Guidance on Re-opening

Guidance for Arkansas Optometrists Regarding In-Person Vision and Medical Care During COVID 19 Pandemic

Routine eye care may begin on May 4th if following the Arkansas Department of Health guidelines .

As patients begin seeking routine and other in-person vision care services, it is recommended Doctors of Optometry adopt protocols in their facilities to address the safety of employees, patients, and themselves.

Below are suggested steps to prepare your practice, staff, and patients for a safe return to delivering the full range of essential eye health and vision care Americans need.

Anticipate when you will return to a normal (or a new normal) schedule.

Watch for communications and updated information from the AOA for national trends and changes.
Closely monitor all federal, state, and local guidance related to routine versus urgent and emergent care and when changes can be expected.
Monitor updates and communicate frequently with your state optometric association regarding guidance from the state board of optometry.
Utilize the time now to evaluate and assess your practice and identify opportunities to enhance the practice moving forward. This includes, but is not limited to, all clinical and non-clinical services, office purchasing and staff roles and responsibilities critical to office recovery and optimization (e.g., scheduling all available open slots and increased/staggered available office hours).
Connect with county and city health boards/officers regarding guidance and alert them of your plans for reopening.
Communicate with local medical offices, surgery centers and hospitals to inform them that you are planning to open for emergent and non-emergent care, consultation, and referrals.

AVERAGE LEVEL OF PATIENT INTERACTION

Optometric services require direct physical contact with patients. This may involve touching members of the public on the face, coming in contact with mucous membranes (conjunctiva) and bodily fluids (tears, mucous).

PROTECTIVE MEASURES

At all times, practitioners and staff will wash hands and/or use hand sanitizer before and after each patient encounter or cleaning event. Gloves are to be worn while cleaning. Practitioners will wear face masks. All employees interacting with the public will wear face masks.
Employees are not allowed to remove supplied PPE from the office.
To address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.

○ This action is recommended to help prevent transmission from infected individuals who may or may not have symptoms of COVID-19.

○ Cloth face coverings are not considered PPE because their capability to protect healthcare personnel (HCP) is unknown. Facemasks, if available, should be reserved for HCP.

○ For visitors and patients, a cloth face covering may be appropriate. If a visitor or patient arrives at the healthcare facility without a cloth face covering, a facemask may be used for source control if supplies are available.

Strategies for Optimizing the Supply of N95 Respirators can be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Frespirator-supply-strategies.html
Using Personal Protective Equipment (PPE): Instructions for how to don and doff PPE can be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

○ How to put on (don) PPE instructional video: https://youtu.be/of73FN086E8

○ How to remove (doff) PPE instructional video: https://youtu.be/PQxOc13DxvQ

CDC hand washing, office disinfection, and other infection control guidelines should be observed. (https://www.cdc.gov/handhygiene/index.html).
Signs will be posted on the front door/window stating that any patient who has a fever or cough must reschedule their appointment.

○ h ttps://www.cdc.gov/coronavirus/2019-ncov/communication/print-resources.html?Sort=Date%3A%3Adesc

○ https://www.healthy.arkansas.gov/images/uploads/pdf/Public_Health_Notice_General_3.16.20.pdf

Actively screen everyone for fever and symptoms of COVID-19 before they enter the healthcare facility.

○ Employees must be screened daily with questionnaire and temperature readings.

■ Any staff member showing signs of illness should not be permitted to work and should be referred to their primary care provider.

Use one public entrance and disinfect the door frequently.
Prior to initiating any service:

○ Pre-Screen patients for cough, breathing difficulty, fever, recent travel outside of Arkansas, and COVID-19 exposure prior to scheduling appointments.

○ Patient/companion's temperature is to be verified prior to office entry.

■ Companion’s name, date of birth, and COVID 19 screening will be kept in the patient's record.

○ Patients and visitors exhibiting signs of illness should be rescheduled and referred to their primary care provider unless an emergency dictate otherwise.

Patient scheduling should be staggered to enhance social distancing.
Routine services should be done by appointment. No walk-ins. Patients may be worked into the schedule as social distancing limitations allow.
When scheduling appointments:

○ Offices should discuss with patients the need to reschedule their appointment if they develop fever or symptoms of COVID-19 leading up to the time of their appointment.

○ Patients and visitors should also be informed in advance of the expectation that they wear their own mask or cloth face covering upon arrival to the facility.

○ When appropriate, telehealth technology should be utilized.

Limit the number of people in the office to a number that will reasonably adhere to social distancing guidelines.

○ A patient may bring one companion into the office only if the patient is a minor, or an assistant if the patient requires a caregiver.

○ No additional persons will be allowed to wait in the building.

Utilize online paperwork and registration to limit surface interactions and time in the office. If a patient is unable to complete paperwork electronically, sanitize all pens and clipboards immediately after each use.
Request patients use hand sanitizer when entering the office.
When possible, move the patient immediately to the open exam room.

○ The patient may return to their automobile and be called when the exam room is available.

If waiting area space must be utilized, have ample spacing between chairs. Sanitize chairs after each use.
Encourage respiratory etiquette, including covering coughs and sneezes.
Eliminate Handshaking.
Install breath guards on slit lamps.
Optical stations will be separated by at least six (6) feet apart.
In the optical, the practice should maintain measures to sanitize frames touched by patients after each encounter.
Whenever possible, provide curbside service.
Discourage workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible.

○ Sanitize workstations often.

Increase use of contactless payment, consider Apple/Samsung Pay, Venmo, CashApp, Paypal or payment over the phone.
The office will not provide books, magazines, or any reading material for patients.
Office space (e.g. check in desk, restrooms) will be cleaned and disinfected according to CDC-based surface disinfection guidelines.
All equipment will be sanitized between patients.

○ Doctors, technicians, and opticians will sanitize all equipment, chin rests, and chairs after providing services to each patient.

○ https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

MEASURES SHOULD BE COMMUNICATED TO EMPLOYEES IN A CLEAR AND CONSISTENT MANNER

Owners/managers will meet with all employees and communicate measures verbally and in writing.
Owners/managers should require employees to sign a statement that they understand and will follow guidelines and recommendations.

PROTECTIVE EQUIPMENT (PPE), SUCH AS FACE-MASKS OR GLOVES

PPE required for staff will be face masks and gloves, if necessary. One facemask can be used per day, if possible. Disposable gloves are to be changed after each patient.

○ Decontamination and Reuse of Filtering Facepiece Respirators

■ https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

MEASURES WILL BE COMMUNICATED TO PATIENTS IN A CLEAR AND CONSISTENT MANNER

Measures will be communicated via social media (Facebook/Instagram) and on the practice website.
These measures will be posted on the front door/window for patients to read before entering the practice.
Signs will be posted on the front door/window stating that any patient who has a fever or cough must reschedule their appointment.

○ https://www.cdc.gov/coronavirus/2019-ncov/communication/print-resources.html?Sort=Date%3A%3Adesc

USEFUL RESOURCES

Governor's Notice Pursuant to State of Arkansas Executive Department Proclamation EO 20 - 13 (3) f