Embedded Files
Page 18
As with any aspect of professional care, the optometrist who provides services within nursing homes is expected to display the highest degree of professional conduct and regard for the overall welfare of his or her patients. Nursing home care can present a number of ethical issues in the evaluation of residents, provision of spectacles, and decisions not to treat or provide interventions. The optometrist is expected to evaluate nursing home residents only as requested by attending physicians, to follow all rules of examination and documentation set by governmental and third party agencies, and to bill charges only as appropriate. Given the level of under utilization of eye care in nursing homes, it might be expected that provision of spectacles would constitute a large portion of nursing home practice. Decisions to prescribe spectacles or to recommend cataract surgery should be tempered by ethical decision making in regard to how beneficial the intervention is likely to be. Residents who are terminally ill or in a persistent vegetative state also represent a unique challenge. The optometrist should assist residents and their families in carefully weighing the benefits and burdens of intervening or not intervening for these individuals. Decisions regarding highly debilitated residents in nursing homes are frequently not clear cut. Seeking input from other professionals within the nursing home, family members, and the resident himself or through the resident’s advanced directives can make the process easier. Residents have the legal right and should participate in treatment decisions to the extent that they are able. Foremost in the evaluation of each individual should be the question, "Am I improving this resident’s quality of life?
INSTRUMENTS AND EQUIPMENT
The key issue in determining the type of equipment needed for a nursing home examination is whether an examining room will be set up in the facility or not. This will depend upon a variety of factors including the size of the facility, frequency of optometry visits, available space, and the type of residents to be seen. Many nursing home patients will be seen in wheelchairs, geri-chairs, or in their own beds, making the setting up of a lane impractical. More often than not the optometrist will be called on to do evaluations in space allocated for another purpose. Spaces may include areas such as dining halls, recreation rooms, offices, beauty parlors, and dental examination areas. Under such circumstances, flexibility is the key. This usually means bringing portable equipment from the optometrist's office to the nursing home. The equipment needed is essentially the same as required for providing hospital or other out-of-office services. A variety of hand-held equipment is now available including lensometers, tonometers, slit lamps, autorefractors, and binocular indirect ophthalmoscopes. A list of possible equipment needed for nursing home service is found below. It is best to remember the golden rule of out-of-office care: “if you think you might need it, bring it with you.”
Google Sites
Report abuse