Transcript

00:00:01 Candice White

Hi everyone, I want to welcome you to our NeoLight Cares educational session.

00:00:08 Candice White

We do have a global audience here with us today, so we are so excited to be able to present this information to you all.

00:00:18 Candice White

We have done this in the past and we will be doing it in the future.

00:00:22 Candice White

So, we are just really excited to have a detail with us today and talk about ROP screening or retinopathy prematurity screening and nurse LED program.

00:00:33 Candice White

So, for those of you who are joining us for the first time, NEO like cares is a program that supports educational resources for users of all new light equipment.

00:00:44 Candice White

A little background for cares.

00:00:46 Candice White

It stands for continuing advancements and resources and education support, and that is exactly what we do.

00:00:53 Candice White

We have a plethora of information, including policies and procedures.

00:00:57 Candice White

We have competencies, skills, checklists, quick guides, manuals, really just anything that you would need to be successful with using equipment that we provide.

00:01:07 Candice White

Here at NeoLight

00:01:09 Candice White

We have that all on a single platform at theneolight.com and that is the neolith.com. If you navigate to our education tab, you are going to find E seminars like what we are recording today. You are going to find system specific information for the systems that you have in your unit.

00:01:28

OK.

00:01:29 Candice White

You will be able to find updated information as we learn more about what is going on in the market.

00:01:35 Candice White

We continuously look to provide more information for those nurses and staff members who may be utilizing our equipment in the field.

00:01:42 Candice White

So, we are really excited to bring it.

00:01:44 Candice White

That to you and kind of use that platform to present information like what we have today.

00:01:50 Candice White

A few housekeeping items before we get started.

00:01:53 Candice White

We do have everyone on mute just to minimize background noise, we know some people join us in different time zones, so they get to be home with their families, or some people are listening from break room.

00:02:03 Candice White

So, we want to make sure that we have a good educational platform with minimal noise.

00:02:08 Candice White

Everyone's camera is also turned off.

00:02:10 Candice White

So that we do not have any distractions from things happening in the background as we move into the presentation Edyta, and I will also turn off our cameras that way we can really focus on the information being presented.

00:02:21 Candice White

We do not have to worry about moving cameras back.

00:02:22 Candice White

00:02:23 Candice White

Be able to see the screen and see the information very clearly.

00:02:28 Candice White

There is also the opportunity to post questions throughout the presentation. If you have questions, feel free to submit them.

00:02:34 Candice White

We will also open the platform for people to submit questions at the end of the presentation, and that is when we'll answer as many questions as we can get to.

00:02:42 Candice White

If for some reason we do not get to your question, you are more than welcome to reach out to any of our clinical team.

00:02:47 Candice White

You can also find support on neolight.com.

00:02:51 Candice White

And we will make sure that we get it.

00:02:52 Candice White

Back with you.

00:02:53 Candice White

We can share documentation, we can talk about educational opportunities, anything that we can do to help your system and help with.

00:03:00 Candice White

The use of.

00:03:00 Candice White

The equipment we are happy to help with.

00:03:03 Candice White

So, without taking any more of anyone's time, I would love to do an introduction for Edyta and then we will get started with our presentation.

00:03:10 Candice White

So, I have known Edyta for many years.

00:03:12 Candice White

She brings 12 years of experience as a nick.

00:03:14 Candice White

You are in and later worked as an RP clinical manager and coordinator specialist.

00:03:19 Candice White

She pioneered an enormous nurse driven program.

00:03:23 Candice White

Her medical nurse, specialist, and ophthalmologist, looked so closely with her, covering 4 high volume Level 3 NICUs.

00:03:31 Candice White

Edyta trained a team of 14 RNs to scream for ROP using a retinal imaging system, and they.

00:03:38 Candice White

We are so successful.

00:03:39 Candice White

With those programs, they screened over five hundred patients annually for ROP with 100% outpatient follow-up rate for all patients, including their high-risk patients as well.

00:03:51 Candice White

So, Edyta comes today with a beautiful program built and she is going to teach us how we can take those successes into building other programs in the nit.

00:04:00 Candice White

So, Edyta, I am.

00:04:02 Candice White

Going to go ahead and share my screen and then we can turn our cameras off.

00:04:07 Candice White

And go ahead and get started with your presentation.

00:04:22 Edyta Lytle

My camera does not want to turn off here.

00:04:25 Candice White

We just want to keep you on the whole time.

00:04:29 Candice White

Let me see here.

00:04:30 Candice White

If I am going to take this, I might.

00:04:31 Candice White

Be able to turn.

00:04:32 Candice White

It is for you.

00:04:33 Candice White

Let me see here.

00:04:38 Candice White

There we go.

00:04:40 Edyta Lytle

OK.

00:04:41 Edyta Lytle

Well, thank you so much, Candace, for that wonderful introduction.

00:04:44 Edyta Lytle

And thank you all for being here today.

00:04:46 Edyta Lytle

I am so excited to share some of my knowledge as Candace had mentioned, I was fortunate enough to establish a very large nurse driven ROP screening program and we were so successful, and it was such a.

00:05:01 Edyta Lytle

Wonderful and incredible experience and I just want to share some of them.

00:05:05 Edyta Lytle

That I took away from that and hopefully that you can implement into programs of your own.

00:05:10 Edyta Lytle

So, without further ado, let us get into the webinar and it is entitled understanding the numerous benefits of a nurse LED retinopathy of prematurity or ROP screening program.

00:05:21 Edyta Lytle

Let us get started.

00:05:26 Edyta Lytle

So here are our objectives for today.

00:05:28 Edyta Lytle

We are going to briefly go over the types of ROP screening programs.

00:05:32 Edyta Lytle

I know a lot of you are familiar with this already.

00:05:34 Edyta Lytle

And then the majority of our webinar is going to be focused on the benefits of a nurse LED ROP screening program.

00:05:40 Edyta Lytle

And for these benefits, I have broken them down into 3 segments.

00:05:44 Edyta Lytle

The first part is the nursing perspective.

00:05:46 Edyta Lytle

Then we are going to go into the patient perspective.

00:05:49 Edyta Lytle

And then also into the unit perspective.

00:05:52 Edyta Lytle

Then after we have understanding of the benefits, we're going to go into, how do you select and create your OP screening team?

00:05:59 Edyta Lytle

And then we are going to go into how to implement your new program and then how to evaluate success.

00:06:09 Edyta Lytle

OK, so the two types of retinopathies of prematurity screening programs are right here.

00:06:14 Edyta Lytle

So, the first one is your traditional binocular indirect thermoscope and that is where the ophthalmologist comes into the unit.

00:06:21 Edyta Lytle

He physically has to come into the unit and wears his binocular indirect headgear.

00:06:27 Edyta Lytle

And screens the patients when he is ready to document his results, he draws the images that he sees from the back of the eye, the retina, onto a document and that scanned into the electronic medical record.

00:06:42 Edyta Lytle

So again, this is very dependent upon his availability to come into the unit, to physically.

00:06:47 Edyta Lytle

Screen your patients.

00:06:49 Edyta Lytle

The other type of ROP screening program is retinal fundus imaging.

00:06:54 Edyta Lytle

So, ROP screening with a camera and this is where we take photos of the retina.

00:06:58 Edyta Lytle

So rather than a drawing, you are having actual photos of that patient’s retina.

00:07:05 Edyta Lytle

The back of the eye and this can be performed by numerous different staff members.

00:07:09 Edyta Lytle

So, it can be.

00:07:10 Edyta Lytle

Performed by nursing staff by the physician’s assistant, it can be done by the neonatal nurse practitioners or by the ophthalmologist, and what is wonderful about this system is that you can easily compare images from week to week and it is much clearer than a drawing.

00:07:27 Edyta Lytle

Of the documentation of the eye, and it also allows for more flexibility because you have way more people that are capable of doing the screening and documenting appropriately.

00:07:43 Edyta Lytle

So why choose?

00:07:45 Edyta Lytle

And nurse LED RLP screening program well, there is lots of reasons, but let us look at some.

00:07:49 Edyta Lytle

Of the benefits.

00:07:51 Edyta Lytle

So, as I said before, I have broken down the benefits into three parts, which are the nursing perspective, the patient perspective and the unit perspective.

00:07:59 Edyta Lytle

And we are going to dive deep into each one of these.

00:08:01 Edyta Lytle

So first, let us start with the nursing perspective.

00:08:10 Edyta Lytle

So here are some of the benefits from the nursing perspective and there are so many, but these are some of the main ones that stick out in my mind.

00:08:17 Edyta Lytle

So, the first one is nurse autonomy and flexibility, an increase in the pride of care that is given to these patients.

00:08:24 Edyta Lytle

The nurses are able to gain a new skill set.

00:08:27 Edyta Lytle

It is an opportunity for growth.

00:08:29 Edyta Lytle

They get control of the patient’s experience.

00:08:32 Edyta Lytle

They provide consistent care, and there is ample time for teamwork.

00:08:38 Edyta Lytle

So, let us look at each of these individually.

00:08:42 Edyta Lytle

So, one of the first benefits is nurse autonomy.

00:08:45 Edyta Lytle

What is wonderful about this one is that it gives the nurses really the freedom to work both independently and as a team.

00:08:52 Edyta Lytle

They can make decisions on how best to obtain those patient images, which is so amazing because nurses know these babies better than anyone else, and so they can really make adjustments to fit the patient.

00:09:05 Edyta Lytle

Situation and make it most comfortable and get the best images possible for those babies and because of that, they are able to embrace and implement their patient care knowledge that they know from taking care of these babies in the NICU during them.

00:09:19 Edyta Lytle

Sam and it also gives them the ability to drive the entire program from scheduling to doing the exams to working closely with the ophthalmologists, to parent education and also scheduling treatment.

00:09:30 Edyta Lytle

They are involved in every facet of the program.

00:09:37 Edyta Lytle

The next benefit is flexibility.

00:09:39 Edyta Lytle

What is wonderful about having a camera to do RP screenings, screening exams, is that there really is just so much flexibility.

00:09:48 Edyta Lytle

And when these exams can be done, rather than having an ophthalmologist being very limited in time to coming in to see your entire unit of.

00:09:57 Edyta Lytle

You can really split the exams up.

00:09:59 Edyta Lytle

You can do them during the day shift.

00:10:00 Edyta Lytle

You can do them during night shift and not only that, but you can decide what time and those shifts work best for the patients, for the nurse screeners and for the unit as a whole.

00:10:11 Edyta Lytle

Maybe at 4:00 o'clock in the morning is the best time for you to do your screenings because there are no families.

00:10:17 Edyta Lytle

On the unit and it is just a quieter time.

00:10:19 Edyta Lytle

The unit is really up to the screening, RN's and the unit and the ophthalmologist to really work together and make it flexible and really make it work for them.

00:10:28 Edyta Lytle

The other key player that it is flexible for is the ophthalmologist, so the ophthalmologists can identify the best day of the week, best, best for them to read the exams and then if they need.

00:10:40 Edyta Lytle

More exams on a baby because the baby is more critical and the disease is progressing more rapidly, they are able to ask their RP screening RNs to go in and do additional exams rather than having to stop their entire day to come in to see one.

00:10:56 Edyta Lytle

Patient, they can have this, the RN screening, nurses that are often they are already working shift or it is just easier for them to come in.

00:11:03 Edyta Lytle

They do not have a whole clinic that they are taking care of to come in and do those more frequent exams as needed.

00:11:09 Edyta Lytle

Also, it provides flexibility with the patient, so this is patient need dependent.

00:11:14 Edyta Lytle

So, you can really modify the times that the exams.

00:11:17 Edyta Lytle

You are done if the parents are visiting there, you can go a different time.

00:11:21 Edyta Lytle

If the parents do not want to be there during the exam.

00:11:24 Edyta Lytle

If they have physical care times or assessment times, which most babies do, they are on every three- or four-hour schedule.

00:11:30 Edyta Lytle

You can schedule their exam times for those hands-on care.

00:11:34 Edyta Lytle

Times and then you can also do it before and after feedings.

00:11:37 Edyta Lytle

Some babies have problems with reflux and so it is better for them to do the exam before their feedings.

00:11:43 Edyta Lytle

But some you are really working on that endurance for feedings, and so maybe you want to do the exam after their feeding is complete.

00:11:50 Edyta Lytle

It is up to you.

00:11:52 Edyta Lytle

And for the bedside nurse.

00:11:54 Edyta Lytle

And for them, the patient’s needs are present, and you can also one of the other amazing features is that you can schedule around procedures.

00:12:03 Edyta Lytle

So rather than the ophthalmologists coming in.

00:12:05 Edyta Lytle

At 9:00 AM and getting all of the RP screening done himself.

00:12:12 Edyta Lytle

If that baby has an MRI scheduled that day for 9:00 AM, they can do it.

00:12:17 Edyta Lytle

Prior to that or after that?

00:12:19 Edyta Lytle

Or if the baby has to go off the unit for another diagnostic test, it's really way more flexible.

00:12:25 Edyta Lytle

Then having the ophthalmologists come in to do the binocular indirect exams.

00:12:32 Edyta Lytle

So, another benefit from the nursing side is that that it really does increase their pride of care.

00:12:37 Edyta Lytle

They have more control over these exams being done and they are going to the more they do it, the more their confidence is going to grow the quality of the exam is going to increase the quality of the images is going to increase and they will be motivated to do their best.

00:12:54 Edyta Lytle

Additionally, they will have the benefit of building relationships not only with the other nurses on the unit, because they are going to be helping them as their second pair of hands for these exams, but also with the ophthalmologist, the neonatologist, the entire care team and of course, the family.

00:13:12 Edyta Lytle

Another nurse benefit is that they are able to gain a new skill set, so this is really exciting for a lot of nurses because a lot of nurses get it.

00:13:23 Edyta Lytle

You know, excited about the idea of helping with new things, being involved in something bigger than just providing care, although providing care to these babies, nursing care.

00:13:34 Edyta Lytle

Is so important, it is often really.

00:13:39 Edyta Lytle

Intriguing to be part of something bigger, right?

00:13:41 Edyta Lytle

And so, if you do purchase a camera screening system, you will obtain a false patient head with a false eye.

00:13:50 Edyta Lytle

And we really encourage the nurses to practice as much as they can with this false head and false eye to really gain a sense of comfort with the equipment.

00:13:59 Edyta Lytle

And with the software and just to understand how exams are done before they place that on a patient.

00:14:06 Edyta Lytle

It is something that they are going to need to learn to do, to maintain their proficiency, and that's totally unit dependent on how many exams you have and what you feel is adequate to maintain proficiency.

00:14:17 Edyta Lytle

If something that they can add to their resume and they just become a more valuable part of the unit and like I said, they feel part of a bigger team as a unit.

00:14:29 Edyta Lytle

This kind of piggybacks off of that, but another benefit is that it is an opportunity for growth.

00:14:34 Edyta Lytle

So, with this new skill set that this nurse has obtained, they become more marketable and much more valuable to the unit, right?

00:14:41 Edyta Lytle

And so, they can also add this for any career ladder advancements or any other leadership opportunities that.

00:14:48 Edyta Lytle

Become along the road.

00:14:50 Edyta Lytle

It is something that they can use to maintain their competency, and it is a new learning opportunity.

00:14:55 Edyta Lytle

The more they understand the disease process of ROP, the better it is going to be for the entire program, and they might even continue to decide that they want to continue getting educational continuing education.

00:15:08 Edyta Lytle

But excuse me by attending conferences and other educational things like this webinar to further progress their skills and everyone will benefit from that.

00:15:18 Edyta Lytle

Also, the more involvement they have in the unit and the patient care, the more they are going to have more pride in the care and you are just going to have an overall better patient and family experience.

00:15:34 Edyta Lytle

The next benefit is the ability to control the patient’s experience.

00:15:39 Edyta Lytle

So again, as I had mentioned and I will say this several times during this presentation, but nobody knows these better these babies better than.

00:15:46 Edyta Lytle

And the NICU nurses, so they are able to read the baby's stress cues, and they can pass the exam.

00:15:52 Edyta Lytle

However, it is tolerated by the patient.

00:15:54 Edyta Lytle

If they need to go a little bit faster, if they need to slow down, if they need to stop in between eyes and come back and do the next eye, they can absolutely do that.

00:16:03 Edyta Lytle

So again, they can reschedule as needed.

00:16:06 Edyta Lytle

And it is based on patient tolerance and then they can also work with the family.

00:16:11 Edyta Lytle

So, if the family wants to be there to watch, they can schedule it for that time.

00:16:14 Edyta Lytle

If the family would prefer not to watch, that is OK too, and they can schedule it for that for a time that is appropriate for that.

00:16:22 Edyta Lytle

Family can also provide appropriate comfort measures.

00:16:26 Edyta Lytle

Again, they know these babies, they can provide containment.

00:16:29 Edyta Lytle

A pacifier if a baby is critically ill and requires pain medication prior to the procedure, they can advocate for that, and they again can schedule to fit in for the patient needs.

00:16:43 Edyta Lytle

Another benefit is that it provides consistency of care, so this you will see the.

00:16:48 Edyta Lytle

Throughout all three areas, but what is wonderful about having a small RN screening team is that they come.

00:16:56 Edyta Lytle

They become very familiar with it.

00:16:59 Edyta Lytle

And so similar to the primary care nurse model, wherein nurses care for babies, a primary baby when they are on shift, they really get to know the INS and outs of that baby and the family, the family dynamics, and all the intricacies of that are involved with the care of that baby.

00:17:17 Edyta Lytle

It is so similar to RP.

00:17:19 Edyta Lytle

Training with nurse screeners so they get really familiar with those patients.

00:17:24 Edyta Lytle

And then you are also just going to have a consistent presence of the screening team and because they're going to be there during the consistent day and time, maybe it's every Tuesday at 9:00 AM that they start the family, and everyone will be aware that that's when the baby gets their exam.

00:17:39 Edyta Lytle

Typically, it also builds trust within the family because they are seeing a familiar face.

00:17:44 Edyta Lytle

And like I said before, they are going to really learn and understand those patient cues.

00:17:52 Edyta Lytle

And last but not least is a benefit, a benefit from the nursing perspective is teamwork. So again, your team, your ROP screening team is going to be made-up primarily of these, at least three people.

00:18:03 Edyta Lytle

So, you are going to have your RP coordinator, your screening RN's and that's totally unit dependent size dependent. However, many you might need to provide adequate.

00:18:13 Edyta Lytle

And then your ophthalmologist and those are going to be the people in your screening team.

00:18:17 Edyta Lytle

They are going to be in constant communication not only with each other but also with the entire care team so that they can let the whole care.

00:18:25 Edyta Lytle

We know what is going on with the patient and of course, you know, discharge planning begins upon admission.

00:18:32 Edyta Lytle

And so, it is just another part of that discharge process for everyone to be on the same page.

00:18:37 Edyta Lytle

And of course, it is just wonderful to be a part of something bigger.

00:18:44 Edyta Lytle

So, the next set of benefits that we are going to look at are benefits from the patient perspective.

00:18:52 Edyta Lytle

And here they are.

00:18:53 Edyta Lytle

So again consistency, flexibility, flexibility to meet the patient care needs, decreased disruption of care promoted as family centered care.

00:19:04 Edyta Lytle

Minimizing patient discomfort.

00:19:06 Edyta Lytle

Increased parent understanding, increased compliance, post discharge and decreased patient transfer.

00:19:15 Edyta Lytle

So, let us look at these individually here.

00:19:18 Edyta Lytle

So, the first one is consistency and I kind of mentioned this one before, but just like with the primary care nursing model, you're going to have your primary RP RN screening team that's going to be so familiar with that baby with that family, with all the circumstances surrounding that that path.

00:19:36 Edyta Lytle

Again, the consistent day in day and times of the exam building trust with the family, seeing them week after week after week, the same faces, the more the family sees you, they're going to build a relationship with you and they're going to be more comfortable asking those questions that maybe they be too shy or uncertain.

00:19:55 Edyta Lytle

Themselves to ask of a stranger that they have never seen before, but when they seem that familiar face, they are going to build a comfort level with you and be able to ask those questions.

00:20:06 Edyta Lytle

And the better understanding that they have, the more education that they have regarding ROP and all the risks about it.

00:20:13 Edyta Lytle

It is just going to be a better all-round scenario for everyone.

00:20:16 Edyta Lytle

They are going to be more involved in their baby's care and it is just going to spiral, and it is going to.

00:20:21 Edyta Lytle

And again, the consistency allows them to learn and understand patient cues, and the baby will kind of know learn to kind of know what to expect when the exams are coming and.

00:20:32 Edyta Lytle

And the screening team will learn.

00:20:33 Edyta Lytle

What is best for that baby?

00:20:37 Edyta Lytle

So, the next from a patient perspective, the next benefit is flexibility to meet the patient’s care needs.

00:20:43 Edyta Lytle

Again, the nurse can adjust the pace if the baby's not tolerating it, they can go faster.

00:20:48 Edyta Lytle

They can go slower; they can reschedule for a whole another day if they need to.

00:20:52 Edyta Lytle

They can provide containment and pain control measures as needed.

00:20:56 Edyta Lytle

They can reschedule based on the patient and condition, or if they're having any procedures that day, they can make sure that nothing overlaps and that the baby doesn't get miss an exam, but that it's done in appropriate time period and that's all the care that the baby needs to receive that day is done.

00:21:13 Edyta Lytle

Also, another key thing is that it does allow for family bonding if the family is there for feeding, they can reschedule.

00:21:20 Edyta Lytle

They can come back if the family is there skin to skin.

00:21:23 Edyta Lytle

Maybe it only works for them to come at noon every day to do skin to skin for their baby.

00:21:29 Edyta Lytle

They can understand that and not schedule an exam during that time.

00:21:33 Edyta Lytle

So that the.

00:21:33 Edyta Lytle

Caregivers can have that uninterrupted skin to skin family time bonding time if the siblings come in all that good.

00:21:42 Edyta Lytle

Stuff so it is.

00:21:43 Edyta Lytle

Really flexible in doing whatever that baby needs for that day.

00:21:50 Edyta Lytle

Another patient benefit is that it decreases the disruption of care.

00:21:55 Edyta Lytle

So again, schedule it when it is best for the patient, whether that's day shift or night shift and where in those shifts that falls.

00:22:02 Edyta Lytle

And then, because we are trying to get in there, usually the goal is to get in there with those hands-on times.

00:22:09 Edyta Lytle

It really allows for uninterrupted sleep times between those sessions, which promotes growth, digestion and respiratory stability, which is what the baby needs to be able to go home.

00:22:20 Edyta Lytle

And that is always our ultimate goal, right is to get those baby’s home.

00:22:26 Edyta Lytle

It also promotes family centered care.

00:22:28 Edyta Lytle

You are going to really advocate for that uninterrupted family time that we just discussed, and the family can tell you whether they want to be there.

00:22:36 Edyta Lytle

If for the exams, or if they would rather not, and either way is fine, but it just gives them another way of having control over their baby being in the NICU.

00:22:47 Edyta Lytle

Which can be such a difficult experience, but it just fosters another level of parent involvement and understanding and what is going on with their specific infant.

00:22:58 Edyta Lytle

So, any time we can do that and make the parents more of an advocate for their baby, you are setting them up for success.

00:23:07 Edyta Lytle

The next patient benefit is that we really can minimize patient discomfort rather than an ophthalmologist coming in and rushing through all the exams because he has to get back to his clinic or he has.

00:23:17 Edyta Lytle

To get back.

00:23:18 Edyta Lytle

Into the OR to treat patients the screeners are in the QRN's they understand those patients.

00:23:25 Edyta Lytle

They can adjust the exam and the pace to fit the patient cues, and what is most importantly is most important is that they can.

00:23:34 Edyta Lytle

Then prepare the patient adequately and then finish with the patient adequately so they can provide that containment.

00:23:41 Edyta Lytle

The swaddling, any kind of pain medication if they need it, sucrose.

00:23:45 Edyta Lytle

If they are able to have a pacifier, proper positioning, you can get that second pair of pants 3rds, 4th, 5th pair of hands.

00:23:52 Edyta Lytle

If you need to.

00:23:54 Edyta Lytle

Depending on the patient’s situation, if they are an older baby that's a little bit stronger and they need more firm containment, you can do that.

00:24:02 Edyta Lytle

If they are very critically ill, baby, maybe on high frequency ventilation and you need more hands to manage all their lines and tubes because they are so critically ill, that's always an option too.

00:24:13 Edyta Lytle

So, we are really doing it to maximize patient comfort and do it as quickly of course as we can, but also to have the baby tolerate the exam as well as possible.

00:24:25 Edyta Lytle

And then one of the other final pieces that is so fantastic is that again, because these screeners are Nick you nurse.

00:24:32 Edyta Lytle

We tuck those babies in after the exam comes.

00:24:35 Edyta Lytle

Delete and it really decreases the bedside RN workload, so rather than the baby just being open and unsaddled and uncontained and somebody walking by and it's very quiet obvious that someone has been in that bed examining that baby and Nick, you nurses are fantastic at tucking those babies in.

00:24:55 Edyta Lytle

And really, letting them settle before they move on to that next patient because again, they have more time.

00:25:01 Edyta Lytle

To do so.

00:25:05 Edyta Lytle

So, this is a really important patient benefit and you're going to increase.

00:25:13 Edyta Lytle

So again, with all these things that we've kind of talked about, the more consistent you have the same group of people coming to scream the same babies, you're going to build trust between not only the Screener and the ophthalmologist, but also with the family.

00:25:26 Edyta Lytle

And you are going to build a relationship that's going to be ongoing.

00:25:32 Edyta Lytle

Better to provide parent education for their infant’s disease process.

00:25:39 Edyta Lytle

As squeamish or as averse to hearing about it, I find that they are really interested and at least understanding what's going on and why you're taking these pictures of their baby's eyes and what's wonderful about using a camera system is that you get clear photos and you can compare them from week to week, which is much better.

00:25:59 Edyta Lytle

For a parent to understand what is going on than hand drawn drawing.

00:26:02 Edyta Lytle

Which, although they do show progression of disease, are a little bit cumbersome and are a little bit confusing for someone who is not trained in looking at these.

00:26:10 Edyta Lytle

But a picture is clear, and the picture is concise, and a picture can very clearly show you what is going on, and you can compare from week to week and what's great about that is that if their baby does.

00:26:23 Edyta Lytle

Require some sort of treatment.

00:26:25 Edyta Lytle

You can pull up these images and show them OK, last week your baby looked like this.

00:26:30 Edyta Lytle

And this week, your baby looks like this.

00:26:32 Edyta Lytle

And This is why we are thinking about treatment, and they can get a better understanding of what's happening.

00:26:38 Edyta Lytle

And why it is so dangerous if we don't follow them closely?

00:26:42 Edyta Lytle

Because of course nobody wants a baby to go blind.

00:26:45 Edyta Lytle

And because they get this understanding, they feel like they are an advocate for their vision and truly, they become lifelong advocates for their child's eye care, which is an amazing benefit.

00:26:59 Edyta Lytle

So, if they feel like their lifelong advocates for their child's eye health because they have been advocating for this since they were teeny tiny in the NICU, they're.

00:27:09 Edyta Lytle

Going to take them to their post discharge appointment.

00:27:12 Edyta Lytle

So, you are going to have increased compliance post discharge and this one is huge.

00:27:16 Edyta Lytle

This is something that the program that I led really prided itself on and getting all those babies at 100% to comply with post discharge appointments.

00:27:27 Edyta Lytle

It takes a lot of effort, it takes a lot of education, but the more understanding that those parents have of what is going on with their baby, the risks that are associated with ROP, it really gets them on board for following up and making it to those outpatient appointments.

00:27:45 Edyta Lytle

Again, because you can show them the weekly photo progressions.

00:27:49 Edyta Lytle

And they know that the ultimate goal is to have their baby preserve their baby's vision, right?

00:27:54 Edyta Lytle

And that is what we want.

00:27:55 Edyta Lytle

And so, it really helps them to make it to those post discharge appointments which are so important.

00:28:04 Edyta Lytle

Another patient benefit if you have an RN screening program is that it decreases your patient transfers, so families are able to stay together at the hospital that they delivered at.

00:28:16 Edyta Lytle

They can stay there.

00:28:17 Edyta Lytle

Oftentimes that hospital is near to their home, and so it allows for the family.

00:28:24 Edyta Lytle

To be able to visit more often, which of course is going to promote breastfeeding, family bonding, more frequent family visits and just family care.

00:28:33 Edyta Lytle

Involvement in every facet of this baby's care, which is what you would like.

00:28:38 Edyta Lytle

It just keeps everyone happier.

00:28:43 Edyta Lytle

OK.

00:28:43 Edyta Lytle

So, then the next set of benefits that we are going to look at are benefits from the unit perspective.

00:28:52 Edyta Lytle

So here they are.

00:28:53 Edyta Lytle

So, one of them is increased environments, an increased environment of family centered care, decreased miss patients, decreased patient transfers.

00:29:03 Edyta Lytle

Decreased ophthalmology needs to physically access the unit.

00:29:07 Edyta Lytle

The ophthalmologist is available to see more patients, autonomy to continue to provide ROP care and maintain their accreditation status.

00:29:18 Edyta Lytle

Increased communication within the healthcare team and, of course, seamless discharge.

00:29:25 Edyta Lytle

So, let us look at each one of these.

00:29:26 Edyta Lytle

The first one, from a unit perspective, it is going to increase your environment of family centered care.

00:29:32 Edyta Lytle

So, the more family centered that a unit can be, you are going to have patient satisfaction scores.

00:29:38 Edyta Lytle

That is what parents want what families want.

00:29:40 Edyta Lytle

They want to be comfortable in a situation where they feel like their baby is supported, that their family is supported.

00:29:49 Edyta Lytle

That they matter, right?

00:29:50 Edyta Lytle

And so, if they feel happy with their care, they are going to increase their word-of-mouth referrals and in turn, this is going to create much more local community support for your healthcare institution, which is wonderful, right?

00:30:06 Edyta Lytle

And so, if your families are happy and they're coming back.

00:30:09 Edyta Lytle

And they are enjoying being there.

00:30:12 Edyta Lytle

You are going to have happier staff, which is going to also lead to higher staff recruitment and retainment, which is so important because you're going to have an overall positive workplace environment.

00:30:28 Edyta Lytle

The next benefit from a unit perspective is that you are going to have decreased missed patients, so missed patients are a huge source of litigation for facilities.

00:30:39 Edyta Lytle

These lead to massive lawsuits, so you are going to potentially alleviate these massive lawsuits for our miss, our peace training and potential blindness cases.

00:30:51 Edyta Lytle

And of course, if that is decreased, then you're going to increase your patient safety.

00:30:55 Edyta Lytle

Because the nurses on the unit are in control of scheduling the patients, they also know and understand when patients are moved to like, let us say, a step-down unit or if they're going to be moved to maybe a unit that is closer to home for them.

00:31:10 Edyta Lytle

They are going to ensure that the patients remain within the screening program.

00:31:15 Edyta Lytle

Until they are no longer at risk or fully vascularized, as determined by the ophthalmologist.

00:31:20 Edyta Lytle

So, you are not going to lose miss patients for this.

00:31:24 Edyta Lytle

And then also they are going to ensure that proper follow up is scheduled prior to that baby going home or being transferred out to a different unit.

00:31:34 Edyta Lytle

Also, they are going to make sure that your parents have a better understanding and that they're really going to know the importance again of not missing those outpatient appointments prior to discharge.

00:31:49 Edyta Lytle

So, another huge benefit to the unit is that you are going to have decreased missed revenue opportunities from decreased patient transfers.

00:31:59 Edyta Lytle

So, you are going to keep all that revenue from the admissions.

00:32:04 Edyta Lytle

Less missed opportunity for admissions because you are going to have a program in which you can screen those patients and that it's not a problem.

00:32:11 Edyta Lytle

So, they are not going to have to be admitted to a different unit.

00:32:14 Edyta Lytle

You can keep those patients in the house and then you are going to have increased patient satisfaction because families are going to be able to stay together.

00:32:21 Edyta Lytle

They are not going to be separated.

00:32:23 Edyta Lytle

They distance and have to travel to different units and it's just going to provide an overall, it's going to provide less disruption in the care of that patient.

00:32:38 Edyta Lytle

The next unit benefit is decreasing.

00:32:41 Edyta Lytle

The ophthalmologists need to physically access the unit.

00:32:46 Edyta Lytle

So, because you have, you are going to have an RN screening team to provide excellent and of course comfortable or as comfortable as they can be.

00:32:53 Edyta Lytle

RP screening exams.

00:32:55 Edyta Lytle

The ophthalmologist does not need to come into the unit as frequently.

00:32:59 Edyta Lytle

Therefore, they can spend less time traveling because they can view exams remotely.

00:33:04 Edyta Lytle

They can spend more time in their clinics, and it really disrupts, does less of a disruption to their clinic practice because they do not have to leave in the middle.

00:33:13 Edyta Lytle

Of the day to see their RFP babies and then come back to them.

00:33:18 Edyta Lytle

They can sit at lunch time and review all of the RP exams and then make decisions from there.

00:33:24 Edyta Lytle

It is really a great benefit for the ophthalmologist and the unit as a whole.

00:33:32 Edyta Lytle

So, to kind of piggyback off of that one, another unit benefit is that the ophthalmologist is able to see more patients so they can spend more time in their clinic, they can spend more time in the OR wherever they need to.

00:33:47 Edyta Lytle

They can spend more time focusing really on those high-risk patients, whether they are inpatient or outpatient.

00:33:53 Edyta Lytle

Take it because again, if they need, if it is an inpatient exam and they need closer, follow up.

00:33:59 Edyta Lytle

Those RN screeners are able to complete that close follow up as needed by the ophthalmologist or from the ophthalmologist recommendation.

00:34:07 Edyta Lytle

And so again, they can follow the disease trajectory more closely in those higher risk patients and that is by doing multiple or more frequent exams if needed.

00:34:17 Edyta Lytle

Also, they can spend because they are not having to be at the bedside doing all of these exams.

00:34:22 Edyta Lytle

They really have more time to educate their parents if their baby is.

00:34:27 Edyta Lytle

Critical and going down a disease progression where they might need treatment.

00:34:31 Edyta Lytle

They can really sit down with those families and give them more understanding of what is going on.

00:34:36 Edyta Lytle

And it is able they're it's able to grow their practice.

00:34:39 Edyta Lytle

So, they are able to screen truly at different locations very easily because they can remotely view those exams.

00:34:50 Edyta Lytle

So, another unit benefit is the autonomy to continue to provide RP care and maintain accreditation, so contracts with OPTHAMOLOGISTS can be sticky right contracts with any in any aspect of medical care can be sticky.

00:35:05 Edyta Lytle

Sometimes conflicts arise.

00:35:06 Edyta Lytle

Sometimes the ophthalmologist needs to retire.

00:35:08 Edyta Lytle

Sometimes he or she becomes sick.

00:35:10 Edyta Lytle

And is unable to provide RP care.

00:35:13 Edyta Lytle

The unit is not limited or dependent upon those contracts as much because they're going to have their own imaging system.

00:35:20 Edyta Lytle

So much like having the icon, you are able to really take ownership of the program, and you're able to continue to screen those babies, continue to provide adequate RP care.

00:35:31 Edyta Lytle

Which is going to prevent a lapse in care time and that you are going to decrease your legal potential for missed patients, which is huge, right?

00:35:40 Edyta Lytle

You are going to decrease the revenue opportunity for decrease loss revenue opportunity.

00:35:45 Edyta Lytle

I am sorry for patient transfers and it's going to help you maintain your Level 3 status which?

00:35:51 Edyta Lytle

Units need to have in order to provide, they need to be able to provide RP screening care in order to maintain that status.

00:36:03 Edyta Lytle

Another benefit, of course, is increased communication within the care team.

00:36:08 Edyta Lytle

Everyone is on the same page.

00:36:10 Edyta Lytle

Everyone is discussing what needs to happen for this baby to go home, and that includes everyone on the orange screening team, the ophthalmologist, the neonatologist, the nurse practitioners, case managers, OT PT, developmental specialists.

00:36:25 Edyta Lytle

Any other specialists that are involved in the patients care and of course.

00:36:30 Edyta Lytle

And if everyone is on the same page with the baby getting ready to go home, then you're going to have.

00:36:37 Edyta Lytle

The end goal of a seamless discharge.

00:36:40 Edyta Lytle

Again, everyone is on the same page.

00:36:41 Edyta Lytle

Your family is prepared.

00:36:43 Edyta Lytle

They understand what is going on with their baby.

00:36:46 Edyta Lytle

They understand the disease process and most importantly, they understand that there is a risk level of their baby going blind and so they are going to make it to those follow-up appointments.

00:36:57 Edyta Lytle

Because they are going to understand what they need to do to prevent, to preserve their baby's vision and prevent their baby from going blind, and also when they have this understanding, and they have this knowledge base, and they have this confidence they.

00:37:11 Edyta Lytle

They just are confident in caring for the infant at home, you know, taking.

00:37:15 Edyta Lytle

Home a Nikki.

00:37:16 Edyta Lytle

Baby is different than taking home a term newborn.

00:37:20 Edyta Lytle

And so just preparing them, arming them with that knowledge base just gives them confidence and caring for their baby at home and doing the best that they can for them.

00:37:30 Edyta Lytle

And that is what we want.

00:37:31 Edyta Lytle

We always want our babies to have the best care possible, especially when they go home.

00:37:38 Edyta Lytle

OK, so now that you kind of listen to so many of the benefits, I mean, I can just go on and on and on about the benefits.

00:37:44 Edyta Lytle

But so now what?

00:37:46 Edyta Lytle

So now you are ready to move on to the next step and you want to select and create a screening team, so.

00:37:52 Edyta Lytle

One of the priority things that you need to ask yourself is who is going to oversee the schedule so often times this is someone who is an RP.

00:37:59 Edyta Lytle

Coordinator or program manager and this is typically a registered nurse or an MP.

00:38:05 Edyta Lytle

How many screeners do you need?

00:38:07 Edyta Lytle

Well, I recommend a minimum of two, and then that way they can cover vacations or sick days or what have you.

00:38:15 Edyta Lytle

But this is totally unit dependent.

00:38:17 Edyta Lytle

If you are a high-volume unit, who is going to be screening a lot of patients, you're going to want more people.

00:38:24 Edyta Lytle

But again, you do not want.

00:38:26 Edyta Lytle

You are not going to train all of your nurses.

00:38:27 Edyta Lytle

This is going to be a specialty group of nurses that will provide RP training for your patients.

00:38:35 Edyta Lytle

I do also recommend that it is someone who has some experience, so a minimum of two years of clinical experience at the NICU or in the clinic or at the bedside, so that way they're comfortable with how the unit, how the clinic functions, the unit processes, and they're comfortable handling the patients.

00:38:53 Edyta Lytle

You do not want someone who's.

00:38:55 Edyta Lytle

Never touched a Nikki baby before because it is going to be a lot.

00:38:58 Edyta Lytle

It is going to be intimidating for them.

00:39:00 Edyta Lytle

And so, if it's someone who.

00:39:03 Edyta Lytle

Has had experience with this.

00:39:05 Edyta Lytle

You are going to have more success in the long in the long run.

00:39:08 Edyta Lytle

Also, you want to select people who have a desire to learn a new skill set, right?

00:39:13 Edyta Lytle

You want someone who volunteers rather than being volunteered to do something.

00:39:19 Edyta Lytle

That is a huge, huge point.

00:39:22 Edyta Lytle

Also, you want someone who is a very clear and excellent communicator.

00:39:27 Edyta Lytle

You want someone who is going to be on top of things.

00:39:29 Edyta Lytle

You also want someone who is comfortable with the eye screening.

00:39:32 Edyta Lytle

Now, they may have never participated in doing RP exams with the camera before, and that is OK as long as it's someone who.

00:39:42 Edyta Lytle

Knows why the baby needs to be strained, is not squeamish about the eye, because that can be a big thing too.

00:39:49 Edyta Lytle

Is ready to learn and is ready to jump in there and help and learn a new skill.

00:39:53 Edyta Lytle

They also need to be someone who is.

00:39:55 Edyta Lytle

Semi comfortable with technology, right?

00:39:57 Edyta Lytle

Because it is technology that we are using to screen these babies and technology does change and it is a little bit confusing.

00:40:05 Edyta Lytle

So, if you have someone who really does not want anything to do with technology, that's probably not your best bet of someone that you want on this team, someone who's more comfortable with it would be a benefit.

00:40:15 Edyta Lytle

Also, you want someone especially for your RFP coordinator role, who is very highly organized because you do not want any missed patients.

00:40:23 Edyta Lytle

Those schedules need to be complete.

00:40:25 Edyta Lytle

They need to be thorough.

00:40:27 Edyta Lytle

They need to be maintained and they need.

00:40:28 Edyta Lytle

To be checked often.

00:40:33 Edyta Lytle

OK, so here is some next steps.

00:40:35 Edyta Lytle

What do you do to implement a new nurse led ROP program?

00:40:39 Edyta Lytle

So, we kind of talked about this a little bit.

00:40:41 Edyta Lytle

First, you are going to select an RP coordinator, and this person should be organized, reliable, motivated, and willing to learn.

00:40:47 Edyta Lytle

Excited, excited about this new program and they should maintain and possess some leadership skills because they are going to be kind of overseeing a lot of it and kind of helping with your team.

00:40:58 Edyta Lytle

So, with your team, you want someone who is experienced.

00:41:03 Edyta Lytle

You are going to want a small team, but an appropriately sized team for your unit or your situation.

00:41:09 Edyta Lytle

So, I recommend at least two people.

00:41:12 Edyta Lytle

These people should be organized, reliable, motivated, willing to learn, excited again, just like the RP coordinator, and they should like to work as a team.

00:41:20 Edyta Lytle

OK, so now you have got your team, you've got your RP coordinator now what?

00:41:24 Edyta Lytle

So now you are going to establish your protocols and workflows, so you're going to create your policies and procedures and make sure of those.

00:41:33 Edyta Lytle

You can use wonderful tools like the cares kits as a guide so that you are not starting from scratch.

00:41:39 Edyta Lytle

This provides a wonderful template that is best in its class for creating these.

00:41:44 Edyta Lytle

Protocols that you should be following that as A and it's just meant to be used as a guide.

00:41:50 Edyta Lytle

You can absolutely edit it.

00:41:52 Edyta Lytle

You do not have to use it word for word, but it at least gives you a wonderful, very complete starting point.

00:41:59 Edyta Lytle

Then you are also going to need to understand what your ophthalmologist preferences are.

00:42:03 Edyta Lytle

So, when does he or she want to sit the exams?

00:42:06 Edyta Lytle

Does he or she want to do them at lunchtime?

00:42:08 Edyta Lytle

Do they want to do them first thing in the morning?

00:42:10 Edyta Lytle

Do they want to do them in the evening after they were done with all their clinic patients?

00:42:14 Edyta Lytle

Those are all things to consider and what day of the week works best for them?

00:42:19 Edyta Lytle

Because often or not often, I should say, sometimes the babies do need to be treated, and so this needs to be something that they need to consider.

00:42:27 Edyta Lytle

And when do they want to read the exams and when will they have time to complete the treatment?

00:42:33 Edyta Lytle

And then how will images be transferred so this is something that you can work with IT and every unit is a little bit different in how those images will be transferred, how they will be read so that everyone is on the same page.

00:42:46 Edyta Lytle

OK, so now you have your team, you've got your protocols.

00:42:49 Edyta Lytle

You are ready to move forward, you have got your device, you're going to train your team, you're going to train your team on the device, and this is going to help give them comfort before they actually lay the device on patients.

00:43:02 Edyta Lytle

So again, when you purchase a camera, you are going to receive the false baby head with the false eye.

00:43:07 Edyta Lytle

And the more practice that your team can do on this false baby head with the camera, the more comfortable they are going to be.

00:43:15 Edyta Lytle

And it is only going to add to their image quality and produce better exams.

00:43:21 Edyta Lytle

A quick look more in a faster, quick fashion than someone who has never practiced before, and it is just going to set you up for better success long term.

00:43:30 Edyta Lytle

Also, you need to establish what kind of continuing education or skills check off you are going to use this.

00:43:37 Edyta Lytle

This is totally unit dependent, but this could be annually.

00:43:39 Edyta Lytle

It could be every six months.

00:43:40 Edyta Lytle

It could be every two years, whatever you think, and we are going to train the trainer.

00:43:44 Edyta Lytle

So, we are going to train a handful of people, but then you also want those people to be able to train new employees.

00:43:51 Edyta Lytle

If there is any staff turnover or if someone just decides this is not for them, that way they're competent and confident.

00:43:58 Edyta Lytle

Also, in passing the skill along and training new RP screeners.

00:44:04 Edyta Lytle

OK.

00:44:04 Edyta Lytle

And then once you have all those pieces in place, you are going to roll it out and you know, when you roll it out, you are probably going to make some changes.

00:44:13 Edyta Lytle

So, you are just going to have to evaluate and modify and make adjustments as needed after that initial rollout and ensure that the entire care team who's involved on the unit understands this new process because right, it's a change.

00:44:24 Edyta Lytle

And in your old process and then just kind of make it to what you need it to be to fit your unit’s needs.

00:44:34 Edyta Lytle

OK, so you are off and running.

00:44:36 Edyta Lytle

So how are you going to evaluate your success?

00:44:39 Edyta Lytle

Well, I highly recommend and especially at the very beginning, but really throughout the whole life of the program, you are going to have frequent observation and evaluation and evaluation of missed patients.

00:44:51 Edyta Lytle

That is number one.

00:44:52 Edyta Lytle

You want to make sure that whatever you are doing too.

00:44:57 Edyta Lytle

Complete the schedule and update that schedule that it is working that you are not missing any patients because that is a huge piece of it, right?

00:45:04 Edyta Lytle

We do not want missed patients and then also the quality of your imaging.

00:45:08 Edyta Lytle

Again, practice makes perfect get as much practice as you can with the baby doll because honestly some units might be smaller, and they may not.

00:45:16 Edyta Lytle

Have patients to be screened every week and so you do not want to lose those skills. So honestly, anytime you kind of think about it, if you're having kind of a slow day, get that baby doll head out and practice, even if it's just for 10/15/20 minutes of practice here and there, that will help maintain your skills, maintain your image quality and really take it to that.

00:45:38 Edyta Lytle

Also, it would be wonderful if you could have support and feedback from your reading ophthalmologist, so that way he or she can voice with the team and especially with the OP coordinator, which can kind of disseminate the information throughout to the team.

00:45:53 Edyta Lytle

What is most important in imaging if images need to be lighter if they need to be in better focus or what the ophthalmologist.

00:46:00 Edyta Lytle

Specifically, needs from those images to make them better and just make them of higher quality.

00:46:07 Edyta Lytle

Another thing that you are going to want to do is just continue that the education for our end screeners so that they are aware of what they're doing, how they're doing it, why they need to do it.

00:46:17 Edyta Lytle

And then, of course, make adjustments in your workflow as needed.

00:46:21 Edyta Lytle

You know it is probably not going to be perfect the first time you roll it out, and you might be making changes for a little while and that's OK.

00:46:28 Edyta Lytle

You can make it be whatever you need it to be, and that is so wonderful.

00:46:32 Edyta Lytle

What is so wonderful about it is that it is so flexible and really the opportunities and the options for how it should be structured really are endless.

00:46:41 Edyta Lytle

So, it is totally unit dependent and make those adjustments as needed.

00:46:47 Edyta Lytle

So, thank you so much for listening today to my webinar.

00:46:50 Edyta Lytle

I hope you were able to glean some information about the benefits of a nurse LED ROP screening program.

00:46:57 Edyta Lytle

I hope you are excited about it and wanting to learn more.

00:47:00 Edyta Lytle

Just know that here in the new light we will support you every step of the way.

00:47:05 Edyta Lytle

We will hold your hand just like we are holding this baby's hands.

00:47:07 Edyta Lytle

We have a passionate sales team, our clinical care team is so knowledgeable, we've got excellent resources like the Cares kit, which is.

00:47:17 Edyta Lytle

There is nothing better out on the market.

00:47:19 Edyta Lytle

It really is such a fabulous, fabulous resource and something I really wish I had when I was starting my program.

00:47:25 Edyta Lytle

So, I hope that is something that is very beneficial to you.

00:47:28 Edyta Lytle

And then of course our IT support is outstanding as well as everyone that works for NEO Lite is really on the same page and we are such empathy driven.

00:47:37 Edyta Lytle

Company and ready to be here to help you and your program’s needs.

00:47:42 Edyta Lytle

So, thank you again so much for listening.

00:47:44 Edyta Lytle

I hope you were.

00:47:45 Edyta Lytle

I hope you found it useful, and we hope to talk to you.

00:47:48 Edyta Lytle

You are soon. Thanks so.

00:47:50 Candice White

Thank you, Anita, so much.

00:47:52 Candice White

To go ahead and.

00:47:53 Candice White

Close this program.

00:47:54 Candice White

Out and we are going to get cameras back on and open the floor for some questions.

00:47:58 Candice White

So let me see.

00:48:00 Candice White

Let us get to this.

00:48:12 Candice White

So, we are going to.

00:48:13 Candice White

Get Adidas camera here on with us.

00:48:16 Candice White

Also, we have had a couple questions.

00:48:18 Candice White

Posed through our Q&A platform.

00:48:20 Candice White

If you are on a device, it is going to be different for every device.

00:48:26 Candice White

iPads, phones, computers.

00:48:27 Candice White

But there should be a little question mark.

00:48:30 Candice White

Maybe at the bottom of your screen and when you push that question mark it should give you the ability to.

00:48:35 Candice White

Type in questions.

00:48:37 Candice White

We are going to get through as many of them.

00:48:38 Candice White

As we can.

00:48:39 Candice White

Today we have 5 or 6.

00:48:41 Candice White

That it looks like we can answer.

00:48:44 Candice White

And then we will.

00:48:48 Candice White

Closeout our session.

00:48:51 Candice White

So let me see here.

00:48:54 Candice White

Aditi, can you hear me?

00:49:12 Candice White

I know we have her here in the background, so I'm going to leave.

00:49:16 Candice White

We have Ryan here with us today.

00:49:17 Candice White

I am going to leave.

00:49:18 Candice White

Him try and get a Dida.

00:49:21 Candice White

Can you hear me now?

00:49:22 Edyta Lytle

OK, it was just taking a while.

00:49:24 Edyta Lytle

Once it switched over.

00:49:26 Candice White

At first it wanted to keep you on camera and now it wants to keep you from camera so.

00:49:33 Candice White

All right, so I do have.

00:49:34 Candice White

A couple questions Aditi and I will post a few.

00:49:36 Candice White

To you, I think there's a couple.

00:49:37 Candice White

That I may be able to answer just in terms of billing, but.

00:49:42 Candice White

I know one of them.

00:49:42 Candice White

Questions that we had come through based on your presentation are, are there certain credentials that are required for being a part of these imaging programs or RFP programs?

00:49:52 Candice White

So, do you have to?

00:49:52 Candice White

Be in R and do you have?

00:49:53 Candice White

To be in NP, what did?

00:49:55 Candice White

You see built with your facility.

00:49:58 Edyta Lytle

So, we use all nurses and that is what worked for us registered nurses.

00:50:03 Edyta Lytle

And so there are other programs out there in which the nurse practitioners do it.

00:50:10 Edyta Lytle

Or the ophthalmologist does it.

00:50:11 Edyta Lytle

But for us it worked best to have the nurses.

00:50:14 Edyta Lytle

You can also have an ophthalmology technician if you are in a clinic.

00:50:19 Edyta Lytle

Just someone who's.

00:50:20 Edyta Lytle

Familiar with the patient and want to make sure that's part of their scope of practice.

00:50:23 Edyta Lytle

Right.

00:50:23 Edyta Lytle

So that is the most important part too, that you are not just having.

00:50:28 Edyta Lytle

Anyone come in and do it, but it should be a nurse or someone who.

00:50:31 Edyta Lytle

Is certified and caring for those patients.

00:50:36 Candice White

And I agree with you, every program is built just a little bit differently.

00:50:39 Candice White

So, my background is ophthalmology, I am a technician that works with Retina specialists, and I would go over every now and then and kind of.

00:50:45 Candice White

Help with that.

00:50:45 Candice White

So, you are right in saying.

00:50:47 Candice White

It is not someone, it is not certain.

00:50:50 Candice White

It is just making sure that they are good with patient hearing confidence.

00:50:54 Candice White

We did have another question pop up and I think you will be able to help with.

00:50:56 Candice White

This is because you had a pretty high volume.

00:50:58 Candice White

Clinic, it says sometimes.

00:50:59 Candice White

We have six or more infants to screen in.

00:51:02 Candice White

A day and how do you recommend?

00:51:04 Candice White

Spreading that out.

00:51:05 Candice White

So, when you were looking at your imaging days, did you kind of set a plan for what that looked like and how quickly you thought you'd be running through your exam?

00:51:15 Edyta Lytle

So this is something that you'll adjust kind of as your program develops and as you get more experience, but kind of time and it doesn't have to be you know exact but kind of understand the amount of time that takes you to image one patient and then that way you can kind of adjust your schedule.

00:51:32 Edyta Lytle

So maybe you can do three patients in an hour.

00:51:35 Edyta Lytle

Maybe you can do all six of them in an hour and that way you can kind of understand how you're doing your drop schedule and then again adjusting with whatever that baby needs for that day.

00:51:47 Edyta Lytle

So maybe some need it in the morning, some need it a little bit later in the afternoon.

00:51:51 Edyta Lytle

So really it is just kind of dependent upon how quickly you can do them with your comfort level.

00:51:56 Edyta Lytle

Newer screeners are going to take a little bit longer and that is OK that is to be expected as they're building those skills and really establishing an understanding of how to screen the babies with the camera.

00:52:07 Edyta Lytle

So that is something that is flexible.

00:52:09 Edyta Lytle

So, like I said, just kind of time yourself.

00:52:11 Edyta Lytle

And gain an understanding of what works best for your situation.

00:52:15 Edyta Lytle

I mean, we did have days.

00:52:16 Edyta Lytle

We would cut it off usually, I think.

00:52:17 Edyta Lytle

Twelve were ours.

00:52:19 Edyta Lytle

Maximum again, this was a very high level.

00:52:24 Edyta Lytle

So, in each unit we kind of would cut it off from 12 to 15 and then spread it to maybe the next day because we did want to take our time and we didn't want to just run through all those babies.

00:52:34 Edyta Lytle

So again, that's very unit dependent.

00:52:38 Candice White

I have a couple of questions here that I think we could ask.

00:52:39 Candice White

Could probably both answers.

00:52:42 Candice White

And you are going to hear us say this a lot, but it is unit dependent, so I know we had a question about.

00:52:48 Candice White

And one of the questions was what parts can be dropped when you have an RN performing exams, so I know for myself and our units.

00:52:59 Candice White

I live in southern.

00:53:00 Candice White

Missouri, we did not actually Bill for exams.

00:53:02 Candice White

They were just kind of covered.

00:53:04 Candice White

We did not bill for them separately, but over so many years I've kind of onboarded.

00:53:08 Candice White

Facilities throughout the world and what we will see are some units.

00:53:12 Candice White

Using modifiers on their codes, so a technical component and a professional component.

00:53:17 Candice White

And if you are wondering what your unit should do, more than likely if you were imaging, you would charge for the professional component or the technical components, and then your reading position can charge for the technical component.

00:53:27 Candice White

So, you are splitting that code into two parts.

00:53:29 Candice White

Who is doing the imaging and who is reading them?

00:53:32 Candice White

There are also.

00:53:33 Candice White

Codes that are pretty specific.

00:53:34 Candice White

Telemedicine is for retinal care and in our cares.

00:53:38 Candice White

Kit, we have.

00:53:39 Candice White

A CPT code guide.

00:53:41 Candice White

Again, you are going to want to do your own due diligence, but it kind of leads you down to see what codes available and what modifiers are available so that you can look.

00:53:51 Candice White

And see what is best for your unit.

00:53:55 Candice White

Another question here is.

00:53:59 Candice White

What amount of time is required to clean the camera in between patients?

00:54:03 Candice White

And I know adyta you all had adjusted for that, and it is probably dependent on patients.

00:54:09 Candice White

I know we have some cleaning guidelines that we are happy to share, and they are leveled out because like a broken record, every unit is different than how they reprocess and clean their systems.

00:54:19 Candice White

So again, that may be dependent on your processes specific to your system.

00:54:28 Candice White

Another question about the hand piece is do we?

00:54:31 Candice White

Feel that a.

00:54:32 Candice White

Heavy camera can cause pain or damage.

00:54:35 Candice White

To the eyes.

00:54:37 Candice White

So, a data that.

00:54:38 Candice White

Kind of goes back to your discussion about practicing, like getting comfortable with that muscle memory, right?

00:54:44 Candice White

And is that what your nurses did?

00:54:46 Candice White

In your unit.

00:54:48 Edyta Lytle

So, the more you practice with it, you will get kind of a sense for how.

00:54:51 Edyta Lytle

You hold the camera.

00:54:53 Edyta Lytle

And once you start imagining patients, if you are using too much pressure on the eye, you will actually see the optic nerve pulsing and you don't want that.

00:55:02 Edyta Lytle

That means you are using way too much pressure, so we always recommend using gel, and that is just an extension of your camera lens.

00:55:09 Edyta Lytle

It kind of helps to soften them.

00:55:13 Edyta Lytle

The pressure that you need to use, and you will your kind of just establish A technique for how you hold the camera, whether you use a pinky to kind of, you know, on the baby's forehead or however you do.

00:55:23 Edyta Lytle

Bit, but again, the more you practice on the false baby head, you will have a better sense of how to hold that camera and how to very gently lay it.

00:55:32 Edyta Lytle

On the patient’s eye.

00:55:34 Candice White

That is such good advice, because I feel like you.

00:55:36 Candice White

Have more opportunities too.

00:55:38 Candice White

Hold the camera and.

00:55:39 Candice White

Practice on your false baby head and figure out what your movements are.

00:55:43 Candice White

Or I had something called a fancy pinky, so I balanced myself on their temple, and if anybody is ever trained with me, they have always heard me talk about my fancy pinky.

00:55:51 Candice White

But everyone's hands and muscle memory are different, especially if you are left-handed versus right-handed. So, getting that out and really practicing in a clinical setting, like actually in a unit in.

00:56:03 Candice White

A radiant warmer in a crib.

00:56:05 Candice White

However, you would normally be imaging practice like you play and you are going to pick up on those muscle memories, which is just going to make you even better when we're actually imaging on life.

00:56:13 Edyta Lytle

Patients absolutely and just kind of mentioned this a.

00:56:16 Edyta Lytle

Little bit but.

00:56:17 Edyta Lytle

Also, putting your baby head in different types of beds that you have on your unit so that you can understand.

00:56:23 Edyta Lytle

How that changes your arm position now you know, because maybe now you're in a bassinet and maybe we learned that for us.

00:56:29 Edyta Lytle

The Bassinets were not fantastic.

00:56:31 Edyta Lytle

We would actually take the baby out and put them on a flatter surface.

00:56:35 Edyta Lytle

Be that a scale or something else where they are safe, of course, but.

00:56:39 Edyta Lytle

That does create a little bit of difficulty with your elbow having to be up so high.

00:56:44 Edyta Lytle

So that is again something.

00:56:46 Edyta Lytle

The more you practice with the false head before you get on a live patient, it is going to be better.

00:56:52 Candice White

It is so crazy it is.

00:56:53 Candice White

It is wonderful to hear the different ways that people on board work through their programs because like you're saying, I've been at units before where they have.

00:57:02 Candice White

Almost a designated room for eye exam.

00:57:04 Candice White

So rather than going to each bed side, they are bringing those few infants into their imaging room so that they can image, you know, like you said, on a flatter surface.

00:57:13 Candice White

So, there is really no right or.

00:57:17 Candice White

There are obviously some very specific things to imagine correctly, but the rest of those things.

00:57:22 Candice White

You get to be built on what is perfect for your infants.

00:57:25 Candice White

Perfect for your unit.

00:57:27 Candice White

So many opportunities to make it the best that it can be.

00:57:33 Candice White

Another question that we had come through was, do you have any recommendations for imaging micro preemies so when we have small infants coming through, are there any tips and tricks to imaging them?

00:57:45 Candice White

The best that we can?

00:57:46 Edyta Lytle

So, I think the biggest tip that we can offer you or that I can offer you is to make sure you have the correct speculum size.

00:57:53 Edyta Lytle

So, if you have really large speculums, it's going to be really difficult to imagine a little tiny micro creamy eye.

00:58:02 Edyta Lytle

So, it is nice to have at least two, maybe three different sizes that you can kind of play with and see what works best for that.

00:58:09 Edyta Lytle

Because if you have a large speculum that is going to inhibit your camera even being able to lay on the surface of the eye, that is a big tip.

00:58:17 Edyta Lytle

Another tip would be just made sure they are positioned correctly.

00:58:21 Edyta Lytle

Use those extra sets of hands you know.

00:58:23 Edyta Lytle

Maybe use OT or PT if they are available, or respiratory therapists if they are available.

00:58:29 Edyta Lytle

Whoever you can get to help you just support that patient while you are imagining, and then again, the more you do it, the more comfortable you are going to be, and it will flow more smoothly.

00:58:40 Edyta Lytle

But the speculums I think are the biggest tip.

00:58:45 Candice White

So, we are almost at the top of the hour.

00:58:46 Candice White

I do have one question that I think I can answer here.

00:58:50 Candice White

It says are their good videos on how to?

00:58:51 Candice White

Perform the eye exams.

00:58:52 Candice White

With the camera we are in the process of trying to get some good videos.

00:58:56 Candice White

Put together and there's a.

00:58:58 Candice White

Delicate balance, and I am sure everyone knows in terms of imaging or recording things in the units.

00:59:04 Candice White

Because we have to be very careful to make sure that parents have signed off, but we are working on producing some really great videos that allow people to.

00:59:13 Candice White

See someone else being successful in a certain way.

00:59:18 Candice White

We do have a lot of.

00:59:19 Candice White

Education material, though that is going to help you improve unit flows.

00:59:24 Candice White

So, Edyta talks so much today about setting expectations, helping people say, do I need to review this information every six months?

00:59:31 Candice White

Every year, every two years?

00:59:33 Candice White

We have a skills checklist.

00:59:34 Candice White

We even have a goals document because everyone may want to set different goals to say I'm going to do 5 exams in a week and if I only had two babies, that means I'm going to get the system out three times and just practice in the unit so that I have 5 exams that have been done throughout the week and.

00:59:50 Candice White

You can set those goals.

00:59:52 Candice White

And then follow up on them and kind of file that information away.

00:59:56 Candice White

So always check back.

00:59:58 Candice White

In with us, we are going to.

00:59:58 Candice White

Continue to do E seminars like.

01:00:01 Candice White

This we are going to continue to help.

01:00:03 Candice White

Improve processes within hospitals throughout the world.

01:00:07 Candice White

So, without and without stopping to cover any more information, we will let Edyta go and I cannot thank you guys enough for joining us today.

01:00:17 Candice White

If you have any more questions, do not.

01:00:18 Candice White

Hesitate to reach out.

01:00:20 Edyta Lytle

Thank you so much.