Tues NNMC PI ProjectVISION SCREENING

Marcia FryeCandice SnyderKatie Charnock

Michael CunninghamBridget Cunningham

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

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

Data

Dates: 01 Jul – 04 Aug• 4yo 3/28 11%• 5yo 28/42 67%• 6yo 16/24 67%• 7yo 7/17 41%• 8yo 13/24 54%• 9yo 7/17 41%• 10yo 4/10 40%• 11yo 12/25 48%• 12yo 5/17 29%• 13yo 7/12 58%• 14yo 5/14 36%• 15yo 2/6 33%• 16yo 3/4 75%• 17yo 2/8 25%• 18yo 0/1 0%• 19yo 2/2 100%

• Total: 117/252 46%• Excluding 4yo 114/224 51%• Abnormal: 26/117 22%

– (12 of 26 referred)

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)

Repeat Data

Dates 16 Feb – 12 Apr• 3yo 0/2 0%• 4yo 0/35 0%• 5yo 17/49 35%• 6yo 13/35 37%• 7yo 12/26 46%• 8yo 12/21 57%• 9yo 10/17 59%• 10yo 8/17 47%• 11yo 9/19 47%• 12yo 9/15 60%• 13yo 3/10 30%• 14yo 3/7 43%• 15yo 5/7 71%• 16yo 3/4 75%• 17yo 2/4 50%• 18yo 2/2 100%• 21yo 2/2 100%

• Total: 110/272 40%• Excluding 3-4y/o 110/235 47%• Abnormal: 10/110 9%

– (4 of 10 referred)

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)

Future

• Improve documentation• Incentive program with HMs• Personal responsibility