Blind Spot

When examining OASIS data for large groups and comparing it to care plans, there is one major discrepancy that never fails to raise a red flag: having a large number of patients with identified visual impairments compared to the number of careplans and clinical notes that address visual acuity.

Do this for your next staff meeting or case conference or any other occasion when you call your nurses in. Buy a pair of the strongest reading glasses you can find at the dollar store. Bring the glasses along with three scavenged pill bottles, a potato and a veggie peeler and a photograph of someone famous. As a younger staff member who functions without corrective lenses to wear the glasses and choose the medication bottle of your choice. Have her try to peel a potato and identify the photograph. Ask her to dial a number on the office phone.

After you have had your fun (and I assure you that it is fun!), ask the nurse if her attitude towards vision has changed. Is it possible that she is even more empathetic towards patients with impaired vision after the demonstration than before?

Even patients who can read pill bottles and do not reach the criteria for impaired vision in MO390 may have their life greatly enhanced by improved vision. Being able to really appreciate a photograph of a grandchild or being able to read comfortably can greatly add to the quality of life.

Low Vision programs are great for the severely impaired. But many patients can benefit from the following simple, less complicated approaches to improving vision:

1. Upon assessing a patient with impaired vision, obtain their eye doctor’s number and coordinate a visit for them if it has been over six months.
2. Place PRN meds in large freezer bags and write the name of them on the freezer bag with a Sharpee so that patients can readily identify Lasix or PRN pain pills.
3. Assign someone in your office to investigate what vision services are available through your state’s Medicaid program.
4. Strategically place lamps where they will most benefit patients. Use the florescent bulbs that put out a lot of light and very little heat.
5. Buy black handtowels or linen napkins for use while patients are taking meds. That way any pills that drop are easily found.
6. Ask family members to assist in buying clocks, scales, phones, remote controls, etc., with large numbers. Suggest that recorded books are borrowed from the library to provide the patient with ‘reading’ materials if the patient enjoys books.