Eyeworld

December 2017 • Ophthalmology Business 11 1. Ask some preliminary ques- tions to determine fall risk. These can include: • Have you fallen in the past year? • Do you feel unsteady when you stand up? • Do you worry about falling? • Are you dizzy or lightheaded some- times? You could ask these in the waiting area before patients are seen for an exam. If patients answer yes to these questions, alert your staff to provide extra monitoring and support. 2. Be aware of depression. One major risk for falls is depression, and a depressed patient is less likely to keep a close watch on his or her own health. Naturally, ophthalmologists aren't in the position to diagnose mental health or prescribe anti-de- pressants, but they can monitor for someone's general mood during an exam. If the patient seems depressed, this would be another reason to stay close when he or she moves. 3. Use signs. In exam rooms or exam lanes, you can have simple signs that say "Stand up slowly" and "Stand still a minute after you stand up." Near the exit, your signs can remind post-dilation patients to take their time and wait for their eyes to adjust. 4. Refer to other facilities as necessary. You don't want your staff to risk an injury when transporting a patient who's at a high risk for falls but who is hard to move for vari- ous reasons. If necessary, refer these patients to a hospital or other facility where that person can be moved around safely with the help of assis- tive equipment. OB Editors' note: Dr. Menke has no finan- cial interests related to her comments. Contact information Menke: amenke@omic.com had screws in her left hip from a pre- vious fracture. Her recovery for the right hip fracture took 90 days. "Here's a case where you try to figure out, did she fall because her hip broke spontaneously, or did she fall and then break her hip?" Dr. Menke said. Eventually an orthopedic sur- geon medical witness said that the patient had a condition that caused her to fall and there was nothing the technician could have done to prevent that. The case went to medi- ation, and a settlement of $100,000 was determined. The ophthalmic practice and general liability carrier split the settlement costs in half. In this case, the patient's daugh- ter had been waiting in the car during the incident, although she did initially help bring her mother into the office. When family members show up to help those with mobil- ity issues, advise them to stay with their loved one for safety reasons, Dr. Menke said. A problem with the wheels The fourth case involved an 82-year- old woman who was sitting on a chair with wheels and fell when moving into that chair. She fractured her hip, and the patient needed sur- gery and nursing home care. There were $100,000 in medical expenses, but when Medicare learned how the fall occurred, they did not want to pay any of those costs. "We settled for $235,000. This is the highest amount we've paid for [a lawsuit about a fall]," Dr. Menke said. Those involved with the case agreed that patients should not be left unattended in seats with wheels, especially older or frail patients. Final pearls There are a few more ways you can prevent falls at your practice, Dr. Menke said. Dilation and a fall In the second case, a 79-year-old woman had her eyes dilated for an exam. When she left the practice and was walking outside, she fell and broke her hip. Although the policy at the practice was to offer sunglasses after dilation, the patient declined and went from the darker office into the sun, lost her balance, and fell on some steps. The first step was 8 feet away from the office door, and there were three handrails around the steps. Each step was 3 feet long with black edge painting. The plaintiff's attorney could not find a legal expert to criticize the practice as the steps were perceived as reasonably safe, Dr. Menke said. "Even if there's a poor patient outcome and a terrible event, you're not held legally liable if there's noth- ing you could have done to prevent it," Dr. Menke said. When a fall happens, let both your professional liability carrier and your general liability carrier know, Dr. Menke recommended. It's not always clear which type of insurance should handle a claim, but it's better to keep both informed. Most practices make darker glass- es readily available after dilation, and Dr. Menke said that staff should let patients know before dilation that it could make it harder to see and that they may have trouble driving. An unexpected hip injury In the third case, a 90-year-old woman had a dilated eye exam. As she went to stand up, she scuffed her shoe on the floor, twisted her body, and fell. A technician caught the patient's head, preventing a head injury. She didn't want ER care but she was in so much pain the next day that she went to the ER. She was diagnosed with a hip fracture on her right side, but the doctor noticed she

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