. Patients attending ophthalmology. Regular visits to opticians Other health problems Total loss of vision

16. Method For Opting Out This has to be formalised by the patients GP after discussion about the possible risks involved. The GP must record their decision in the notes and both parties should sign a disclaimer form. GP must complete a webform on SCI-DC This last for 3 years and must be reviewed.

17. “Opting In” It is the patients right to rejoin the screening programme at any time if they so wish.

18. 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 information. In Scotland the Confidentiality & Security and Advisory Group for Scotland 2002 provided information on the law, patients rights and standards for confidentially.

19. Storage Of Electronic Information Information may only be accessed by use of appropriate individual passwords ( at least 2 ). All information must be firewall protected. If computer is left unattended “log off”.

20. Paper Records 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.

21. 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.

22. Patients Complaints Waiting times Location, easy access for disabled Car parking facilities Busy telephone lines Offer explanation If possible offer alternative site Offer another site Advise patients when lines are less busy

23. Complaints Procedure If possible defuse situation immediately at a local level. 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