Ophthalmology is known for technologic innovations. We strive to improve accuracy, gather information and reduce sources of error to achieve better visual outcomes for our patients. One particular source of error is improper data entry. This can occur at various points in the patient journey from check-in to surgery. Incorrect data entry can lead to errors in patient chart notes, billing and wrong-eye surgery. The good news is there’s a simple method for error reduction—incorporating checklists each step of the way.
The Power of the Checklist
EHR systems require patient names and birthdates to match the information on their corresponding insurance cards for correct processing and payment. An incorrect name or birthdate can delay physician and ASC payments as well as prevent imaging studies from linking with patient charts. A checklist for front-desk and admitting personnel can help reduce these inaccurate entries. The checklist can be a simple laminated reference card or a digital “sticky note” located on the desktop. “Alert fatigue” can be a problem when using EHRs, so a written checklist can improve compliance.
High-Tech Options
Cataract surgery requires multiple measurements necessary for successful surgery. Biometry including K readings and axis of astigmatism, IOL selection for primary and back-up IOLs with intended refraction, and additional information such as small pupil management and pre-existing corneal or lens pathology, density of the cataract, and any factors for increased risk of vitrectomy, are important for the surgeon to review at the time of surgery.
Software integrations such as Veracity (Zeiss) can easily assist the surgeon in performing preoperative calculations for biometry and provide a digital “face sheet” that can be accessed easily via an OR laptop. Veracity allows the surgeon to include relevant data including a “free text” area for additional items that may be utilized, such as iris hooks.
The Lensar Ally Femtosecond Laser system can also help to improve safety and efficiency for cataract surgery with FLACS. Data from biometry can be digitally transferred to the Ally from a variety of diagnostic devices, cutting down on manual entry errors. Along with a digital or manual checklist, it can provide a way to double check data entry.
“Low Tech” Still Gets the Job Done
In addition to high-tech solutions, “low tech” can still be utilized to reduce error without sacrificing efficiency. One such technique that I find extremely helpful is a printed checklist. Before every procedure, I have a face sheet checklist that includes pertinent information for the case. I have it pre-filled out prior to the day of surgery, and it serves as a handy, portable safeguard for correct data entry.
I include the surgical eye, necessary data points, intended refraction, and any additional concerns about the patient and/or procedure. I use this in conjunction with the high-tech Veracity software accessed from an OR laptop as an additional safety checklist.
The “Time Out” is, of course, a mainstay protocol for OR procedures, and a necessary safety check for any procedure. Postoperative instructions should be checked by the discharge nurse to ensure the correct instructions are given to the correct patient for the correct eye. A manual or digital checklist for the discharge team is another safety checkpoint.
Checklists, whether digital or hard copy, are critical for promoting safety and successful outcomes for our patients. OASC
