1. Tues NNMC PI Project VISION SCREENING Marcia Frye Candice Snyder Katie Charnock Michael Cunningham Bridget Cunningham

2. AAP Policy Statement Anatomy and gross visual assessments should be checked from birth to 3 years of age, about the age when visual acuity can be measured reliably. Visual acuity testing is recommended for all children starting at 3 years of age with every well visit Vision should be assessed whenever there is a complaint about vision

3. Problem Perceived low number of documented visual acuity on AHLTA chart Chart review of 250 well visits ages 4yrs and greater Intervention Repeat chart review

4. Data Dates: 01 Jul – 04 Aug 4yo 3/2811% 5yo 28/4267% 6yo 16/2467% 7yo 7/1741% 8yo 13/2454% 9yo 7/1741% 10yo 4/1040% 11yo 12/2548% 12yo 5/1729% 13yo 7/1258% 14yo 5/1436% 15yo 2/633% 16yo 3/475% 17yo 2/825% 18yo 0/10% 19yo 2/2100% Total: 117/25246% Excluding 4yo114/22451% Abnormal: 26/11722% – (12 of 26 referred)

5. Intervention Questionnaire to all corpsmen working in clinic identifying obstacles Education to all corpsmen regarding importance of test/documentation and guidelines from AAP Increased number of charts in clinic by 300% (4 charts-Snellen and picture)

6. Repeat Data Dates 16 Feb – 12 Apr 3yo 0/20% 4yo 0/350% 5yo 17/4935% 6yo 13/3537% 7yo 12/2646% 8yo 12/2157% 9yo 10/1759% 10yo 8/1747% 11yo 9/1947% 12yo 9/1560% 13yo 3/1030% 14yo 3/743% 15yo 5/771% 16yo 3/475% 17yo 2/450% 18yo 2/2100% 21yo 2/2100% Total:110/272 40% Excluding 3-4y/o 110/23547% Abnormal: 10/110 9% – (4 of 10 referred)

7. Hypothetical Problems/Reasons for Decline Not performed due to optometry visit in the last year (w/o documentation of the appointment) Vision screened but not recorded (b/c corpsman brings pt to room w/ vitals sheet) Failure of physicians to recognize screen not performed or documented Patients late to appointment and rushed to room Not recognizing 3 and 4 year olds should be screened (despite training)

8. Future Improve documentation Incentive program with HMs Personal responsibility