Download EI Clinic Manual - Midwestern University

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MIDWESTERN UNIVERSITY EYE INSTITUTE

CLINIC MANUAL

MIDWESTERN UNIVERSITY EYE INSTITUTE 19379 N. 59TH AVENUE, GLENDALE, AZ 85308 623-537-6000 WWW.MWUCLINIC.COM

TABLE OF CONTENTS Item

Page Number

OVERVIEW OF MWU EYE INSTITUTE Mission Statement, Vision and Goals of the Arizona College of Optometry Patient Bill of Rights Responsibilities as Patient or Guardian of the Patient Policy on Dependents and Minors Non-discrimination Policy Medical Records Requests Inmate Procedure Health Insurance Portability and Accountability Act (HIPAA) Mandatory Training Organizational Chart with Definitions Eye Institute Committees Hours of Operation

4 5 5 5 6 6 6 7 8 9 12 14

GENERAL POLICIES AND PROCEDURES FOR FACULTY Clinical Attending Faculty Responsibilities Clinical Privileging Clinical Attending Faculty Absence Policy On-Call Policy

15 16 18 19

OVERVIEW OF THE CLINICAL ROTATION PROGRAM FOR OPTOMETRY STUDENTS Rotation Management System (RMS) Meditrek Key Personnel, Offices and Support Policies and Procedures for Student Clinicians Patient Management and Protocols Professional and Appropriate Communication and Courtesies General Program Guidelines and Policies Clinical Rotation Policies Clinical Rotation Requirements External Rotation Site Selection O.D.-3 Rotation Specific Information O.D.-4 Rotation Specific Information Overview of Rotation Requirements for Third and Fourth year Students

20 20 20 22 25 25 27 38 45 47 48 48 49

SAFETY PROCEDURES FOR THE EYE INSTITUTE MWU Emergency Response Plan MWU Emergency Response Team Eye Institute Emergency Response Plan Protocol for AED and CPR Location of Emergency/Courtesy Phones General Disaster Procedures Universal Precautions and Exposure Control Plan

52 52 52 52 53 53 56

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Housekeeping, Decontamination and Spill Cleanup Clinical Disinfection Procedures Clinical Precautions and Procedures Laser Safety Sheets Material Safety Data Sheets

63 64 65 66 66

SAFETY PROCEDURES FOR EYE INSTITUTE PATIENT CARE Adverse Drug Reactions Abuse or Neglect Reporting Be Safe/Be Smart Crime Prevention Imaging Orders Laboratory Testing Microbiology Cultures Ocular Emergencies Pharmaceutical Samples Policy Prescribing Controlled Non-narcotic Medications Prescribing Narcotic Medications Sterilization and Disinfections Procedures Therapeutic Drug Policy

67 67 69 70 70 70 70 70 70 70 70 70

APPENDICES APPENDIX I - PATIENT CARE POLICIES Clinical Services and Referrals Release of Prescription Policy Optometric Prescription Standards Letter Writing Guidelines Patient Complaint Procedure

72

APPENDIX II - MWU CLINIC POLICIES

76

APPENDIX III- QUALITY ASSESSMENT PROGRAM

78

APPENDIX IV- COURSES DELIVERED IN-PART OR WHOLE WITHIN THE EYE INSTITUTE Clinical Services I-III Ophthalmic Optics/Optical Ocular Prosthetic Electro diagnostics

79

APPENDIX V - INCIDENT REPORT FORM

87

APPENDIX VI - INTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM

88

APPENDIX VII - EXTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM

89

APPENDIX VIII – OPTO 1800-1830 CLINICAL SERVICES XI- XIV MIDTERM AND FINAL 90 GRADING FORM APPENDIX IX - PRECEPTOR AND SITE EVALUATION

94

APPENDIX X – PATIENT LOG

95

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OVERVIEW OF MWU EYE INSTITUTE Mission Statement Arizona College of Optometry The mission of Midwestern University Arizona College of Optometry (AZCOPT) is to educate future optometrists and residents in an inter-professional healthcare environment. The College fosters professional attitudes and behaviors that encourage lifelong learning and scholarship to serve the needs of the public and improve the health and well-being of society. The Goals of the Arizona College of Optometry are listed below.          

Provide broad and innovative educational opportunities in the basic, visual, and clinical sciences. Plan and develop a diversity of clinical experiences to allow our students to enter the practice of optometry. Support and nurture an environment of intellectual inquiry and activity by students, residents, and faculty. Promote inter-professional educational programming to develop students’ appreciation of other health care professions. Ensure that students have a strong basic and vision science foundation. Promote student involvement in community service. Develop a high quality residency program. Establish an Eye Institute that serves the eye/vision care needs of the community. Provide lifelong learning activities and support services to the optometric profession and the public. Maintain the financial viability of the College.

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Patient Bill of Rights The Midwestern University Clinics are committed to providing quality care and service for our patients. As a health sciences university, we also provide training for future healthcare professionals who are supervised by our faculty. As a partner in this educational process, you have the following rights: 1. You have a right to an appointment with your healthcare provider in a timely manner. 2. You have a right to considerate, respectful care from your doctors, health plan representatives, and other healthcare providers that does not discriminate against you. 3. You have a right to accurate and easily understood information about your health plan, healthcare professionals, and healthcare facilities. 4. You have a right to expect appropriate infection and sterilization controls. 5. You have a right to an explanation of the prescribed treatment, treatment alternative, the option to refuse treatment, the risk of no treatment, and expected outcomes of these treatments, and to be told, in language you can understand, the advantages and disadvantages of each. 6. You have the right to know your treatment options and to take part in decisions about your care. Parents, guardians, family members, or others whom you select can represent you if you cannot make your own decisions. 7. You have a right to continuity and completion of treatment. 8. You have a right to emergency, incremental, and total patient care. 9. You have a right to treatment that meets the standard of care for the profession. 10. You have the right to talk privately with healthcare providers and to have your healthcare information protected. You also have the right to ask that your doctor amend your record if it is not accurate, relevant, or complete. 11. You have the right to a fair, fast, and objective review of any complaint you have against your health plan or healthcare provider. This includes complaints about waiting times, operating hours, the actions of healthcare personnel, and the adequacy of healthcare facilities. Along with your rights, there are patient expectations and responsibilities.

Responsibilities as the Patient or Guardian of the Patient 1. You have the responsibility to provide accurate and complete information about your or your child's medical history. 2. You have the responsibility to question treatment or instructions you do not understand. 3. You have the responsibility to keep scheduled appointments and provide at least 48 hours of notice if you need to cancel an appointment. 4. You have the responsibility to provide information about payment to the MWU Eye Institute to ensure that financial obligations are met.

Policy on Dependents and Minors All patients under the age of 18 years are considered minors. All developmentally challenged patients who do not have a declaration of independence are to be considered dependents. All

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minors and dependents will be examined only when a parent, guardian, or caretaker is present at the appointment. At the time the appointment is made, staff will notify the family, guardian, or caretaker that they must accompany the patient to the appointment.

Non-discrimination Policy No patient will be denied treatment based on race, color, religion, national origin, gender, sexual orientation, age, marital status, disability, or public assistance status.

Medical Records Requests All medical records requests require a Release of Medical Records form that is signed, dated and witnessed. The Release of Medical Records form is available at the Reception Desk of the MWU Eye Institute. Once the form is completed and submitted, it will remain on file in the patient’s medical record. All medical records requests should be forwarded to the clinic referral coordinator or the clinic manager. The clinic referral coordinator or clinic manager will take the responsibility to deliver the records to the patient and document their action into the patient chart. When face to face delivery is requested, proper identification is to be presented and documented in the patient’s chart prior to exchange of the medical record envelope. When medical records are handed to, mailed, faxed or otherwise electronically delivered, the records should be sealed in an envelope with the patient’s full name and address with the following statement visible on the OUTSIDE of the envelope: “The information contained in this envelope and any accompanying documents is intended for the sole use of the recipient to whom it is addressed, and may contain information that is privileged, confidential, proprietary to sender, and prohibited from disclosure under applicable law. If you are not the intended recipient, or authorized to receive this on behalf of the recipient, you are hereby notified that any review, use, disclosure, copying, or distribution is prohibited. If you are not the intended recipient(s) or have received this communication in error, please contact the sender by e-mail or mail and destroy all copies of the original message or paperwork. Thank you.” This should then be sealed in a larger envelope and mailed to the patient’s address of record.

Inmate Procedure No more than one inmate patient should be scheduled for a service at a time. Inmate patients should be escorted by correctional institution guards/law enforcement at all times while on University property. Inmate patients should be seen immediately upon arrival and escorted to the patient care area of the appropriate service

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PROCEDURE: MWU Security personnel will be informed at least 24 hours in advance of an inmate patient’s scheduled appointment. Correctional institution guards/law enforcement should be instructed to park in the parking garage and await escort by a member of MWU security. The inmate patient should not be taken through the main entrance upon arrival or departure if possible. The inmate patient should be escorted directly to the appropriate treatment area. The correctional institute guards/law enforcement must remain in the examination area throughout the examination. No MWU Eye Institute faculty, staff, or student(s) may be alone, in the examination room or otherwise, with an inmate patient without a correctional institution guard/law enforcement present. MWU Eye Institute faculty, staff, and students working with inmate patients should keep the door open when possible and should position themselves so that they can quickly leave the room if the patient becomes aggressive, e.g., do not position the patient between the faculty, staff, or student and the door. If an inmate patient becomes aggressive, the faculty, staff, or student should immediately leave the room and notify MWU security. Upon completion of eye services, the inmate will be escorted through the side doors to return to the awaiting transportation vehicle. Should frame selection be required, the optician will make an initial assessment of the inmate’s needs, select several options and present to the inmate in the examination area. Completion of optical services will be done in the examination room. All billing arrangements will be made prior to scheduling the appointment for the inmate with the Assistant Manager of Finance at the MWU Eye Institute. The Assistant Manager will then obtain authorizations and billing information to be entered into Patient Management System along with the necessary demographics. Charges for services will be based on what is usual and customary. The front desk will then make the appointment arrangements and forward necessary paperwork to be completed prior to the appointment to the appropriate authority. Paperwork should be completed and returned prior to the patient being seen, and scanned into the patient’s record.. A routing sheet will be completed by the attending optometrist and returned to the Assistant Manager of Finance for posting.

Health Insurance Portability and Accountability Act (HIPAA) The privacy of patients’ medical information is imperative in all modes of practice. All faculty and students will be compliant with the Health Insurance Portability and Accountability Act (HIPAA). Upon check-in as a patient in the MWU Eye Institute, a patient is asked to read and

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sign the following MWU Clinic forms: Patient Authorization, Assignment and Acknowledgement Form (HIPAA Form), Student Acknowledgement Form (student doctor acknowledgement), and Patient Information Sheet (includes personal and insurance information). They are offered a copy of the HIPAA policy to take with them. All signed forms are scanned into the medical record. The release of information policy will follow HIPAA guidelines in that no information will be released without a written request from the patient. When release of information is requested by a patient, the attending doctor or faculty of the day must review the printed record for completeness before it is released to a patient or doctor. When a patient presents with a letter or form that requires inclusion of a patient’s medical information (e.g. state department of motor vehicles, insurance claims, etc), the attending doctor or faculty of the day will follow the same release of information policy. This is specified in the MWU policy on patient requests to inspect and obtain a copy of their medical records, which is found in the appendix of this manual. A minimum necessary use of protected health information policy is in place to accommodate a patient’s request for special privacy protection of their Protected Health Information (PHI). This is outlined in the standard MWU policy found in the appendix of this manual.

Mandatory Training Mandatory training for faculty and staff will take place annually. These online courses are accessed through Law Room by arrangement through MWU Human Resources. These courses include:  Universal precautions for blood borne pathogens  OSHA updates related to clinical care and safety  Health insurance portability and accountability act as it relates to patient privacy and security  Family Educational Rights and Privacy Act Mandatory CPR training will be offered annually for students and faculty. Cardiopulmonary resuscitation is offered within the course OPTO 1700 Physical Medicine. The successful completion of this course is necessary to work in the MWU Eye Institute. It is the responsibility of the individual to assure that they are in compliance with the mandatory training requirements. If a faculty or staff is identified to be out of compliance, they will be given a written warning to correct the deficiency within a two week period. Non-compliance with this warning will result in ineligibility to work in the MWU Eye Institute with whatever penalty that entails.

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Organizational Chart The clinical faculty of the MWU Eye Institute will hold dual appointments in the Arizona College of Optometry and will be evaluated in accordance with the Faculty Handbook and MWU Human Resources guidelines. The clinic staff will be evaluated annually using standardized evaluation forms by the Clinic Manager in accordance with MWU Human Resources guidelines.

MIDWESTERN UNIVERSITY ARIZONA COLLEGE OF OPTOMETRY EYE INSTITUTE ORGANIZATIONAL CHART

AND

Descriptions for the positions shown in Figure above include: Assistant Dean of Clinical Affairs The Assistant Dean of Clinical Affairs oversees the patient care and teaching activities of the MWU Eye Institute. As such, the Assistant Dean of Clinical Affairs develops clinic policies and

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guidelines appropriate for MWU Eye Institute. All such policies are then forwarded to the MWU Eye Institute Operations Committee. If approved by the committee, policies are then forwarded to the MWU Clinic Management Oversight Committee for approval, and then on to the University President for final approval. The Assistant Dean of Clinical Affairs with the assistance of the Assistant Director, Clinical Rotations and the Clinical Education Coordinator, develops and monitors the externship and community outreach program of the college. This includes setting criteria for preceptors and externship sites, evaluation and training of preceptors, and coordinating contract agreements. The Assistant Dean of Clinical Affairs assumes overall responsibility to ensure that students have ample opportunities to gain the clinical competencies as determined by the faculty. Together they coordinate the receipt, calculation and posting of student grades for internal (MWU Eye Institute) and external rotations. The Assistant Dean of Clinical Affairs works with course directors for the OPTO 1700 and OPTO 1800 series as well as the Assistant Director, Clinical Rotations to identify students with unsatisfactory performance and forwards those grades to the Student Promotion and Graduation Committee for review and action The Assistant Dean of Clinical Affairs monitors, with the assistance of the Clinic Manager, the operations of the dispensary, ordering of supplies, maintenance of equipment and performance of the opticians and ophthalmic technicians at the MWU Eye Institute. The Assistant Dean of Clinical Affairs assists the Associate Dean of Academic Affairs to develop and determine the faculty clinical workload. The Assistant Dean of Clinical Affairs works with the Associate Dean of Academic Affairs on didactic course and clinical rotation teaching assignments of faculty, creation of annual faculty development plans, and annual performance evaluations for the faculty. Additionally, the Assistant Dean of Clinical Affairs works with the Residency Program Advisory Committee to plan and develop residency programs associated with MWU Arizona College of Optometry. Assistant Director, Clinic Operations The Assistant Director, Clinic Operations oversees the daily clinic operations of the MWU Eye Institute. As such, The Assistant Director, Clinic Operations works with the Clinic Manager to: coordinate and implement the daily clinical schedule, including patient, student and clinical faculty schedules, develop and implement staff development and training programs, coordinate maintenance and inventory control of all clinic equipment, manage the on call service and handle patient care or service issues as needed. The Assistant Director, Clinic Operations collaborates with the Assistant Dean of Clinical Affairs to establish and maintain new clinical services, direct marketing strategies and enhance quality and efficiency of patient care.

Assistant Director, Clinical Rotations The Assistant Director, Clinical Rotations sets criteria for preceptors and external rotation sites, evaluation and development of preceptors, negotiating contract agreements, and resolving student and preceptor performance issues. The Assistant Director, Clinical Rotations serves as

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the immediate liaison for all external preceptors and student externs. The Assistant Director, Clinical Rotations works to ensure that students have ample high quality opportunities to gain clinical competencies as determined by the faculty. Clinic Manager This position reports to the Assistant Dean of Clinical Affairs and supervises and monitors the activities of the dispensary and back office staff. The Clinic Manager schedules and monitors the staffing of the optometry clinic to assure efficient clinic operations. The Clinic Manager collaborates with the Assistant Clinical Patient Accounts Manager and the Patients Account Manager to oversee patient registration and collection of fees. The Clinic Manager supports clinic operations by working closely with the Assistant Dean of Clinical Affairs and the Assistant Director, Clinic Operations to organize staff meetings. The Clinic Manager is familiar with Compulink® clinical management and electronic medical record system; is able to prepare reports and statistics on student activities related to practice management; oversees patient flow; and resolves patient issues associated with appointments, fees, and other operational issues. This position requires knowledge and compliance with OSHA and HIPAA regulations; monitoring of clinical and patient safety equipment; and checking expiration dates on all materials, supplies, and equipment. The Clinic Manager assists with monitoring compliance with University policies and procedures. Clinical Education Coordinator The Clinical Education Coordinator works closely with the Assistant Director, Clinical Rotations and the Assistant Dean of Clinical Affairs to assist in the coordination and development of the community based clinical rotations for the third year students and also the external rotation sites for the fourth year students. This individual is responsible for creating and maintaining quarterly clinic schedules for third and fourth year students in both the MWU Eye Institute as well as on external rotations. In addition, this individual maintains the clerkship portion of the MWU Eye Institute Clinic Manual and the External Rotation Manual; processing evaluations of students and preceptors for review by the Clinical Course Directors and the Assistant Dean of Clinical Affairs; and training students and preceptors on the Rotation Management System and Meditrek software. Lead Ophthalmic Technician The Lead Ophthalmic Technician is responsible for the maintenance, storage, and basic operation of all routine and specialized testing instrumentation for the clinical floor of the MWU Eye Institute. The Lead Ophthalmic Technician assists the faculty and students in performing uniform administration of specialized testing. The technician is responsible for transferring test results to the attending optometrist. This individual facilitates quality learning experiences for students during their clinical rotations in the MWU Eye Institute, and therefore demonstrates characteristics of sound patient management and ethical and professional behavior in optometric practice. The lead ophthalmic technician has responsibility for the development of educational activities in the attainment of accurate specialty test administration and equipment maintenance. This position reports to the Clinic Manager. Ophthalmic Technician

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The Ophthalmic Technician is responsible for basic operation of all routine and specialized testing instrumentation for the clinical floor of the MWU Eye Institute. The Ophthalmic Technician assists the faculty and students in performing uniform administration of specialized testing. The technician is responsible for transferring test results to the attending optometrist. This individual facilitates quality learning experiences for the students during their clinical rotations in the MWU Eye Institute, and therefore must demonstrate characteristics of sound patient management and ethical and professional behavior in optometric practice. The Ophthalmic Technician is responsible for ordering and cataloging the contact lenses as prescribed by the attending optometrist. This position reports to the Clinic Manager. Lead Optician The American Board of Opticianry-certified optician within the MWU Eye Institute is responsible for frame inventory, frame board management, meeting with frame representatives, tracking product sales, merchandising, theft prevention, marketing and direct patient care. The Lead Optician fulfills an educational role by coordinating with the ophthalmic optics and practice management educator in the teaching and application of optometric practice development principles, such as the selection and marketing of ophthalmic products, patient education, and service. This position reports to the Clinic Manager. Opticians The Opticians are responsible for frame inventory, frame board management, meeting with frame representatives, tracking product sales, merchandising, theft prevention, and direct patient care. The Optician will additionally fulfill an educational role by coordinating with the ophthalmic optics and practice development principles, such as the selection and marketing of ophthalmic products, patient education, and service. This position reports to the Clinic Manager. Clinical Attending Optometrist (Faculty) Clinical Attending Optometrist is a clinical faculty member or an adjunct clinical instructor. The clinical attending optometrist is responsible for overseeing student clinicians. The specific duties and responsibilities are outlined in the General Policies and Procedures section under Clinical Attending Optometrist responsibilities.

Eye Institute Committees a.

Eye Institute Policy And Procedure Committee

Purpose: To gather input from faculty and staff on various aspects of clinic operations, including policy and procedure. Description: Conducts patient flow analyses and provides recommendations to the Assistant Dean of Clinical Affairs to enhance efficient patient flow; monitors all marketing initiatives to ensure that they are compliant with federal, state, and university policies, procedures and regulations; ensures that information technology requirements are met and data storage is adequate; ensures that specialized equipment requirements are met; reviews and advises on policies and procedures within the Eye Institute; ensures that as new services are developed in the MWU Eye Institute, that appropriate policies and procedures are drafted. The committee

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should provide all draft policies and procedures to the Eye Institute Operations Committee and MWU Clinic Management Oversight Committee for final approval. Membership: The committee is composed of at least four (4) members. At least one (1) member will be a representative for information technology. The Assistant Dean of Clinical Affairs serves in an ex-officio capacity to advise the committee. Chairperson: The chairperson is appointed by the Dean of the Arizona College of Optometry from the committee membership. b.

Eye Institute Best Practices Committee

Purpose: To ensure the highest standards of care are followed in the MWU Eye Institute regarding patient care, faculty privileging/credentialing, HIPAA compliance, and chart reviews. The Best Practices Committee has been meeting regularly since the start of the Eye Institute, but requires MWU Faculty Senate approval to become a MWU Faculty Committee. Description: Develops evidence-based standards of care; establishes privileging levels for the Eye Institute; reviews requests for privileges for individual faculty and provides recommendations on those requests to the AZCOPT Credentialing and Privileging Committee; ensures clinic compliance with HIPPA regulations, cardiac life support, and infection control policies; conducts chart reviews for quality assurance purposes, and reviews and approves of all clinic forms. This Committee provides regular reports of its chart reviews to the Eye Institute Operations Committee. For any deficiencies identified by its audit, the Committee proposes a correction plan to the Eye Institute Operations Committee. Membership: The committee is composed of at least three (3) faculty members, the Assistant Manager of Patient Accounts, and a Patient Account Representative. The Assistant Dean of Clinical Affairs serves in an ex-officio capacity to advise the committee. Chairperson: The chairperson is appointed by the Dean of the Arizona College of Optometry from the committee membership. c.

Credentialing And Privileging Committee

Purpose: To approve privileging level and credentialing of Eye Institute faculty. Description: Ensures that faculty is appropriately credentialed and privileged; approves privileges for individual faculty. Membership: The committee is composed of all AZCOPT Administration members. Chairperson: The Dean serves as the chairperson for this committee.

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Hours of Operation The MWU Eye Institute is open for patient care from 8:00 a.m. to 5:00 p.m., Monday, Wednesday, and Friday, and 8:00 a.m. to 7:00 p.m. on Tuesday and Thursday, excluding holidays. Patient check-in begins at 7:30 a.m. After-hour emergencies are handled by the eye care practitioner on call. The call schedule is approved quarterly by the Clinic Manager. Approved MWU holidays include:  Independence Day-July 4, 2014  Labor Day-September 1, 2014  Thanksgiving Holidays-November 27-28, 2014  Christmas Eve-December 24, 2014  Christmas Holidays-December 25-26, 2014  New Year’s Eve-December 31, 2014  New Year’s Day-January 1, 2015  Martin Luther King, Jr. Day-January 19, 2015  Memorial Day- May 15, 2015 Emergency closing of the MWU Eye Institute is restricted to a catastrophic event, as determined by the University President. The faculty and staff that are required to report to work in the case of an unforeseen event, include the Assistant Dean of Clinical Affairs, the Clinic Manager and the Assistant Manager of Patient Accounts. The use of the MWU Eye Institute during non-clinic hours by students requires written consent of the Assistant Dean of Clinical Affairs. The written consent should include the task to be completed, the date and expected time allotment and expected location of the task. A clinical faculty advisor must be present to supervise students during non-clinic hours. Written requests should be received by the Assistant Dean of Clinical Affairs a minimum of one week prior to the event.

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GENERAL POLICIES AND PROCEDURES FOR FACULTY Clinical Attending Faculty Responsibilities The Clinical Attending Faculty (Attending Optometrist, Clinical Preceptor) must ensure that their licensure, credentialing, and malpractice insurance policy is up to date and on file with the Assistant Dean of Clinical Affairs. The Clinical Attending Faculty is responsible both legally and ethically for the care of the patient. Additionally, at each patient encounter the Clinical Attending Faculty ensures:      

Performance and recording of all indicated examination procedures Comprehension and interpretation of examination results and their implications Determination of diagnosis, treatment and management, inclusive of further testing, referral and/or correspondence Completion of electronic medical record inclusive of examination procedures, disposition, plan and billing Effective patient communication Employment of optometric best practices

Day to day activities of the Clinical Attending Faculty will include but not be limited to:               

Assignment of student clinicians to their patients Demonstration of clinical skills, inclusive of a complete examination sequence in their area of expertise Observation of student clinicians with constructive assistance to improve patient care Consultation on patient care Monitoring and reviewing each patient care encounter Guiding student clinicians to a complete an accurate patient care encounter inclusive of diagnosis, treatment and management Assisting in completion of the electronic medical record including disposition, plan, final review, referral, dispensing, billing and signatures Performing complete ocular evaluation and conducting case disposition with each patient in concurrence with established standard of care guidelines Ensuring continuity of care for each patient Ensuring referral letters and/or outside forms are completed and sent to appropriate source Evaluating the performance of the student clinician on patient encounters with written and/or verbal feedback Identifying any student clinician who may need remediation as soon as possible Providing patient care when students are absent Work willingly with all clinical faculty, staff and students to solve challenges Making use of effective clinical teaching skills and demonstrating the elements of effective clinical teaching

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       

Reading recommended support materials as identified by the Education Committee and the Assistant Dean of Clinical Affairs. Making themselves available to student clinicians Arriving on time Dressing in appropriate professional clinical attire Notifying the Assistant Dean of Clinical Affairs, the Clinic Manager and student clinicians of any planned and approved absences Adhering to the clinical fee schedule Complying with Clinical Faculty Privileging and Credentialing Attending MWU Eye Institute meetings Completing assigned duties

Clinic Privileging An application for credentialing will be completed by each faculty member who is assigned to work in the MWU Eye Institute. The application will include documentation from primary sources to support all state and national license(s), provider numbers, insurance, board certification and DEA number. The credentialing process may take up to three months. Privileging will be granted to faculty members at levels that correspond to the faculty member’s credentials, appropriate patient care requirements, and specialty clinic demands. The privileging levels are described below along with the form that must be completed by the faculty member requesting privileges. Approved privileges of faculty members will be on file in the MWU Eye Institute’s administrative office upon approval by the Assistant Dean of Clinical Affairs.

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Procedure for Privilege Request Form For expanded procedures that clinical faculty would like to perform in the MWU Eye Institute, they must submit a completed procedure privilege request to the MWU Eye Institute Best Practices Committee for review and approval. Once the Best Practices Committee votes to approve the request for privileges, the application and the Best Practices Committee’s decision must be forwarded to the Credentialing and Privileging Committee for final approval. The approval process must be completed before a clinical faculty can perform the specified procedure.

Clinical Attending Faculty Absence Policy When a Clinical Attending Faculty must be absent from their clinical responsibilities, it is his/her responsibility to arrange for coverage of their assigned duties. Notification must be made to the Assistant Dean of Clinical Affairs, Clinic Manager, and the student clinicians. Notification for planned absences should be made no later than two months in advance so that clinic schedules can be altered, if needed.

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On Call Policy On Call schedules will be determined by the Clinic Manager under the direction of the Assistant Director, Clinic Operations. On Call schedules will be posted online as well as distributed via electronic mail. Each clinical faculty member is expected to cover after hours, weekends, and holidays as dictated by the call schedule. Schedule changes will require notification of the Clinic Manager and the Assistant Director, Clinic Operations. The On-Call service used by the faculty to contact the patient has this number: 623/537-6000.

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OVERVIEW OF THE CLINICAL ROTATION PROGRAM FOR OPTOMETRY STUDENTS The clinical experience for students in the Arizona College of Optometry program begins in the first professional year with clinical observations and progresses to more hands-on involvement as the students learn clinical skills and procedures. Starting in the summer quarter of the third professional year the student clinicians will be scheduled weekly in the MWU Eye Institute to the primary care service to perform comprehensive eye care and contact lens examinations on patients under the supervision of AZCOPT Clinical Faculty. These experiences will continue and expand to the specialty services for each of the 4 quarters of the third year rotations within the MWU Eye Institute. By the end of the third professional year the student clinicians will be eligible to see patients in most of the specialty services of the MWU Eye Institute and its affiliated clinical sites. During the fourth professional year the student clinicians may be assigned to external rotation sites throughout the nation during the quarterly rotation periods. The information included in this manual will primarily refer to the MWU Eye Institute clinical experience. For comprehensive external rotation policies and procedures refer to the AZCOPT External Rotation Manual.

Rotation Management System (RMS) RMS is a Web-based rotation information system that houses AZCOPT student information and documents necessary for external clinical rotation assignments. Additionally, RMS is utilized to assist in the external rotation assignments process by providing information on preceptors and rotation sites and calculating rotation assignment requirements along with student preferences.

Meditrek Meditrek is a Web-based medical education management and administration tool. Meditrek houses all of the student, preceptor, and site evaluations, as well as third and fourth year student patient logs.

Key Personnel, Offices, and Support 1. Preceptors A preceptor is a licensed health care provider who works directly with students in the provision of health care services to patients. The preceptor is a teacher, mentor, supervisor, role model, evaluator and counselor. It is the preceptor’s responsibility to help students prepare themselves for effective and successful provision of optometric services. The internal preceptor is commonly an AZCOPT faculty, either full time or adjunct, that is scheduled to supervise the student clinician in the MWU Eye Institute or affiliated clinical site. The course director of the clinical courses within the MWU Eye Institute is the point of contact for MWU Eye Institute faculty preceptors. The external rotation preceptor is a health care provider affiliated with AZCOPT through the external rotation program, and is responsible for the evaluation of optometry students at their

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rotation site. The external rotation preceptor is appointed as an adjunct faculty member of AZCOPT. The Assistant Director of Clinical Rotations is the point of contact for the external rotation preceptor. Preceptor supervision and mentoring are essential components of a successful rotation experience, and are further described below. a. Professional Supervision by Preceptor Professional supervision, as it relates to assigned optometry students, means (at a minimum) that in no case shall a patient receive services or be treated based solely on a student’s evaluation where a preceptor has not agreed to the findings, the conclusions and the plan. The College does not intend that professional supervision requires direct physical observation of all student clinical activity, however, students cannot be required or allowed to provide professional services at any time when a preceptor is not on the premises and not aware of the student activity. b. Professional Mentoring by Preceptor Professional mentoring includes many types of teaching activities including coaching on technique, case analysis, patient communication, strategies for differential diagnosis, role modeling of proper professional demeanor; making recommendations for study or practice; providing evaluation feedback, career counseling and other activities. In this way, the preceptor serves as a valuable role model for optometry students as the latter gain confidence and expertise in their clinical skills and decision-making. 2. Assistant Dean of Clinical Affairs The AZCOPT Assistant Dean of Clinical Affairs, with the assistance of the AZCOPT Assistant Director, Clinical Rotations and the Clinical Education Coordinator, develops and monitors the internal and external clinical educational and community outreach program of the college. This includes setting criteria for preceptors and external rotation sites, evaluation and development of preceptors, negotiating contract agreements, and resolving student and preceptor performance issues. The Assistant Dean of Clinical Affairs assumes overall responsibility to ensure that during the clinical experiential component, students have ample high quality opportunities to gain clinical competencies as determined by the faculty. The Assistant Dean of Clinical Affairs, Dr. Joshua Baker can be contacted by phone 623-806-7254, or e-mail [email protected] 3. Assistant Director, Clinical Rotation The Assistant Director, Clinical Rotations sets criteria for preceptors and external rotation sites, evaluation and development of preceptors, negotiating contract agreements, and resolving student and preceptor performance issues. The Assistant Director, Clinical Rotations serves as the immediate liaison for all external preceptors and student externs. The Assistant Director, Clinical Rotations works to ensure that students have ample high quality opportunities to gain clinical competencies as determined by the faculty. The Assistant Director, Clinical Rotations, Dr. Alicia Feis can be contacted by phone 623806-7268, or e-mail [email protected].

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4. Assistant Director, Clinic Operations The Assistant Director, Clinic Operations oversees the daily clinic operations of the MWU Eye Institute. As such, The Assistant Director, Clinic Operations works with the Clinic Manager to: coordinate and implement the daily clinical schedule, including patient, student and clinical faculty schedules, develop and implement staff development and training programs, coordinate maintenance and inventory control of all clinic equipment, manage the on call service and handle patient care or service issues as needed. The Assistant Director, Clinic Operations collaborates with the Assistant Dean of Clinical Affairs to establish and maintain new clinical services, direct marketing strategies and enhance quality and efficiency of patient care. The Assistant Director, Clinic Operations can be contacted by phone 623-806-7254. 5. Clinical Education Coordinator The Clinical Education Coordinator will work closely with the Assistant Director, Clinical rotations and the Assistant Dean of Clinical Affairs to assist in the coordination and development of the community based clinical rotations for the third year students and also the external rotation sites for the fourth year students. This individual is responsible for creating and maintaining quarterly clinic schedules for third and fourth year students in both the Midwestern University Eye Institute as well as on external rotations. In addition, this individual will be responsible for being the immediate liaison for external preceptors and students, maintaining the clerkship portion of the MWU Eye Institute Clinic Manual and the External Rotation manual, processing evaluations of students and preceptors for review by the Clinical Course Directors and the Assistant Dean of Clinical Affairs; and training students and preceptors on the Rotation Management System and Meditrek software. The Clinical Education Coordinator, Mrs. Lori Klein, can be contacted by phone 623-806-7243.

Policies and Procedures for Student Clinicians Standards of care and behavior must to be observed by all optometric student clinicians within the Eye Institute or at any affiliated clinical sites. These standards are not exclusive to the MWU Eye Institute but are held as standards we all must honor as optometrists. Code of Ethics for Optometrists1 It shall be the ideal, resolve, and duty of all optometrists:      

TO KEEP their patient’s eye, vision, and general health paramount at all times; TO RESPECT the rights and dignity of patients regarding their health care decisions; TO ADVISE their patients whenever consultation with, or referral to another optometrist or other health professional is appropriate; TO ENSURE confidentiality and privacy of patients’ protected health and other personal information; TO STRIVE to ensure all persons have access to eye, vision, and general health care; TO ADVANCE their professional knowledge and proficiency to maintain and expand competence to benefit their patients;

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   

TO MAINTAIN their practices in accordance with professional health care standards; TO PROMOTE ethical and cordial relationships with all members of the health care community; TO RECOGNIZE their obligation to protect health and welfare of society; and TO CONDUCT themselves as exemplary citizens and professionals with honesty, integrity, fairness, kindness, and compassion

1

Adopted by the House of Delegates as: Substantive Motion M-1944-1, June 1944; Modified June 2005; Repealed June 2007 Modified and Adopted as Resolution #1969, June 2007 http://www.aoa.org/about-the-aoa/ethics-and-values/code-of-ethics?sso=y (accessed 6/19/2014) The Optometric Oath2 With full deliberation I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously, and to the fullest scope of my competence. I will uphold and honorably promote by example and action the highest standards, ethics and ideals of my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted me. I will provide professional care for those who seek my services, with concern, with compassion and with due regard for their human rights and dignity. I will place the treatment of those who seek my care above personal gain and strive to see that none shall lack for proper care. I will hold as privileged and inviolable all information entrusted to me in confidence by my patients. I will advise my patients fully and honestly of all which may serve to restore, maintain or enhance their vision and general health. I will strive continuously to broaden my knowledge and skills so that my patients may benefit from all new and efficacious means to enhance the care of human vision. I will share information cordially and unselfishly with my fellow optometrists and other professionals for the benefit of patients and the advancement of human knowledge and welfare. I will do my utmost to serve my community, my country and humankind as a citizen as well as an optometrist. I hereby commit myself to be steadfast in the performance of this my solemn oath and obligation. 2Written

by Dr. Richard Hopping Adopted by the American Optometric Association House of Delegates, June 1986 http://www.aoa.org/about-the-aoa/ethics-and-values/the-optometric-oath?sso=y 6/19/2014

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Professionalism The demonstration of professionalism is critical to the success of a healthcare professional. The development of the values and attitudes that are required of a professional occurs over a period of time and must begin early in a student’s education. In this way, professional behavior becomes an integral part of an individual. Professionalism is demonstrated by the student who:  Uses appropriate verbal and non-verbal communication  Is punctual  Is reliable, dependable and accountable for one’s actions  Behaves in an ethical manner  Produces quality work  Accepts constructive criticism and modifies behavior, if necessary  Is cooperative, i.e. non-argumentative; willing and helpful  Is non-judgmental-student demonstrates an attitude of open-mindedness toward others and situations; does not “stereotype” others or prejudge situations  Communicates assertively - actively and appropriately engages in dialogue or discussion  Is self-directed in undertaking tasks; self-motivated  Is respectful-demonstrates regard for self, patients, peers, faculty, staff and university property  Is empathetic - demonstrates appreciation of others’ positions; attempts to identify with others’ perspectives; demonstrates consideration towards others  Handles stress - remains calm, level-headed and composed in critical, stressful or difficult situations  Is an active learner - seeks knowledge; asks questions, searches for information and takes responsibility for one’s own learning  Is confident - acts and communicates in a self-assured manner, yet with modesty and humility  Follows through with responsibilities - if a task is left incomplete or a problem is not resolved, student seeks aid  Is diplomatic - is fair and tactful in all dealings with patients, peers, faculty and staff  Is appropriately attired  Demonstrates a desire to exceed expectations - goes “above and beyond the call of duty, “ attempts to exceed minimal standards and requirements for tasks assignments and responsibilities  Utilizes time efficiently - allocates and utilizes appropriate amounts of time to fulfill responsibilities; utilizes others’ time wisely  Adheres to appropriate clinic policies and guidelines  Understands and respects patient confidentiality and adheres to all HIPAA requirements Professional demeanor must be maintained at all times while in clinic and class. This includes attitude, work habits, patient communication, ethics, dress code, attendance, conduct, courtesy, respect, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Any observed behavior not consistent with a professional demeanor will be documented using the Student Incident Report Form. Any significant documented behavior over the duration of the OPTO 1700 or OPTO 1800 course series not consistent with a professional demeanor will result in a written warning. Any subsequent incident report will result in the following:

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1st report: Written communication from the Course Director to the student outlining the infraction and a review of the professional conduct policy including repercussions for not adhering to the professional conduct policy 2nd report: Meeting with the Course Director. 3rd report: Meeting with the Course Director and Assistant Dean of Clinical Affairs. 4th report: Meeting with the AZCOPT Dean, referral to the Student Promotion and Graduation Committee, failure of the course, and/or dismissal from the program. An egregious unprofessional act of conduct reported at any time may result in immediate failure of the course, and/or dismissal from the program regardless of whether any previous Student Incident Report has been filed. Additionally, if a student receives a “needs improvement” (NI) on the professionalism and conduct portion of the student clinical grading form at the midterm evaluation, a meeting with the course director and/or the Assistant Dean of Clinical Affairs will be held to discuss acceptable behaviors and the consequences of failure to meet the expectations for professional conduct. If a student receives a “needs improvement” (NI) on their final evaluation, a meeting with the AZCOPT Dean will be scheduled, as well as referral to The Office of Student Services, and the student may receive a failing grade for the course, and/or be dismissed from the program.

Patient Management and Protocols Students and faculty are expected to demonstrate professional demeanor when addressing a patient and one another. When a patient is called from the waiting area they should be addressed by either a full name or salutation of Mr., Ms. and surname. In a more private setting a second personal identifier should be asked of the patient to assure that the correct patient has responded. Students must introduce themselves as student clinicians, and introduce a faculty preceptor by title and name i.e. Dr. John Smith. Private personal history and personal information should not be queried outside of the exam room to protect patient privacy.

Professional and Appropriate Communication and Courtesies Patient Communication Protocols Students and faculty should always attempt to communicate in the English language to patients. If it is felt that proper patient care cannot be delivered because the patient is unable to comprehend or follow directions during the examination, an interpreter will be called. If an interpreter is not available (family member, friend, faculty, etc.), the examination will be rescheduled on a day when the presence of an interpreter can be arranged. This policy will hold true for sign language and will be consistent with the Americans with Disabilities Act of 1990.

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Suggested Practice Management Procedures A. The Greeting – The intern should greet the patient cordially in the reception area before taking the patient back for their exam. B. Escorting the Patient – The intern should walk next to the patient while escorting them to the exam room. Under no circumstances should the intern discuss the reason for the patient’s exam when walking to the exam room. This would violate HIPAA regulations. C. Introduce the Patient to the Supervising Faculty – this should be done when the intern’s supervising faculty enters the exam room to briefly check the intern’s work. D. Patient Education – The intern should always explain to the patient the procedures being tested and the reason for each specific test. This allows the patient to understand the examination and the purpose to the testing. E. Leaving the Exam Room – The intern should politely excuse themselves whenever leaving the exam room to consult with the supervising faculty. If the patient can be left with information to read or look at this is preferred. Turn the room lights up to a comfortable level of illumination; do not leave the patient in the dark. F. Discussion with Faculty – The intern and faculty should discuss the results of the patient’s exam privately in a consultation room to ensure patient privacy. G. Ending the Exam – The intern should affirm the treatment plan (including return date) and explain “why” with the patient afterwards. Make sure to thank the patient for coming into the Eye Institute and that you would be happy to see anyone else they thought may benefit from your services. The intern should present the patient with two business cards (one for the patient and one for a friend). The student will complete a “Thank You” letter to be mailed to the patients home address at the conclusion of every examination. H. Inform Patient of On-Call Policies- The intern should educate the patient of on-call services available twenty-four hours a day, seven days a week. Patients can call, 623537-6000, after hours with any questions, concerns, or challenges concerning their patient care. Protocol for Patients Waiting in the Reception Area Patients will be advised to arrive 15 minutes early for their exam to complete the registration form or update the registration forms if the patient has been here previously. The intern should meet the patient immediately but no later than 10 minutes after the appointment time. The intern is responsible to monitor the patient’s arrival status and pick them up as soon as possible. If the intern cannot start the exam with the patient immediately, the intern should advise the patient of the delay and advise the patient of the expected time to start the exam. If the wait is

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unacceptable to the patient, the intern should speak with their supervising faculty and determine if another intern is available to assist. If after 15 minutes past the scheduled appointment time the intern has not come to the waiting area to communicate with the patient, the Front Office will contact the supervising faculty to determine the course of action.

General Program Guidelines and Policies Examination Room Care and Preparation Student clinicians are expected to bring their equipment roller boards with all equipment in working order. Each student clinician will be assigned to a clinical faculty preceptor and an examination lane for each patient care session. A concerted effort will be made to arrange assignments so student clinicians will have exposure to as many patient encounter types and specialty areas as possible. In the case of patient failure to appear, other clinical cases or case discussions will be assigned by the clinical attending optometrist. In the case of equipment failure every attempt will be made to correct the problem immediately. The ophthalmic technician, biomedical technician, clinic manager or attending facultyshould be notified to correct the problem. In the event correction is not possible immediately, another examination lane will be made available. Examination Room Equipment: The responsibility for the condition of all the examination rooms belongs to students, as well as, faculty. Procedures to be followed by all students are as follows:       

Arrive early to prepare your examination room Be sure you have paper towels, soap, Kleenex, needed supplies such as diagnostic dye strips, saline or eye wash, diagnostic drugs, contact lens case, sample artificial tears, Uncover all equipment and store the covers in the cabinet Disinfect the examination chair surfaces, handhold bars, counter tops, computer keyboard , mouse, acuity remote, door and cabinet knobs, and any patient contact points on the instruments (chin or forehead rests). Store your roller board under the counter and set up the instruments you will need ready for use. Turn on the acuity computer system, computer, stand power, overhead lamp, desk light as needed and set up your diagnostic equipment When your patient care is complete, clean and cover all equipment, turn off all power and lights, exit the computer program and shut down the computer. Return all supplies to their original location.

PLEASE DO NOT: 

Leave the power on to anything

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Use the examination room computers only for patient examination or treatment related data. DO NOT access the internet or your email from these computers. If you write report letters, do not save them on this computer.

Examination Room Infection Control Each examination lane in the Eye Institute is supplied with a container of Clorox disinfection wipes, alcohol prep pads, a box of Kleenex tissues, antibacterial hand soap and paper towels. The Clorox wipes are specifically for disinfecting hard, surfaces only. The alcohol prep pads are specifically for disinfecting hard surfaces that the patient’s head and face surfaces may touch. The protocol for each examination lane is as follows: 1. Using one disinfection wipe: a. Prior to patient care and before setting-up equipment, each Intern will wipe down: i. all exam and side chair arm rests ii. hand grips on instruments iii. head rests iv. countertops v. computer keyboard and mouse vi. acuity system remote control vii. door/drawer handles/knobs b. They should then discard the wipe and wash their hands with the antibacterial soap and water. 2. Using alcohol wipes: a. Wipe: i. all chin and forehead rests ii. face touching surfaces on the phoropter/ slit lamp/ keratometer (and any other instruments) iii. occluders 3. Between each patient, the chairs, headrests, armrests, computer keyboards and mouse should be wiped down again with a disinfection wipe and alcohol wipes used on face/chin and forehead contact areas and occluders. 4. As an infection control step in the public areas of the clinic: the wipes should be used on any solid surface (door handles/ stair railings/counters/ telephone handsets and dial pads/ computer keyboards and mouse, elevator buttons and hand rails) every four- six hours. 5. All employees and interns can use the alcohol based hand sanitizers that are available as well. 6. Disinfection products will be replenished on a weekly basis. Examination Room Electronic Health Records The Eye Institute uses the CompuLink Electronic Medical Records Software. To protect the privacy rights of the patients the medical record should be closed and locked whenever the clinician and/or student clinician leaves the examination lane. Electronic medical health records should be completed at the conclusion of each patient encounter. Each patient encounter should include all pertinent data such as: patient supplied information, examination findings, impression, plan inclusive of recommendations and follow up, fee assessments including

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notification of exclusion, if additional non-covered examination is performed, patient education, phone conversations, referrals, and signatures of the student clinician and Clinical Preceptor. All programs should be closed when the student clinician closes down the examination lane after their patient care schedule. The student clinician should log off. Any letters or patient care documents should be deleted from the desktop and the computer should be powered off. Student Attire Professional appearance and demeanor are critical to developing patient rapport and confidence. Adherence to the established dress code will be factored into the students’ midpoint and final grade in the area of professionalism. The following information outlines the dress code requirements observed at the MWU Eye Institute. It is recommended that these requirements also be observed at external rotation sites, unless the site has its own specific requirements that may or may not conflict with MWU Eye Institute requirements. The external rotation site has the ultimate authority over optometry student dress code. a) Name Tags Students must be identifiable by a name tag while on campus or external rotation sites. The name tag should be kept current and should be clearly visible. The external rotation site may also provide a name tag specific to that site. b) Lab Jackets and Coats AZCOPT-approved short white, long-sleeved student lab coats should be clean and pressed at all times and are required during patient care activities (unless otherwise approved). You may have to purchase a clinic coat without the AZCOPT logo, if required by the site. (Student is responsible for this cost). Clothing worn beneath the lab coat should be appropriate for a health care professional. Proper Attire: common sense and a sense of professionalism should dictate daily attire.  Be attentive to all aspects of your personal hygiene.  Hair should be clean and well groomed. Long hair should be tied back. Dramatic styles and wet hair are not appropriate. Beards should be well groomed.  Jewelry should be kept to a minimum, with limited visible body piercings. Earrings should be small and no longer than one inch below the lobe.  Clothing should fit and should be clean and pressed. Clothing that has unprofessional wording or images of any kind are not appropriate. T-shirts are not appropriate. Baggy “sagging” pants, halter tops, backless or midriff-baring tops, and fatigues are not considered appropriate. Sweatshirt material is not considered appropriate. Dresses and skirts should be no more than two inches above the knee and should be worn with appropriate hose and shoes. Mini-skirts or revealing necklines are not appropriate.  Tattoos should be covered.  Perfume should not be worn in a patient care setting.  Make-up should be kept light.  Shoes should be appropriate. Open toe shoes are prohibited. Appropriate hosiery or socks are to be worn at all times.  Dress slacks, dress blouses or tailored shirts are appropriate. Ties are required.

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Additional pins are limited to professional organizations only. (ie. AOA, AAO, COVD etc.) Industry-sponsored awards or logos are not appropriate. Cell phones should be turned off or placed on “silent” mode and will be limited to emergencies only during internal and external rotation hours. Appropriate clinical applications may be accessed to assist in patient care. Personal use during clinic encounters is inappropriate.

These guidelines are not all-inclusive. Students are expected to adhere to the spirit of the dress code. The Clinical Preceptor and/or the Assistant Dean of Clinical Affairs will make the final determination of whether a student is in compliance with these standards. An out of compliance student will be removed from patient care immediately, will receive a failing grade for the patient encounter, and can be referred for a professional ethics evaluation. Alcohol/Drug Policy and Procedures A Drug-Free Workplace and Substance Abuse Policy and Procedure has been established for Midwestern University in order to appropriately serve the needs of faculty, staff, and students. This policy has been established to implement a drug-free workplace and academic environment consistent with federal and state law, including the terms and conditions whereby employees, students, volunteers, faculty, physicians, and other professionals may be disciplined for violation of these policies and tested for suspected use of an illegal drug or alcohol. As part of the Drug-Free Workplace policy, entering students must sign and submit a statement to the Office of Student Services indicating they are drug-free and that they agree to abide by the Midwestern University’s Drug-Free Workplace and Substance Abuse Policy. The signing and submitting of this statement occurs as part of each new student’s Orientation Program the week prior to the onset of classes. The Dean of Students maintains these statements in the Office of Student Services. In addition, the Office of Student Services emails a copy of the current DrugFree and Substance Abuse Policy annually to all students for their review. Midwestern University maintains a drug-free environment consistent with the principles of the Federal Drug-Free Schools and Communities Act and the Drug-Free Workplace Act. All offers of employment and enrollment of students are conditional on students abiding by Midwestern University’s Drug-Free Workplace and Substance Abuse Policy. In addition, a student who is convicted of a state or federal offense involving the possession or sale of an illegal drug (a controlled substance as defined by the Controlled Substance Act and does not include alcohol and tobacco) that occurred while the student was enrolled in school and receiving Title IV aid, is not eligible for Title IV funds. For more detailed information concerning Title IV funds and convictions for the sale of illegal drugs see the Student Financial Services section of the catalog. The stated policies and procedures apply to all students of Midwestern University on campus, or at all facilities operated by the affiliated entities. The stated policies and procedures also apply to any student who is enrolled at another academic institution but rotating in a clinical service on the premises of a facility operated by MWU. The University reserves the right to evaluate any student if there is a reasonable cause to suspect that he/she is abusing or is under the influence of alcohol or illegal drugs/substances. A student is considered to be under the influence when his/her ability to perform usual tasks is diminished or impaired due to the apparent use of an illegal drug/substance, alcohol, or a combination thereof. Any student who attends a class or a

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clinical rotation under the influence of alcohol or who is suspected of abusing drugs will be required to undergo an immediate drug and/or alcohol screening in accordance with this policy. While the costs of these initial drug screenings are typically the responsibility of the appropriate college or the Office of the Dean of Students, transportation to an emergency room for those students who are exhibiting signs of physical/mental impairment will be the responsibility of the student. If a student is found to have a positive drug screen and he/she is taking prescription drugs, he/she will be asked to provide documentation to both the University and/or the Medical Review Officer in the form of either a physician’s or pharmacist’s name and phone number where they can be contacted for verification. If however, the student is found to have a positive drug screen without documentation of a legitimate prescription, he/she will be subjected to disciplinary action, which may include immediate suspension and/or medical leave. Although extreme cases may result in expulsion, it is the intention of Midwestern University to assist students with chemical dependencies by helping the student receive the appropriate counseling and treatment for his/her dependency. Criminal Background Checks Due to growing nationwide concerns regarding the suitability of today's health care providers, many hospitals, health care systems, clinics, physician offices, or pharmacies providing health care services require disclosure of an individual's criminal history. In addition, many state statutes also require disclosure of an individual's criminal history in order to apply for certain health professional certificates, registrations, and licenses. Existence of a criminal history may subject an individual to denial of an initial application for a certificate, registration, or license to practice in a clinical setting or result in the revocation or suspension of an existing certificate, registration, or license. In response to this growing trend, Midwestern University requires students to submit to criminal background checks. It is the policy of Midwestern University that all accepted students must submit to a criminal background check prior to matriculation. In addition, students who remain enrolled must submit to a criminal background check as needed to remain eligible for continued participation and/or to participate in clinical rotations. In accordance with the laws of the State of Illinois, CCOM students are required to undergo fingerprinting as part of the criminal background check process. Students in other programs may also be required to undergo fingerprinting. The criminal background check involves obtaining an authorization from a matriculating or current student that allows the University to obtain the student's individual criminal history. The results of the background check are reviewed by the Dean of Students to determine whether or not there is a record of misdemeanor and/or felony convictions. If there is a positive record, the Dean of Students will inform the appropriate Academic Dean and the Director of University Risk Management so the University can make a determination whether the criminal history will negatively impact the student's admission status or ability to complete the practical training/rotation requirements of the degree program.

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Criminal background checks are conducted through Student Services as part of the initial student matriculation process and on an as-needed basis thereafter while a student is actively enrolled at Midwestern University. 1. All matriculating students must complete the Criminal Background Release and Consent Form to conduct the criminal background check. All newly admitted students who have submitted a matriculation deposit are provided with access to a copy of the University policy and the Criminal Background Release and Consent Form. By going to the Midwestern University website (http://www.midwestern.edu) and selecting MWUNET, the student can find the Student Handbook and consent form. 2. The Office of Student Services will contract with a professional service to conduct the criminal background check. 3. The Dean of Students will review all criminal background reports and determine whether or not a misdemeanor or felony conviction record exists. If a felony or misdemeanor conviction exists, the Dean of Students will conduct a criminal background investigation. The investigation may include any of the following components: a. Request for additional detailed information about the positive criminal background check report. This may entail one or more meetings with the student. b. Collection of additional data, e.g., Federal Bureau of Investigation fingerprints and report, concerning the positive criminal background check report. Following the criminal background investigation, the Dean of Students, in consultation with the Academic Dean (or their designees), will determine whether or not the student should be disqualified from matriculation or continued enrollment. Criminal convictions will not automatically disqualify a student from enrollment or continued enrollment. The University will consider such factors as (but not limited to) the nature of the crime, the age of the individual at the time the crime was committed, length of time since the conviction, the nature of the clinical program and the relatedness of the conviction, and whether the University will be able to provide appropriate professional clinical training to the student. 4. Failure of the student to present appropriate forms to the Office of Student Services for the purpose of conducting criminal background checks when requested will bar the student from initial matriculation and/or continued enrollment. 5. Students with a positive criminal background check are individually responsible for checking the licensing and certification requirements in any state where the student is interested in participating in a preceptorship, internship, clinic or other rotation to determine whether or not their conviction may be a barrier to participation. 6. Students are required to disclose to the Dean of Students and appropriate Academic Dean any arrests, criminal charges, or convictions against them during their entire period of enrollment as a student at Midwestern University. Such arrests, criminal charges, or convictions may negatively impact a student's ability to obtain and/or complete clinical rotations or preceptorships. 7. Midwestern University does not guarantee clinical rotations for students who have a history of felony or misdemeanor charges/convictions. In such cases, the University confidentially shares information about the student’s positive criminal background

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history with potential preceptors and practice site representatives as necessary and on a need-to-know basis. This may include releasing a copy of the original Criminal Background Check report for their review. This gives the preceptor and site representatives an opportunity to decide whether the student is acceptable to the site. For this reason, scheduling and completion of practical training/rotations and graduation may be delayed. In some instances, it will not be possible to arrange for practical training/rotations at specific sites. a. If this information is known by the University prior to the student’s matriculation, the Dean of Students and/or Academic Dean (or their designee) will meet with the potential student to discuss the consequences of the positive criminal background investigation on the student’s ability to complete degree requirements so that appropriate action can be taken. b. If this information is known by the University after the student’s matriculation, the Dean of Students and/or Academic Dean (or their designee) will meet with the student to discuss the consequences of the positive criminal background investigation on the student’s ability to start/resume practical training/rotations and the student’s ability to graduate so that appropriate action can be taken. 8. Records concerning a student’s positive criminal background check are stored in a confidential file in the Student Services Office and Office of the Academic Dean. 9. In the event that a student is assigned to a practical training/rotation site that requires a copy of the original Criminal Background Check report prior to a student’s placement at the site, the student’s criminal background check report and cover letter will be scanned into an encrypted password protected PDF file. The encrypted PDF file will be forwarded via email to the rotation site coordinator.

Immunization Guidelines Midwestern University requires that all students submit documented laboratory proof of the absence of tuberculosis (updated yearly) and proof of immunization against measles, mumps, rubella, varicella (chicken pox), diphtheria/tetanus, annual influenza, and hepatitis B prior to matriculation (there may be some exceptions depending on the student’s particular program). In addition, depending on the program, students may be further required to prove the efficacy of their immunizations through blood titers, to measure the level of circulating antibodies associated with these various diseases. Depending on the program, students may also be required to submit to a drug screen. All students enrolled in clinical programs must also submit to a completed physical form, signed by a physician, indicating the student is medically cleared to be a student and to participate in clinical rotations. Cost for these requirements must be paid by the student. Titers and annual drug screens, however, can be built into the student’s financial aid budget. Any reimbursement from an insurance plan is a matter between the student and his/her insurance carrier. Cost and other information about immunizations/titers can be obtained from the Office of Student Services. All students are required to provide current documentation to the Office of Student Services of the following immunizations at least two weeks before a clinical rotation begins. Failure to

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comply with immunization requirements will result in cancellation of the assigned rotation, may cause extension of the student’s program of study, and may delay graduation. Vaccination or tests that must be completed:  Measles/Mumps/Rubella (MMR) o Measles: Two dates needed or documented disease and positive titer o Mumps: One date needed and positive titer o Rubella: One date needed and positive titer  Tetanus/Diphtheria: Must show proof within last 10 years  Tuberculosis (PPD) test: o Initial two-step PPD test with an annual one-step PPD test. If it has been greater than one year since the PPD test, the two-step test will be required. If student has a positive PPD test, this requires a chest X-ray and documentation annually that the student does not have active tuberculosis (TB).  Chickenpox (Varicella): positive titer  Hepatitis B vaccination: three dates needed and positive Hepatitis B Surface Antibody titer  Influenza vaccination: annual date needed  Other immunizations: may be required by external rotation site Students may contact the Office of Student Services (Phone: 623-572-3210, Fax: 623-572-3287) with questions regarding immunization requirements. Students should take all previous immunization records with them to the Office of Student Services so that all proof of immunizations can be recorded. A copy of current immunizations must be on file with the Office of Student Services in order to begin clinical rotations. The student should retain a copy to place in their records. An Immunization Compliance Letter can be downloaded and printed by students from their student portal. Preceptors can request a copy of the Immunization Compliance Letter from the Clinical Education Coordinator. Immunization compliance is monitored quarterly by the Clinical Education Coordinator. On-Line Pre-Rotation Training Students are required to complete the following self-instructional, self-paced, (or independent study) on-line training via Law Room before clinical experiences are assigned and renewed annually.  Universal Precautions Related to Blood borne Pathogens  HIPAA Privacy and Security  OSHA Regulations in Illness and Injury Prevention  Anti-Harassment and Discrimination Students will be provided with all necessary login information and instructions by the Clinical Education Coordinator. A record of the students who completed the training is kept on file in the Clinical Education Coordinator’s office. Failure to complete all requirements as requested by the Clinical Education Coordinator may result in cancellation of the clinical rotation causing the student to be placed on an extended track requiring a late graduation date as well as additional tuition fees.

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Special Requirements for Clinical Rotations Clinical rotation sites may have additional requirements such as, but not limited to: corporate online training, urine drug screens, additional health requirements, and fingerprinting. Students will be notified in advance so that these requirements can be completed before the clinical rotation starts. These costs will be at the student’s expense. Failure to complete all requirements may result in cancellation of the clinical rotation causing the student to be placed on an extended track, requiring a late graduation date as well as additional tuition and fee charges. CPR Training All students, prior to the start of the clinical program, must become certified in Basic Life Support for Healthcare Providers (CPR & AED). A copy of the student’s Healthcare Provider certification card must be submitted to the Clinical Education Coordinator before the student will be allowed to begin their clinical experiences. Contact the Clinical Education Coordinator if your certification will expire during your clinical rotation sequence. If the student does not have a current CPR card and does not complete CPR training when offered, the student must make his/her own arrangements at his/her own cost to become certified through the American Heart Association or another organization. Proof of certification must be submitted to the Clinical Education Coordinator at a minimum of one month prior to the start of both the third and fourth academic year. Liability Insurance Midwestern University provides liability insurance for all students enrolled in the clinical rotation program. This insurance covers students only when they are participating in the optometry practice experiences in the United States as a part of the curriculum to satisfy graduation requirements. Counseling Midwestern University provides confidential student counseling by an on-campus counselor to help students deal with a variety of non-academic and personal concerns. Short-term counseling is provided at no cost for all students who are currently enrolled in classes at Midwestern University. Students who present with long-term issues are referred to known off-campus specialists for assessment and treatment. All efforts are made to make referrals to providers on the student’s health insurance network so that the student does not incur additional costs. To preserve confidentiality, appointments are made directly with the Student Counselor (623572-3629). The counselor can be reached Monday through Friday during business hours to schedule an appointment; however accommodations in scheduling are flexible for student’s offcampus or on rotations. For those students who cannot be on-campus, the counselor can provide assistance via telephone. If a student is failing a rotation or not performing well, the student is highly encouraged to seek academic counseling from the Assistant Dean of Clinical Education, 623-806-7211, Associate Dean of Academic Affairs, 623-572-3941, or the Dean, 623-572-3901.

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Disability Statement or Medical Concerns If you require accommodation for reasons such as a disability, if you have emergency medical information (e.g. medication or food allergy), or if you need special arrangements in case the building must be evacuated, please notify the Office of the Dean of Students as well as the Clinical Education Coordinator. All requests for accommodations must be processed by the Midwestern University Dean of Students, following the guidelines outlined in the Midwestern University Student Handbook. Students should review any information regarding approved accommodations with their clinical preceptor on the first day of rotation. Compensation Students cannot receive payment, gifts, or rewards for any work for which they receive academic credit. There is no monetary compensation to students for participation in the external rotations. Students are responsible for all transportation, housing, food and any other personal expenses associated with their clinical rotations. In rare cases, site-specific housing may be provided for students. Travel and Lodging for Clinical Rotations It is the student’s responsibility to assure that he/she has made appropriate arrangements for lodging and transportation to/from clinical education/rotation/fieldwork sites throughout the curriculum. The University does not generally provide for the cost of transportation and lodging. Travel arrangements are the sole responsibility of the student. Students are not considered an agent or employee of the University and are not insured for any accidents or mishaps that may occur during any traveling that is done as part of the student’s professional program. Students are usually responsible for all expenses associated with clinical education, such as transportation, meals, housing, professional attire, laboratory fees, etc. Communications Internet access is available in the Eye Institute. Such Internet use is to be limited to professional communication and the student’s current practice-related tasks. Internet access for personal use is available on-campus, public libraries, and other local Wi-Fi locations. College faculty and administrators will use electronic means, in addition to regular mail, to communicate with students. This information may be important and/or time sensitive. Thus, the following are expectations of the College:  All students are required to check their University e-mail account on a daily basis. Official, “in writing” college and campus-wide communications are sent to students over e-mail. Students are responsible for information that is transmitted through this electronic medium (see Computer Code of Conduct in the MWU Student Handbook). The student University e-mail account is the only electronic mailing address recognized by the University. The University and its employees are not responsible for forwarding email to students at personal email accounts that are not held by the University. Information included in the student emails should follow the guidelines of appropriate professional conduct. (See Computer Code of Conduct and Appendix 4, Section 2, Subsections a and b under Grounds for Action: Academic and Professional Misconduct of the MWU Student Handbook).

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Lack of access to electronic communication is not a valid excuse for failure to respond to a request, perform an assignment, or meet a deadline.

Academic Honesty Academic honesty and integrity are expected of all students throughout their course of study at Midwestern University. Academic dishonesty is intentional cheating, fabrication, or plagiarism. It is also knowingly helping or attempting to help others be dishonest. Academic dishonesty lowers scholastic quality and defrauds those who will eventually depend upon your knowledge and integrity. Any violation of this code is considered to be a serious academic violation and may result in a reprimand, written warning, academic and/or disciplinary probation, suspension, or dismissal. Academic dishonesty constitutes a breach of academic integrity that violates the academic foundation of an institution and compromises the integrity and well-being of the educational program. The policies on students’ academic and professional responsibilities are included in the Appendices 1 through 4 of the Midwestern University Student Handbook. Professional Misconduct Violation of the policies, procedures and protocols of Midwestern University, the Arizona College of Optometry, or affiliated clinical rotation site constitutes academic or professional misconduct. Professional misconduct includes (but is not limited to) dishonesty involving any component of clinical care or patient records by alteration, fabrication, forgery of signatures; excessive unexcused absences; practicing optometry without a license; use of the clinic for financial gains, or receiving a fee for services rendered or materials ordered. Patient endangerment or abandonment also represents professional misconduct. Any form of professional misconduct is grounds for disciplinary action as outlined in the Midwestern University Student Handbook. Concerns Students and preceptors should contact the Assistant Director, Clinical Rotations to report verbally and/or in writing, violations of optometry rotation program policies. This includes alleged ethical and legal violations of the practice of optometry, alleged sexual harassment, verbal abuse, inappropriate and offensive physical contact and any form of discrimination. These types of incidents should be reported immediately. Immediate reporting of such incidents will allow the appropriate action to be taken in accordance with Midwestern University AZCOPT policies.

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Clinical Rotation Policies Student Schedule The internal rotation program goal is for each third year student to initially average 8 hours of patient contact per week and increase this to 16 hours per week by the second quarter of clinical experience. Early rotations may have less direct patient contact as the student’s abilities are being assessed and the student becomes familiar with clinic policies and procedures and patient care skills. As the student adapts to the clinical procedures and increases efficiency, the patient contact time will increase with sequential quarters. The first quarter of clinical experience for third year clinicians will allow for appointment slots of 2 hours, the second quarter will allow appointment slots of 1 hour and 45 minutes, the third quarter will allow appointment slots of 1 hour and 30 minutes, and the fourth quarter will allow appointment slots of 1 hour and 15 minutes. Fourth year students on rotation in the Eye Institute will be scheduled for 1 hour primary care appointment slots. One to three hour specialty care appointment slots will be scheduled for either third or fourth year student clinicians depending on the specialty service provided. Fourth year clinicians will be scheduled in the Eye Institute or its affiliated clinics to a 40-hour work week; each rotation will be scheduled for 12 weeks in length instead of the 10 week long rotation schedule of the third year student clinicians. Fourth year student clinicians are not limited to a 40-hour work week and may be assigned at all times that the Eye Institute is open. Student Clinician Attendance Policy Attendance is mandatory for all assigned clinic sessions. Students are responsible to report 15 minutes before the assigned clinic session starts. Students must remain in the assigned clinic (e.g., Primary Care, Contact Lens, Vision Rehabilitation, Pediatrics etc.) or classroom of the Eye Institute at all times until all patients have been examined and the attending doctor has released the student. In the Eye Institute the second floor classroom will be utilized for case presentations and class instruction. All possible consideration will be made to complete the clinical assignments within the business day. If the student needs to leave the clinic during their shift, the student must obtain permission from the clinical attending faculty and notify the reception desk of the student’s whereabouts. 

Excused Absence for a Personal Reason Make-up requirements for excused absences for a personal reason (i.e. illness, family issues) will be determined by the Course Director and or the Assistant Dean of Clinical Affairs while located at the Eye Institute. Make up requirements for excused absences while at an external rotation will be determined by the external rotation site preceptor. Failure to comply with any portion of the attendance policy or the process for requesting time-off will be considered an unexcused absence. An unexcused absence is grounds for a failure of a rotation Time off for these reasons is limited to a maximum of two days during the last academic year of the program.



Excused Absence for a Professional Reason Professional time is a benefit that fourth year students can use for activities that further their professional career (i.e., interviews for residency programs, attendance at professional meetings of scientific organizations, etc.) Fourth year students may be

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granted a maximum of six (6) professional days off during the last academic year of their program. In the case of an external rotation site closure or activity other than patient care, the external rotation site will notify in advance the Clinical Education Coordinator. AZCOPT students are required to take National Boards. Time off for National Boards is excused. Travel time to and from National Boards Part III is also excused, but this time must be approved by the Clinical Education Coordinator, the Assistant Director, Clinical Rotations, the external preceptor, and the office of the Dean. Approved time off for this purpose is applied to the six (6) professional days off during the last academic year of the program. Failure to comply with any portion of the attendance policy or the process for requesting time-off, will be considered an unexcused absence. An unexcused absence is grounds for a failure of a rotation. All excused absences must be reported to the Clinical Education Coordinator and appropriate Clinical Rotation Absence Forms completed and submitted. Part I: March and August Part II: December and April Part III: variable dates throughout the year State Law: varies by state 

For those that are rotating through the Eye Institute at the time of the National Board Exams the day before the National Boards exam may be excused for first time test takers.

. Jury Duty If any 3rd or 4th year student receives their first summons for jury duty, the AZCOPT Clinical Course Director or Clinical Education Coordinator recommends that students first postpone their summons online as indicated on the letter received from the court. If students get a second summons, they should bring the summons to the Office of Student Services. The Office of Student Services will write a letter for the student, asking for a delay in jury duty. The next time a student receives a summons, a letter cannot be written and the student should appear for jury duty. The student should inform the court that selection would result in hardship. An absence for jury duty needs to be documented, and a copy of the summons given to the Clinical Education Coordinator prior to the duty date. Maternity Leave / Prolonged Illness Policy Enrolled students who become pregnant can request a leave of absence for maternity reasons. The request must be in writing and sent to the Dean; however, prior to officially requesting a maternity leave, pregnant students must contact the Office of the Dean to discuss how the leave will affect their progress in the academic program and review options available to them. The amount of leave time granted depends largely on the personal needs of the student and the timing of the birth within the academic program. In addition, students must inform the Office of the Dean of their intentions to return to classes at least one month prior to the end of the leave of absence period. A final decision is reached after careful consideration is given to the personal and professional circumstances.

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For maternity or illness reasons, if more than ten clinic days (not to exceed 80 hours of clinic time), of assigned clinic time during an OD-3 or OD-4 rotation block is missed, the rotation will be cancelled and the student will be rescheduled for a replacement rotation at the start of the next regularly scheduled rotation block. Rotation rescheduling to the same site/ clinic as previously assigned cannot be guaranteed. As a result of the rescheduling, the student’s completion of graduation requirements will be delayed and the student may not qualify to participate in the graduation ceremony for his/her class. No exceptions will be made to this policy. Process for Requesting Planned Time Off in Advance Requests for days off are often approved on a first come, first serve basis. The following process of taking time off must be followed and it is possible that at any point in this process your request may be denied at the discretion of the College. A Request for Clinical Rotation Absence form must be submitted by the student a minimum of 2 weeks in advance of the date of absence and approved by the following individuals in the following order: Eye Institute rotation: 1. The Preceptor for approval 2. The Clinical Education Coordinator for approval The student must be signed out of the clinical assignment to be missed and signed in to the make-up clinic assignment (if required). (Copies of supporting documentation of invitations or conference date times etc. may be requested at this time). 3. The Clinic Manager for approval and to make the appropriate adjustments to the clinic schedule 4. The Assistant Director, Clinical Rotations for approval 5. The Office of the Dean for final signature and approval External Rotations: 1. The Clinical Education Coordinator for approval The student must be signed out of the clinical assignment to be missed and signed in to the make-up clinic assignment (if required). (Copies of supporting documentation of invitations or conference date times etc. may be requested at this time). 2. To the Assistant Director, Clinical Rotations for approval 3. The external rotation preceptor for final approval. The external rotation preceptor can deny any absence request, regardless if approved by the College. 4. The Office of the Dean for final signature and approval NOTE: At any point in this process the approval can be denied if just cause is determined. Flight reservations, professional conference or meeting documentation may be requested from the student at any time during this process. It is suggested that the student obtain approval before purchasing any tickets for transportation and payment of any meeting registrations fees. Midwestern University is not responsible for any cancellation fees for reservations that are made prior to approval being given.

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Non-Planned Absence due to Personal Illness or Family Emergencies If unforeseen circumstances make an absence necessary, such as illness or accident, the student must notify the preceptor or designated contact if out on external rotations. The Assistant Director, Clinical Rotations and/or the Assistant Dean of Clinical Affairs should be notified at the earliest possible opportunity. If the student is currently at the Eye Institute they must contact the Clinical Educational Coordinator and the Clinic Manager. by 8:00 am of the assigned clinic day. Failure to notify the Clinic Manager and/or the Clinical Education Coordinator will result in an unexcused absence for the day. An absence not reported to the appropriate contact will be considered an unexcused absence and may result in rotation failure. The clinical make-up time will be scheduled with a one-to-one ratio if a doctor’s note or verifying documentation is provided on the day of the student’s return; otherwise the absence is considered unexcused and will result in a two-for-one make-up.

Off Campus Activities Any students seeking permission to attend an off-campus conference or program must be in good academic and professional standing. Midwestern University approved student organizations must seek and be granted permission from the appropriate college dean or program/division director to send student representatives to an off-campus activity. This written request (usually made by the president of the organization) must be made at least one month prior to the activity. Students who desire to attend an approved off-campus activity must submit a Request for Clinical Rotation Absence form and supporting documentation to the Clinical Education Coordinator. Once the Clinical Education Coordinator has approved the absence request, the form will be submitted to the course director and/or the Assistant Director, Clinical Rotations, to the student’s preceptor(s), then to the Assistant Dean of Clinical Affairs for final approval and filing. Approved and completed forms, along with supporting documentation are to be submitted to the Clinical Education Coordinator at a minimum of two weeks prior to the scheduled absence dates. Students in both the Eye Institute and external site rotations need to follow these guidelines for an excused absence. Students attending off-campus conferences or events must take full responsibility for making up any missed clinic, classes, laboratories, examinations, or other course assignments. The Request for Clinical Rotation Absence form may be obtained from the Office of the Dean, RMS, or the Clinical Education Coordinator. Requesting Schedule Changes Generally schedule changes are not allowed for Third or Fourth year students. If there are extraordinary circumstances, requests can be made to the Clinical Education Coordinator, Assistant Director, Clinical Rotations or the Assistant Dean of Clinical Affairs. Such requests will be considered on a case-by-case basis. Clinic schedules may not be traded with other students.

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Externship Failure (refers to OPTO 1800, 1810, 1820, and 1830 Clinical Services XI-XIV) Externships are completed sequentially. If a student receives an “F/WF” in an externship he/she may appeal the failing grade, in writing to the course director. This must be done within 3 calendar days after the grade is posted. In this case the course director will review the premise of the failure and the college policies regarding course failures. After consideration of the circumstances of the “F/WF”, the course director will either accept or reject the appeal and must inform the student, in writing, within 5 working days of this decision. If the appeal is accepted the course director may place the student on an individualized education plan (IEP) under the direction of the course director and require that the student take coursework. The course director’s options are not limited to the above and can be modified on a case-by-case basis. If the course director decides to uphold the “F/WF”, the matter will be forwarded to the Status Promotion Graduation Committee who may exercise any combination of the following sequence: a. b. c. d.

Place the student in an extended program, if eligible; Put the student on a leave of absence to undergo a period of independent study; Require the student to repeat the failed externship rotation; or Be dismissed from the program

If a student receives an “F/WF” in an externship he/she may also petition the course director, in writing, to retake the same type of externship, if available. This petition must be filed within 3 working days of the failing grade being posted. The timing of any reassignment will be as early as possible once the student has satisfied the committee’s requirements or concurrent completion with reassignment and is subject to availability of sites as determined by the College. The reassignment, if granted, must be completed within 12 calendar months of the date the petition is received by the course director. If the student does not successfully complete the assigned options or receives an “F/WF” in the reassigned or repeated externship he/she will be dismissed from the program. Students are allowed only one failed or withdrawn failed externship, and only one retake of the failed or withdrawn failed externship while enrolled at the college. Clinical Education Remediation Policy The Arizona College of Optometry clinical education remediation policy is based on the following concept: Clinical education is an interactive process and successful clinical performance requires the full participation of the student. A student who has difficulty in areas of clinical performance (that have been identified by low scores on the grading form or by observation of clinical skills) is expected to seek help, to identify and understand the problem, and to take an active role in correcting it. Faculty and preceptors may provide intense supervision at the student’s request; ultimately, however, the success of remediation depends on the student. Specifically if a clinical attending/external preceptor notifies the college of concerns or failure of the performance of a student clinician and there are documented deficiencies in expected competencies, remediation in the form of an individual education plan (IEP) may be created to assist the student in the documented deficiencies. The individual education plan will be developed and implemented by the Assistant Director, Clinical Rotations in concert with the

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Assistant Dean of Clinical Affairs at the request of any clinical attending faculty and/or if failure of the student is reported at midterm evaluations. The IEP will be constructed to the following format: 1. Clearly identify the area(s) of deficiency 2. Outlines activities to enhance the student’s clinical understanding and skills related to the area(s) of deficiency Student clinicians may be suspended from direct patient care if patient safety is an identified risk. This would be considered a failure of the rotation and dealt with according to Midwestern University Policies. It is up to the student to work towards the set goals. Re-assessment will be made during the rest of the quarter but ultimately the final grade will determine if the student has successfully passed the rotation. Although maximum effort may be exerted by the student in the event of a potential failure, this does not guarantee a passing grade. The student’s expectations of themselves as well as the attending’s expectations will be higher at the final than the midterm and it is possible that the effort may not be enough to have achieved a final passing grade. Extended Program Problems may arise that may necessitate the deceleration of a student’s academic course load. Accordingly, an individual’s academic course load may be reduced so that the student enters what is termed an extended program or split academic course of study. Such a program rearranges the course schedule so that the normal time period for the program is extended, usually by one additional year. Only enrolled students may enter an extended program. To enter an extended program, either one or both of the following conditions must be met: 1. Personal hardship. If a student is experiencing unusual stresses in life and an extended academic load could alleviate added stress, the student may petition the College for an extended program. This petition must be submitted to the Dean or Associate Dean of Academic Affairs and may not be automatically granted but may be approved in exceptional circumstances. The Dean, Associate Dean, and the Assistant Dean are responsible for reviewing and assessing the petition and may forward to the Student Promotion and Graduation Committee if appropriate. The student will be informed of the decision, in writing, by the Associate Dean of Academic Affairs. 2. Academic. As described above, a student ending an academic year with an annual GPA of less than 2.0 may be given the option to repeat courses from that year in which “F” grades were received. A student may be placed on an extended program for academic reasons at the discretion of the Student Promotion and Graduation Committee. A student placed on an extended program for academic reasons is automatically placed on academic probation and may not be returned to good academic standing until the extended program is completed.

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If a student is placed on an extended program, such action does not modify or limit the committee’s actions for dismissal. Thus, the student may be dismissed for academic reasons while on an extended program. A student placed on an extended program for academic reasons will be returned to good academic standing when he/she reenters the prescribed academic program and completes all courses that were unsatisfactory and are required for graduation. A reentering student must achieve a cumulative grade point average of 2.00 at the end of each quarter to continue at the college. A student is allowed to go through an extended program only once. Grade Appeals Policy a) Appeal of Non-Failing Course Grades A student who wishes to appeal a non-failing course grade must make the appeal to the course director within one week following the receipt of the grade. The course director must act upon the student’s appeal within one week following the receipt of that appeal. A narrative explaining the basis of the appeal must accompany the request. An appeal must be based on one of the following premises:  Factual errors in course assessment tools  Mathematical error in calculating the final grade  Bias If the appeal is denied, the student has the right to appeal the decision to the course director’s immediate supervisor within one week of receipt of the course director’s denial. The course director’s supervisor should notify the student of his/her decision within one week following receipt of the student’s re-appeal. The decision of the course director’s supervisor is final. b) Appeal of Course Grades Subject to Academic Review A student whose academic progress will be subject to review by the Student Promotion and Graduation Committee and who wishes to appeal a grade must do so in an expedited manner prior to the scheduled meeting of the Committee. In this case, an appeal of a course grade must be submitted within 24 hours following receipt of the grade and must be based on one of the premises stated above. The course director must act on this appeal within 24 hours. Any appeal of this decision will be addressed by the course director’s supervisor. An appeal of a failing clinical rotation grade must be submitted within one week after a grade for rotation is posted. The course director must act on this appeal within one week of receipt of the grade appeal. Any appeal of this decision will be addressed by the course director’s supervisor. The student is responsible for notifying the chair of the Student Promotion and Graduation Committee that a grade appeal has been filed prior to the meeting of the Committee. All appeals and decisions must be communicated in written form.

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Dismissal or Removal from Clinical Rotation Sites Establishing clinical rotation sites, whether local or remote, requires a great deal of time and effort. The College and the site must maintain a mutually beneficial partnership. Students are required to meet and maintain the highest professional standards. Under certain circumstances, the Assistant Director, Clinical Rotations (for External Sites) reserves the right to cancel its obligation to provide a rotation assignment for students who exhibit unprofessional behaviors as defined by the Midwestern University Student Handbook. This includes, but is not limited to, any student who steals any assets, property and/or drugs from any participating facility will be denied the privilege of participation in the rotation. Students recognized as being under the influence of any drug substance for non-medical purposes while on a clinical rotation may also lose their participation privilege. Such breaches will result in appropriate disciplinary actions. Preceptors may request the student’s removal from patient care regardless of the location, if it has been determined that the student is potentially harmful to patient care, incompetent, behaving inappropriately, and/or exhibiting academic or professional misconduct. If the student violates any of the policies or procedures of the rotation site or the College, does not clear the background check, does not provide proof of proper immunizations, does not pass a drug screen, or fails to meet other necessary requirements, the student may have their rotation assignment cancelled. If a student is removed from a clinical rotation or dismissed by the preceptor at the site or by the Assistant Director, Clinical Rotations, the student will not be placed at another external clinical site for that rotation block, will receive a failing grade, and will be subject to further review and action by the College Student Promotion and Graduation Committee (SPGC), and/or the Assistant Dean of Clinical Affairs. The purpose of this policy is to ensure patient’s safety, honor the privilege of participating in the practice site, protect and support the preceptor, and maintain the College’s reputation. Student conduct is expected to be exemplary at all times. It is considered unprofessional conduct if the student were to argue, beg and or plead in the event of a failing grade, and/or removal from a rotation. In the event that this happens, please contact the Assistant Director, Clinical Rotations immediately.

Clinical Rotation Requirements Scope of Clinical Experiences Students want and need to be exposed to as many full-scope primary care clinical experiences as possible. In addition, patient encounters in specialty areas such as contact lenses, ocular prosthetics, pediatrics, low vision, ocular disease, geriatrics, electro-diagnosis and vision therapy are beneficial and will be available within the Eye Institute. If specific categories of patients are not available in the Eye Institute, the student may experience some of these special encounters at AZCOPT affiliated clinical sites or when on their external rotations.

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Practice Management One of the identified shortcomings of traditional optometric education is the lack of adequate training in optometric practice management. With this in mind, the students should be exposed to as much clinical practice management as possible within the Eye Institute and at each external rotation site. The appointment scheduling process, patient flow within the clinic, billing and coding, and staff management are all important aspects of optometric practice. The student should gain exposure to all aspects of daily operations. Students should be encouraged to take advantage of this time and these opportunities. Professional Portfolio Students are required to have their updated Professional Portfolio readily available at all times during clinical rotations. This should be shared with the preceptor at the beginning of the clinical rotation. Failure to adhere to this program requirement will be handled on a case-by-case basis. Students completing out-of-state clinical rotations in their fourth professional year may be required, at their expense, to mail updates of their Professional Portfolio to the Clinical Education Coordinator or Assistant Director, Clinical Rotations upon request. Professional Portfolio Requirements Prior to Start of Clinical Rotations (Place all information in Portfolio in this order)         

Updated Curriculum Vitae Student’s Goals and Expectations (Career Goals and Rotation Goals) Emergency Contact Information Immunization Record (Obtained from Clinical Education Coordinator) CPR Certification Documentation Annual Universal Precautions Related to Blood borne Pathogens Certificate Annual HIPAA Privacy and Security Certificate Annual OSHA Regulations in Illness and Injury Prevention Certificate Health Insurance Coverage and Copy of Health Insurance Card

General Timeline of External Rotations Requirements PRIOR TO START OF ROTATION  Contact preceptor at least 2-6 weeks before the start of the external rotation. If unable to contact them for any reason, contact the Clinical Education Coordinator immediately.  Update CV and other documents for current portfolio. WEEKS 1 through 3  Site orientation  Familiarize self with site’s policies and procedures  Review portfolio with preceptor  Set goals and expectations (for student and preceptor)  Complete Patient Activity Log WEEKS 4 through 7

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 

Mid-Rotation evaluation completed and reviewed with the student Complete Patient Activity Log

WEEKS 8-11  Review with preceptor a plan to complete any remaining work for the rotation  Complete Patient Activity Log WEEK 12  Final evaluation to be completed by preceptor and reviewed with student  Complete Patient Activity and anonymous and confidential Student Evaluation of the Site and Preceptor (if not completed after 3 calendar days of the end date of the rotation an incomplete will be given).

External Rotation Site Selection    



 

 

Students will identify external rotation site preferences from a list of AZCOPT-affiliated sites provided by the Clinical Education Coordinator. Students will be required to rotate through at least one disease designated rotation site. This includes a Veteran’s Affairs Hopsital, Indian Health Service and Bascom Palmer. To prevent conflicts of interest, the student will not be allowed to complete an external rotation with a family member, current/former partner, friend, or colleague. Students are not permitted to complete external rotations at sites where he/she is currently and/or has previously been employed, unless the rotation experience is determined to be different educationally. The Assistant Director, Clinical Rotations will review requests and finalize rotation schedules on an individual basis. Final external rotation assignments are at the discretion of the Assistant Director, Clinical Rotations, and if needed, the Assistant Dean of Clinical Affairs, following review of student site preferences, professional experience, considerations of site characteristics, College commitments to the site and rotation site availability. External rotations will be completed at AZCOPT-affiliated sites. The student is responsible for any financial costs incurred for travel and housing during the external rotation program. Once the external rotations schedules are finalized, students may not drop, change, or cancel rotations unless the student demonstrates that an extreme hardship exists, and the change in rotation assignment is approved by the Assistant Director, Clinical Rotations and the Assistant Dean of Clinical Affairs. In the case of a rotation reassignment, the student may have a delayed start that requires a later graduation date as well as additional tuition and fee charges. In unforeseen circumstances, a rotation site may become unavailable and necessitate a change in the student’s schedule. In these instances, the Assistant Director, Clinical Rotations will handle all reassignments. Students are not to make arrangements or travel plans that affect rotation schedules before receiving permission from their assigned preceptors.

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The student is not allowed to at any point contact a site on their own without the proper permission to try and change their rotation assignments or obtain a new assignment in the event their original site got canceled. This is considered unprofessional conduct and could be subject to disciplinary action or a failing course grade due to poor professional conduct.

O.D.-3 Rotation Specific Information AZCOPT OD-3 Rotation Schedule 2014-2015 OPTO 1770 Clinical Services VII, Summer Quarter (June 2- August 8, 2014) OPTO 1771 Clinical Services VIII, Fall Quarter (August 25- October 31, 2014) OPTO 1772 Clinical Services IX, Winter Quarter (December 1, 2014- February 20, 2015) OPTO 1773 Clinical Services X, Spring Quarter (March 9- May 15, 201) Midwestern University Holidays The student will be scheduled according to the regular work day and holiday schedule of the MWU Eye Institute site. The following are Midwestern University holidays observed at the Eye Institute:         

Independence Day-July 4, 2014 Labor Day-September 1, 2014 Thanksgiving Holidays-November 27-28, 2014 Christmas Eve-December 24, 2014 Christmas Holidays-December 25-26, 2014 New Year’s Eve-December 31, 2014 New Year’s Day-January 1, 2015 Martin Luther King, Jr. Day-January 19, 2015 Memorial Day- May 15, 2015

O.D.-4 Rotation Specific Information AZCOPT OD-4 Rotation Schedule 2014-2015 Kenneth A. Suarez Annual Research Day - Capstone Poster Presentation – TBD Rotation 1-OPTO 1800, Summer Quarter (May 26 – August 13, 2014) Rotation 2-OPTO 1810, Fall Quarter (August 18 – November 3, 2014) Rotation 3-OPTO 1820, Winter Quarter (November 10 – February 18, 2015) Rotation 4-OPTO 1830, Spring Quarter (February 23 – May 15, 2015) Clinic Make-up: All clinic days after May 15, 2015 Midwestern University Holidays The student will be scheduled according to the regular work day and holiday schedule of the external rotation site. The following are Midwestern University holidays (no classes held), but the external rotation site preceptor is not obligated to observe this schedule:

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        

Independence Day-July 4, 2014 Labor Day-September 1, 2014 Thanksgiving Holidays-November 27-28, 2014 Christmas Eve-December 24, 2014 Christmas Holidays-December 25-26, 2014 New Year’s Eve-December 31, 2014 New Year’s Day-January 1, 2015 Martin Luther King, Jr. Day-January 19, 2015 Memorial Day- May 15, 2015

Class of 2014 Pre-Graduation Activities Students are required to attend mandatory activities on campus prior to graduation on May 28, 2015. More information regarding dates and schedules as well as the financial aid exit interviews, AZCOPT focus groups, AZCOPT Student Survey, Post-AZCOPT student survey, and AZCOPT lectures and debriefings at a later date. Class of 2014 Graduation Students will graduate at Midwestern University campus in Glendale, Arizona on May 28, 2015

Overview of Rotation Requirements for Third- and Fourth-Year Students Clinical experiential sequences will vary depending upon the availability of affiliated external rotation sites, students’ preferences for rotation assignments, and the rotation schedule determined by the Office of the AZCOPT Assistant Dean of Clinical Affairs. Each student is expected to complete four consecutive quarters of study during each of the last two professional years. 1. Course Description The Rotation Program consists of fourth-year optometry students being assigned to rotation sites. The purpose of these rotations is to provide the student the opportunity to be mentored and taught by outstanding practitioners in primary and/or secondary care optometry settings. The Rotation Program is an essential and integral part of the curriculum, designed to contribute to the transformation of students into complete health care professionals who can apply scientific knowledge and clinical abilities for the benefit of patients. The student is expected to participate in patient care under the instruction and guidance of Faculty, according to the highest standards of clinical, moral and ethical conduct. 2. Educational Objectives It is expected that students’ cognitive, technical and analytical skills will continuously improve over the fourth-year experience. It is expected that their knowledge base will be broadened and deepened during the external rotations, and that interpersonal skills,

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attitudes and values will improve throughout the process. AZCOPT graduates are expected to have achieved entry-level competence that allows them to independently manage the most common eye and vision care needs of patients accurately and efficiently. Graduates are expected to manage conditions that may be outside entry-level competence through effective utilization of appropriate referral or consultation. In addition, the externship experience is intended to provide opportunities for students to interact within a practice or other health care institution in a manner that furthers their ability to establish themselves in a setting that is conducive to the provision of excellent services to patients and results in a satisfying and successful professional career. 3. OD Daily Patient Encounter Log The OD Daily Patient Encounter Log is to be completed daily during each quarter of internal and external rotations. This is part of a total patient care requirement necessary for graduation as well as accreditation purposes. These logs represent the minimum number of patient encounters required during the extern’s clinical education. Demographics such as age, race and gender for each patient will be logged. In addition Patient encounters are to be logged into the following areas: Exam Type:

Primary Care Contact Lenses/Prosthetics Ocular Disease Peds/Binocular Vision Vision Therapy Low Vision Specialty Testing Optical/Dispensing Vision Screening Observation Follow-up

Diagnosis:

Refractive Error Anterior Segment Disease Posterior Segment Disease Glaucoma Neurologic Disorder Binocular Vision Disorder Diabetes Hypertension

Example: If a student sees a patient for a routine primary care exam that also wears contact lenses, the student will mark: primary care and contact lenses as the exam type. If this same patient also has diabetes and hypertension along with corneal scars from previous overuse of contacts, the student will mark: refractive error, anterior segment disease, diabetes, and hypertension in the diagnosis box. All Logs will be reviewed by the Clinical Education Coordinator and/or the Assistant Director, Clinical Rotations. Third year students must complete their logs daily or at a minimum within 24 hours of the encounter or they will not receive a grade for the encounters of that day. Fourth year students have 3 calendar days to accurately complete the log from the last day of the rotation; if the log has not been accurately completed during that time, the course director will post an “I” for incomplete as the final grade. All incomplete grades must be resolved within 10 calendar days starting from the last day of the external rotation for the quarter. If an incomplete grade remains beyond the 10 calendar days, it is automatically converted to a grade of “F” by the Registrar, which signifies failure of the course. This will be dealt with like all other failing course grades according to Midwestern University policies.

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4. Third Year Patient Evaluation Form During the third professional year the students will receive evaluations on every patient encounter. The Patient Evaluation Form for the third year student clinical experience will be completed after each patient care experience by the attending clinical faculty. This is completed on-line in the Meditrek system and should be completed within 24 hours of the patient encounter.

5. Fourth Year Evaluation Form With support from the Assistant Director, Clinical Rotations as required, preceptors must evaluate student performance at a minimum at the midpoint and end of each rotation, identify strengths and weaknesses and provide learning opportunities to ensure student development in the established competency areas. Constructive and regular feedback to the student is a critical element in ensuring appropriate student development. If a preceptor is away on vacation or will otherwise be unavailable to complete the final evaluation, the preceptor or site should notify the Assistant Director, Clinical Rotations of the situation immediately. It is very important that preceptors contact the Assistant Director, Clinical Rotations with any concerns regarding a student in any area, as documentation is required from the University to substantiate a poor performer or any course failure.

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SAFETY PROCEDURES FOR THE EYE INSTITUTE MWU Emergency Response Plan The Emergency Response Plan for the Arizona Campus of Midwestern University is available on the homepage: http://mwunet.midwestern.edu/administrative/ERT/documents/Emergency%20Response%20pla n%201-12.doc

MWU Emergency Response Team MWU recognizes that critical incidents affecting students, faculty, and staff will occur and can have a significant effect on individual students, faculty, and staff, their families, and the University community. To plan for and respond to these situations, MWU has created the Emergency Response Team (ERT). Midwestern University ERT Members Erik Carroll Christina Taylor Kathy Dooley Ron Enos Bill Frantz Scott Shuman Ross Kosinski, PhD Vladimir Yevseyenkov, OD, PhD Shannon Sesterhenn, PhD Nicole Chavez Karen Mattox James Pashayan, DDS, MAEd

x3326 x3772 x3346 x3270 x3316 x3945 x3329 x7206 x3357 x6351 x3310 x7011

Information Technology Services Human Resources Media Resources Safety & Security Campus Facilities Risk Management Student Services Eye Institute Student Services Multispecialty Clinic Communications Dental Clinic

Eye Institute Emergency Response Plan In the case of an emergency call 911, and then Safety & Security at x3201.

Protocol for AED and CPR To assist in a medical emergency, first aid kits are located on the first floor in the administration suite and second floor in the pharmacy room. An automated external defibrillator (AED) is located on the first and second floor of the Eye Institute adjacent to the restrooms. Automatic External Defibrillators (AED) can save a life during a medical emergency. The AED device talks the provider through a process of evaluating a patient for, attaching the patient to, and activating the AED therapy. The University provides CPR and AED training on a regular basis. Additionally, an AED/CPR quick reference guide can be found on the home page: http://mwunet.midwestern.edu/administrative/ERT/CPR_AED.htm

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Location of Emergency/Courtesy Phones There are three colors of emergency/courtesy phones available throughout campus. All of the phones connect you directly to Safety & Security in the Welcome Center. RED: Emergency Phones in campus buildings, typically seen near the building exits BLUE: Courtesy Phones in parking lots, parking structures and along sidewalks on campus YELLOW: Courtesy Phones in student housing If you see an emergency, or if you need a walk to your car at night, observe suspicious behavior, find a lost wallet, have a flat tire, need a locksmith resource to call, etc., use these phones. All emergency/courtesy phones are tested monthly and calls are logged at the Welcome Center. If you see a phone that has been damaged, please report it to Safety & Security x3201 immediately.

General Disaster Procedures Weather Safety In the event of a weather or lock down emergency, you will be instructed to assemble in a safer area inside your building if needed. Move to that area quickly and wait for further information. Gathering locations for the Eye Institute during storm situations are the vision rehabilitation suite and the vision training room on the first floor of the Eye Institute. Fire Safety The campus is equipped with a city-approved fire protection and alert system. If there is a fire in your building, calmly find the nearest “Zone Fire Alarm Pull Station” and pull to alert Security, the Fire Department, and all other occupants of the building. In addition to the audible alarm buzzer, the alarms are also equipped with visual strobe laser lights to assist evacuees to find the closest exit from the building. The moment the Fire Pull Stations are activated, the call is sent directly to the Fire Department, but it may also be beneficial to have additional people call 911. In the event of a fire alert, and/or fire drills, everyone in the building or area is to evacuate immediately in a quick, safe, and orderly manner. Be observant for signals that the alarm was pulled for reasons other than a fire. As a general rule, please evacuate to the parking lots furthest away as possible, or in an open area as far away from the building as possible. Avoid driveways and keep clear of the fire lanes. The full cooperation of faculty and staff during evacuation is required. Faculty are charged with final search and security of their assigned work area. The Clinic Manager is charged with final search and security of the optical area, reception and lobby area. Any employee who fails to evacuate during a fire alarm will be subject to action by MWU and local authorities. After arriving in your assigned area, make sure everyone is accounted for from your department. If someone is missing, report that person to a security officer or member of the emergency response team. Safety & Security and Campus Facilities will take responsibility to assure that everyone is evacuated.

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Specific Evacuation Routes from the Second Floor: The “A” and “B” examination pods on the south side and classroom occupants will evacuate through the exterior stair on the south side of the building to the parking garage or surface parking adjacent to the multispecialty building. The “C” and “D” examination pods on the north side of the building and occupants of the specialized testing area will evacuate through the north exterior stairway to the far north end of the tranquility garden.

Specific Evacuation Routes from the First Floor: Occupants of the optical, reception area, lobby, billing office and administrative suite will exit through the front entrance to the parking garage. Occupants of the first floor north pod, conference room and the surgical suite will exit through the north exterior doorway to the tranquility garden. Occupants of the visual rehabilitation suite, vision training area, pediatric examination area and sport vision area will exit through the south exterior door to the parking area. Violence or Suspicious Behavior If someone on campus becomes violent or appears suspicious, call Security immediately at x3201 and get everyone out of the area. If you observe a change in behavior in a co-worker, such as a marked increase in stress or agitation, that causes you concern please call Human Resources at x3208. If you are uneasy about the behavior or emotional state of a student, please contact the Office of Student Services at x3210. If there is an unexpected threat to the health or safety of our students and employees, take the following steps to lock down the campus. Lock Down Instructions  Call 911 if you discover a threat, and if possible, call Campus Safety and Security at 623572-3201. Additionally, there is a panic button located at the patient services desk in the reception area of the Eye Institute, and also worn by the clinic manager. All faculty and staff of the Eye Institute will receive instructions on its appropriate use during their orientation to the building. o Notify those around you as quickly as possible. o Do not attempt to engage the perpetrator(s) 

Move to a location within the building that has a lockable door and lock it; or o Use a door wedge to secure door from inside o Stack furniture in front of the door



Hide, get out of sight o Get away from windows, doors, outer walls o Crouch down in areas that are out of sight o Close, cover or lock if possible all windows



Be quiet, remain calm and do not draw attention to yourself o Turn off audio equipment o Put cell phone on vibrate

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o Listen carefully for instructions broadcasted via the internal/external emergency broadcast system 

During a “lockdown”, do not exit the building if a fire alarm sounds unless o You have reason to believe that there really is a fire in the building o You have been advised by a recognized emergency responder to evacuate



Do not exit the building unless Campus Safety and Security or other recognizable law enforcement has given the “all clear”



What to do if caught outside between buildings o Hide-find cover o Run-get away from area o Fight-as a last option, very dangerous and not recommended o If caught-do not fight back, obey all commands and avoid eye contact

Bomb Threat or Suspicious Objects Everyone in the building or area is to evacuate immediately in a quick, safe, and orderly manner. As a general rule, please evacuate to the parking lots furthest away as possible, or in an open area as far away from the building as possible. Avoid driveways and keep clear of the fire lanes. The full cooperation of faculty and staff during evacuation is required. Follow the evacuation routes described above. Any employee who fails to evacuate during a fire alarm will be subject to action by MWU and local authorities. After arriving in your assigned area, make sure everyone is accounted for from your department. If someone is missing, report that person to a Security officer or member of the ERT. Safety & Security and Campus Facilities will take responsibility to assure that everyone is evacuated. Emergency Call 911 and x3201 MWU Safety & Security: 623/572-3201 Campus Facilities: 623/572-3307 Employee Assistance Program: 1-800/554-6931 Suicidal Thoughts Impact (24-hour line): 480/784-1500 Student Counselor: 623/572-3629 Student Services: 623/572-3210 Human Resources: 623/572-3263 Media Relations: 623/572-3400 (President’s Office) 623/572-3291 (Vice President of University Relations) 623/572-3310 (Manager of Communications)

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Universal Precautions and Exposure Control Plan The following exposure control plan is the Occupational Safety and Health Administration Standard; it is adopted without change. Introduction On December 6, 1991, the Occupational Safety and Health Administration (OSHA) promulgated a final rule entitled “Occupational Exposure to Blood Borne Pathogens”. The purpose of the standard is to eliminate or minimize occupational exposure to the Hepatitis B virus (HBV), the Hepatitis C virus (HCV), the Human Immunodeficiency Virus (HIV), and other blood borne pathogens. The risk of exposure to blood borne pathogens by optometry clinic personnel is low except as it pertains to the use of sharp items (i.e., needles). Situations may arise in which the risk of exposure is increased such as when a patient vomits or experiences a bloody nose, the examiner has breaks or cuts in the skin, or emergency first aid is administered. Even though most optometrists are not generally at high risk, an awareness of high risk situations, the mechanisms of exposure, the availability of personal protective equipment, and what to do if exposure occurs, among other issues, is imperative. Definition of Exposure Incident An exposure incident occurs when a person has contact with potentially infectious materials that can cause the transmission of disease. The three recognized modes of workplace transmission of blood borne pathogens that require medical treatment are: 1. Parenteral Exposure: Piercing, puncturing or cutting the skin with potentiallycontaminated sharp items. Examples include needle sticks, human bites, or cuts with broken glass. 2. Exposure to Non-Intact Skin: Contact of potentially infectious material with existing cuts, rashes, abrasions or other breaks in the skin. 3. Mucous Membrane Exposure: Splashing or spraying of potentially infectious materials into unprotected eyes, nose or mouth. What to Do In the Event of an Exposure Incident Exposure incidents require written reporting and medical attention. The following protocol (Center for Disease Control document Exposure to Blood - What Health-Care Workers Need to Know) should be followed when an exposure incident occurs:     

Wash the exposed area immediately and thoroughly. Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Remove soaked clothing, wash skin and put on clean, dry clothing. No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of transmission of a blood borne pathogen. Using a caustic agent such as bleach is not recommended.

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Go to an emergency department for immediate care. The facilities located near the Eye Institute include: Arrowhead Community Hospital 18701 N 67th Ave, Glendale, AZ (623) 561-1000 Banner Thunderbird Medical Center 5555 W Thunderbird Rd, Glendale, AZ (602) 865-5555 John C Lincoln Deer Valley Hospital 19829 N 27th Ave, Phoenix, AZ (623) 879-6100

In the event of exposure to blood or body fluids, the following procedure shall be followed in the clinic in which exposure occurred  Wash the exposed area immediately and thoroughly. Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Remove soaked clothing, wash skin and put on clean, dry clothing. Do not use antiseptics or squeeze the wound as there is no scientific evidence that this limits exposure or risk.  Instruments that have been exposed to the blood or body fluids of anyone but the patient will be removed from the treatment area and discarded (if disposable) as a biohazard, or, if it is a multi-use device, the instrument will be returned for sterilization.  If the exposure occurs during the course of patient care, the patient is to be stabilized as quickly as possible. The exposed health care worker may arrange to have the procedure completed by another health care worker.  Supervising clinical faculty is to be notified in the case of a student exposure. In the case of staff, physician/health care provider, or visitor exposure, the nursing supervisor or medical director of the involved clinic is to be notified.  Working with the supervising clinical faculty and/or the nursing supervisor or clinic director, the exposure is discussed with the source patient or their legal guardian, and baseline testing will be requested.  The supervisory clinical faculty or clinic director will contact the MWU Multispecialty Clinic Family Medicine/Primary Care Clinic and discuss the exposure with a physician or physician assistant available in the clinic. In the event that no physician or physician assistant is available in the clinic, the on-call physician will be contacted for further recommendations. The following procedure will be followed in the MWU Multispecialty Clinic Family Medicine Clinic

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 

 

With MWU Multispecialty Clinic physician’s approval and orders, the exposed person and the source patient will proceed to the MWU Multispecialty Clinic for the blood work and consultation. The exposed person and the source patient will both be registered and fill out appropriate intake paperwork as patients of the MWU Multispecialty Clinic. The source patient will be asked to complete the attached questionnaire to assist in assessment of risk for an undiagnosed blood borne pathogen infection, and a standard release of information to allow release of the blood results to the exposed person. All documents created (including questionnaire, release of records, consent, and test results) will be filed in the MWU Multispecialty Clinic electronic health record (E H R) created for that individual. All E H R and scanned records will be handled by the standard HIPAA privacy protocol. The exposed person will be required to fill out a Quality Assurance Occurrence Report Form which will be kept in the Risk Management Office. The following laboratory testing will be done on the day of exposure: Exposed Person Hepatitis B Surface Ab and Ag HIV ALT

Source Patient Hepatitis B Surface Ag HIV (viral load if known to be HIV positive) Anti-Hepatitis C Virus Ab

 If the source patient did not have an exposure to the exposed person’s blood or body fluid he/she has no further need for follow up. If he/she did have exposure to the exposed person’s blood, the source patient will be offered the same counseling as below regarding risk and the same testing at the recommended interval.  The covering physician or physician assistant in the MWU Multispecialty Clinic will provide optional recommendations to the exposed person in regard to their risk of contracting Hepatitis B, Hepatitis C, or HIV and the preventive measures that may be available to him/her, using the CDC guidelines for prophylaxis. This should be done within 24 hours of the exposure. If this service cannot be offered within 24 hours of exposure, the exposed person should be referred to an emergency room or urgent care clinic.  If the exposed person chooses to take the HIV post-exposure prophylaxis, this must be started within the first day after exposure, preferably within hours.  If there is a risk of Hepatitis B, as in the situation in which the exposed person is a Hepatitis B Surface Antibody non-responder, the exposed person should be offered Hepatitis B immune globulin (HGiG). If this is not available in the MWU Multispecialty Clinic, an attempt will be made to send the exposed person to a facility where HGiG is available.

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 The exposed person will be asked to return on the following schedule for lab work after the first blood draw: Time After Exposure 6 weeks

12 weeks 6 months



Testing HIV Hepatitis B Surface Ag (if previously negative to HBV-Ab) HIV HIV Hepatitis B Surface Ag (if previously negative to HBV-Ab) Hepatitis B Surface Ab (if previously negative to HBV-Ab) Anti-HCV ALT

Positive results will result in appropriate care or referral to another physician for further care.

Billing for medical care and laboratory testing associated with an exposure will be submitted to the exposed person’s insurance carrier, in the case of a student, staff, or faculty. Any out-ofpocket costs will be submitted to Midwestern University Risk Management for payment. Charges generated for medical services provided to the source patient or a visitor or patient who has experienced and exposure in MWU clinic will be submitted to the Midwestern University Department of Risk Management. (The Department of Risk Management will determine whether submitted bills will be forwarded to the involved college.)

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Report the exposure Fill out the Source Patient Accidental Exposure Questionnaire following the protocol of the Eye Institute. Immediately notify the attending optometrist and the Office of the Assistant Dean of Clinical Education. Within 5 days, students shall send a copy of the Source Patient Accidental Exposure Questionnaire and treatment received from the emergency department to their attending optometrist and the Office of the Assistant Dean of Clinical Education. When making out an injury report for an exposure incident, the student and/or preceptor must give the name of the source individual and medical record number, if known or feasible. If an exposure occurs, the following information should be recorded in the student’s confidential medical record:    

Date and time of exposure Job duty being performed by student at the time of the exposure Whether protective equipment (gowns, gloves, masks, protective eyewear), or engineering controls were used (i.e., recapping device or a needle disposal device or mechanical pipette); Details of exposure, including amount and type of fluid or material, and severity (e.g., depth of percutaneous exposure and whether fluid was injected; extent and duration of skin or mucous membrane contact)

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Description of source material, including Human Immunodeficiency Virus (HIV), Hepatitis B virus(HBV), Hepatitis C virus(HCV) status, if known. In the event the source individual is a dialysis patient, a current HBs-Ag report should be used.

Student Consent The consent of the student must be given before collection of their blood and before any serologic testing can be done. Source Individual The source individual is defined as any individual whose blood or other potentially infectious materials may be a source of exposure to the health care worker. Arizona statutes state “when a health care provider or employee of a health care facility is involved in an accidental direct skin or mucous membrane contact with the blood or body fluids of an individual which is of a nature that may transmit HIV, written informed consent of the source individual (patient) to perform an HIV test is not required.” The source individual should be identified by the student. Situations when it is not feasible to identify the source individual include incidents of needle sticks or cuts from sharps of unknown sources, e.g., unmarked needle or blood sample. The source individual should be tested for hepatitis B, hepatitis C, and HIV in accordance with the directives of the rotation site where the exposure occurred. Sources of Blood Borne Infections Certain human-source fluids and materials are likely carriers of infectious viruses if the host is infected. A list of the most likely infectious waste materials follows:  Amniotic fluid  Blood  Cerebrospinal fluid  Pericardial fluid  Peritoneal fluid  Pleural fluid  Semen  Synovial fluid  Unfixed human body tissue (other than intact skin)  Vaginal secretion Other body fluids are believed to possess little risk for carrying and transmitting pathogenic viruses. The following are not included as sources of blood borne pathogens (unless they contain blood): • Feces • Nasal secretions • Saliva (except in dental treatment) • Sputum • Sweat • Tears • Urine • Vomitus

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Personal Protective Equipment Personal Protective Equipment (PPE) includes items worn by an employee to provide a barrier between the worker and contaminated materials. PPE will be supplied by the employer at no cost to faculty, staff, and students. Appropriate sizes and types of equipment will be provided in the location where they are to be used. Potentially contaminated PPE must be removed before leaving the area where it is used. Examples of the type of PPE used and some of their characteristics are as follows: Gloves  Gloves are required when manual contact is initiated with potentially infectious materials such as blood.  Gloves must be appropriate for the task.  Gloves must be available in appropriate sizes and in hypo-allergenic (non-latex) versions.  Gloves are to be considered single use devices, and properly disposed of as hazardous waste after use. Eye and Face Protection  Eye and face protection is required when danger of splashing or spraying of infectious materials is anticipated.  Safety glasses are the minimum protection. Face shields and surgical-type masks may be required. Clothing  Fluid-resistant clothing must be worn if there is potential for splashing and soak through.  All clothing (lab coats, scrubs) that is potentially contaminated with blood borne pathogens must be laundered through the University. Hazard bags are located in the Eye Institute central specialty testing room on the second floor and in the copy room on the first floor. Clothing is bagged and returned to the administration area for pick up by the University Laundry Service. No potentially contaminated clothing should be taken home for cleaning. Cardio-Pulmonary Resuscitation and Resuscitation Equipment Cardio-pulmonary resuscitation (CPR) training, PPE fitting and automated external defibrillator (AED) training are required for employees whose job includes emergency treatment and direct patient care.  One-way masks are required for mouth-to-mouth resuscitation. Warning Signs and Labels Bio hazardous warning signs and labels are used to notify all persons of the presence of potentially infectious materials. For blood borne pathogens these signs and labels are required to be fluorescent orange or orange-red with words and symbols in a contrasting color. Bio hazardous labels are required for the following situations:  Bio waste containers  Refrigerators and freezers used to store blood or other infectious materials

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 

Containers for storing, transporting, or shipping blood or other infectious materials Contaminated equipment requiring handling for service, repair or shipping

Work Practice Controls Work practice controls involve altering the way a task is performed to reduce or eliminate exposure to potentially infectious materials. The MWU Eye Institute adopted the following work practice controls:      

Recapping of needles is prohibited. Dispose of all needles in an appropriate sharps container. Hand washing after contact with potentially infectious materials is required. Eating, drinking and like activities in areas where potentially infectious materials are used or stored is prohibited. Methods that minimize splashing or spraying of potentially infectious materials must always be used. Absorbent coverings for countertops and equipment to contain spills or splashes and to facilitate easier cleanup must be used when potentially infectious materials are present. All potential exposure incidents must be reported immediately to the clinic consultant and the Midwestern University Risk Management Office.

Housekeeping, Decontamination and Spill Cleanup All work areas where potentially infectious materials are used must be maintained in a clean and sanitary condition. If a spill of a potentially infectious material or bodily fluid occurs, the Environmental Health and Safety Department should be contacted at extension 3201. Under no circumstances should any potentially infectious materials or bodily fluids be handled except by appropriate personnel. Regulated and Other Infectious Waste Regulated waste is waste that is capable of transmitting disease to those handling it. Examples of regulated waste, according to Arizona State regulation http://www.ica.state.az.us/divisions/osha/safety_health_compliance.html include the following:       

Liquid or semi-liquid blood or other potentially infectious materials Contaminated items capable of releasing blood or other contaminated materials if compressed Items caked with dried blood or other potentially infectious materials which are capable of releasing these materials during handling Contaminated sharps Human tissues Infectious biological cultures or agents Contaminated animal carcasses, body parts and bedding

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It is also recommended that the following materials be included in the infectious waste stream:  Potentially contaminated disposable gloves  Potentially contaminated surface coverings, equipment coverings, and protective coverings  Bandages that have contacted blood or other body fluids Containment and Disposal of Infectious Waste Infectious waste must be divided into two waste streams: non-sharp and sharp items. Non-sharp items, including disposable gloves, gowns and barrier materials, are disposed of in an infectious waste bag. Sharp items are those that are sharp in their original form or can become sharp on breaking or bending. Sharp items are disposed of in puncture-resistant sharp containers, typically constructed of heavy-duty plastics. Sharps include the following:      

Glassware Needles Pasteur pipettes Rigid plastic pipettes Scalpels Syringes

Infectious waste must be treated to eliminate its infectious properties prior to disposal. The primary treatment for infectious waste is autoclaving, a heat treatment for inactivating infectious materials. If there is an autoclave within the department or building, infectious waste can be treated on-site and marked “treated”. Once infectious waste has been properly autoclaved and marked as such, it can be disposed as ordinary trash. If there is no autoclave available for use within the department or building, contact Environmental Health and Safety for information on treatment and disposal of infectious waste. An autoclave will be located on the first floor of the Eye Institute adjacent to the surgical suite. Although human blood is listed as a regulated infectious waste, it is allowed to be disposed in sink or sewer drains as long as it is done carefully without splashing and is thoroughly washed down the drain with water. The sewage system and treatment plant provide appropriate treatment for this material.

Clinical Disinfection Procedures Disinfection of Goldmann Applanation Tonometer Prisms and Gonioscopy Lenses Goldmann prisms are the property of each student. It is the student’s responsibility to ensure that the prism has been properly disinfected prior to each use. Disinfection of the tonometer prisms includes:  The tonometer prism should be disinfected between patients with 3% hydrogen peroxide solution or Dakin’s solution for ten minutes.

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 

The tonometer prism should be rinsed with sterile saline solution. The prism should be air dried for two minutes or wiped with lint free tissue.

Trial Contact Lens Disinfection  If infectious risk is present sterile or non-sterile examination gloves shall be worn and hands washed.  All trial contact lenses, including hard, gas permeable and soft lenses, are to be disinfected using products effective against the HIV virus as recommended by the Center for Disease Control (CDC) and appropriate Eye Institute committee. This excludes disposable soft contact lenses.  All contact lens vials are to be emptied of the used saline, filled with fresh 3% hydrogen peroxide and left for 10 minutes, emptied and rinsed well with saline solution (not water) and refilled with fresh saline before inserting the disinfected lens. Contact lens cases used in-office should be discarded after each use or given to the patient for whose lenses it was utilized. Surgical Instruments Disinfection Following usage the metal anterior segment surgical instruments are to be soaked for 10 minutes in fresh 3% hydrogen peroxide solution in an appropriate container. The Alger brush tip must be disengaged prior to sterilization.

Clinical Precautions and Procedures Clinicians are not to handle any body fluid spills other than those encountered in the course of a normal optometric examination (e.g. tears). If a body fluid spill occurs (e.g. vomit, blood, etc.), a faculty member or supervisor should be contacted immediately. The consultant or supervisor will have the body fluid spill removed by appropriate personnel.  Hands should be washed with soap and water or an alcohol-based hand rub should be used immediately before and after performing a procedure that results in patient contact. This step should be performed whether or not gloves are worn.  A sterile cotton-tipped applicator should be used to examine a patient with a red eye.  Gloves should be worn when coming into contact with tears of those patients with potentially contagious conditions. Gloves must be worn when cuts, scratches or other dermatologic lesions are present on the hands of the clinician. Hands must be washed after putting the gloves on to avoid powder contamination of any surfaces.  If a patient appears ill and it is believed body fluid spills such as vomiting may occur, the patient must be rescheduled.  If the clinician is ill with a potentially contagious condition such as a cold or the flu, it is recommended that they refrain from patient care.  Disposable surgical masks are available for use. The use of a mask during patient care is strongly encouraged in cases where the clinician or the patient might harbor a potentially contagious condition.  If epidemic keratoconjunctivitis or other suspected contagious conditions are present, examination rooms must be thoroughly disinfected prior to examining another patient. Disinfection should include ALL surfaces touched by the clinician or the patient and cleaned with Dakin’s solution or effective equivalent. Disinfection solution can be

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obtained from the central equipment room of the Eye Institute. examination room has a spray disinfection solution in the cabinet.

Additionally, each

Laser Safety Sheets The following information pertains to the Diode Laser. • The Diode Laser is a Class 4 laser. • No laser hazard is present if the instrument is turned off. • Class 4 lasers can damage the eyes via direct or reflected exposure (i.e. walls, mirrors, instruments, etc.). • A warning sign is needed when the laser is in use. • Except for the patient and the operator of the laser, personal protective equipment (laser safety glasses) must be worn by all persons in or entering the laser room while the laser is in use. Laser safety glasses are found in the Eye Institute central equipment room and within the laser procedure room. • The risk of injury is minimal when laser safety procedures are followed.

Material Safety Data Sheets Material Safety Data Sheets (MSDS) are documents which provide workers and emergency personnel with the proper procedures for handling or responding to exposure to particular substances. A MSDS summarizes information such as the physical properties of the substance, toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, and spill or leak procedures. Occupational Safety and Health Administration (OSHA) mandated MSDS's for hazardous materials effective May 26, 1986. MSDS's are meant for:   

Employees who may be occupationally exposed to a hazardous material at work. Employers who need to know the proper methods for storage and handling hazardous material at work. Emergency responders and medical personnel who need to know how to handle and treat individuals exposed to hazardous materials.

MSDS’s are kept on file at the Eye Institute in the Clinic Manager’s Office and are clearly labeled and visible for quick reference.

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SAFETY PROCEDURES FOR EYE INSTITUTE PATIENT CARE Adverse Drug Reactions In the event a patient develops a clinically significant drug induced side effect from systemic medications or ocular medications, a modification of the treatment plan will be implemented and documented. A plan for patient follow up should be made as indicated. In the event a patient develops a clinically significant side effect from Rapid Sequence Fluorescein Angiography, immediate steps should be taken to alleviate the patient’s symptoms. Diphenhydramine and Epi-pens® are available in the pharmacy room.

Abuse or Neglect Reporting Abuse can occur with a child or a vulnerable adult. A vulnerable adult is an individual who is eighteen years of age or older and who is unable to protect himself from abuse, neglect or exploitation by others because of a physical or mental impairment. A vulnerable adult includes an incapacitated person. Abuse can take many forms: intentional infliction of physical harm, injury caused by negligent acts or omissions, unreasonable confinement, sexual abuse, or assault (A.R.S. § 46-451) “Abuse of a child is defined as the infliction or allowing of physical injury, impairment of bodily function or disfigurement or the infliction of or allowing another person to cause serious emotional damage as evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior and which emotional damage is diagnosed by a medical doctor or psychologist and is caused by the acts or omissions of an individual having care, custody and control of a child.” (A.R.S. § 8-201). Physical abuse includes non-accidental physical injuries such as bruises, broken bones, cuts or other injuries. Neglect occurs when children are not given necessary care for illness or injury, leaving young children unsupervised or alone, locked in or out of the house, or without adequate clothing, food or shelter. Arizona law requires optometrists and other health care professionals, who reasonably believe that a minor is or has been the victim of physical injury, abuse, child abuse or neglect, or has received a non-accidental injury, to immediately report their concerns to Child Protective Services (CPS) or local law enforcement (A.R.S. §13-3620). Pursuant to A.R.S. §13-3620.O, failure to report or false reporting is a class 1 misdemeanor. If the failure to report involves a reportable offense as defined and listed in A.R.S. § 13-3620(P)(4), the person who violates this mandate is guilty of a class 6 felony. Reports of child abuse shall be made immediately by telephone or in person, and shall be followed by a written report within seventy-two hours (A.R.S. §13-3620.D). The reports should contain: 1. The names and addresses of the suspected victim minor and the minor’s parents or the person having control or custody of the minor, if known. 2. The minor’s age and the nature and extent of the minor’s abuse, physical injury or neglect, including any evidence of previous abuse, child abuse, physical injury or neglect.

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3. Any other information that the person believes might be helpful in establishing the cause of the abuse, physical injury or neglect. Abuse of a vulnerable adult under circumstances likely to produce death or serious physical injury, includes intentional infliction of physical harm, injury caused by criminally negligent acts or omissions, unlawful imprisonment, and sexual abuse or sexual assault (A.R.S. §13-3623). Abuse involves situations where the adult’s safety or well-being is being compromised by their inability to take care of their basic needs, their medical needs, their finances, their home environment or their personal hygiene. In other cases, vulnerable adults may be the victims of financial exploitation or physical, emotional or sexual harm. Arizona Revised Statute §46-454 mandates that an optometrist or other health care professional, who has a reasonable basis to believe that abuse or neglect of the adult and/or the adult’s property has occurred, shall immediately report such reasonable basis to a protective service worker in person or by telephone, followed by a written report mailed or delivered within fortyeight hours or on the next working day if the 48 hours expire on a weekend or holiday. The report shall contain: 1. The names and addresses of the adult and any persons having control or custody of the adult, if known. 2. The adult's age and the nature and extent of the adult's vulnerability. 3. The nature and extent of the adult's injuries, physical neglect, or exploitation of the adult's property. 4. Any other information that might be helpful in establishing the cause of the adult's injuries or physical neglect or of the exploitation of the adult's property. The following are contact numbers to report suspected child and vulnerable adult abuse: Arizona Child Abuse Hotline- 1-888-SOS-CHILD (1-888-767-2445) Child Protective Services (CPS) Arizona Adult Services (APS)

Protective 1-877-SOS-ADULT (1-877-767-2385) or online at https://www.azdes.gov/landingforms.aspx?form=7704

Other resources: ALCOHOL & OTHER 602-264-1341 DRUG ABUSE Alcoholics AnonymousPhoenix or ARIZONA LONG TERM 602-417-6600, http://www.azahcccs.gov/applicants/application/ALTCS.aspx CARE SYSTEM (ALTCS) Phoenix ALTCS Office DOMESTIC VIOLENCE

1−800−799−SAFE(7233), 1−800−787−3224 (TTY) or

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National Domestic Violence http://www.thehotline.org/ Hotline LAW ENFORCEMENT ATTORNEY GENERAL Office of Victim Services

- 866-742-4911/complaints 602-542-8409 Phoenix 602-542-4911

1-800-MEDICARE (1-800-633-4227) or www.medicare.gov MEDICARE Federal Health Insurance Program Part A & B National SUBSTANCE ABUSE AND 800- 487-4889 or http://www.samhsa.gov/prevention/ MENTAL HEALTH SERVICES ADMINISTRATION National Mental Health Info SEXUAL ASSAULT & EMPACT Sexual Assault Hotline (480) 736-4949 Crisis Hotline (602) 222-9444 or (800) 631-1314 ABUSE Arizona Sexual Assault http://www.arizonasexualassaultnetwork.org/ Network (AZSAN)

Be Safe / Be Smart Crime Prevention Following safety precautions can decrease crime and your risk of becoming a victim.  Lock your office doors when unoccupied. Always keep personal belongings in locked drawers, cabinet or lockers.  Do not leave messages on your door indicating when you are away and when you will return. This information can be left with the Clinic Manager, the Faculty of the Day, or the Assistant Dean of Clinical Education.  If someone asks to use your office phone, direct them to the front lobby for a general use phone.  Do not put your office location or address on your key ring.  Do not put keys in hiding places.  Report suspicious persons to campus security.  Call for campus security for escort services if you are working after clinic hours. Campus Safety & Security at x3201, or 623-572-3201 City Emergent Services Call 911 For non-emergent services the following numbers can be used: Glendale Police 623-930-3000 Glendale Fire 623-931-5600 Glendale Paramedics 623-931-5600 Poison Center 602-253-3334 Hazardous Material Hotline 623-930-3410 Health Department, Maricopa County 623-344-6700

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Imaging Orders For imaging not available within our campus clinics (MRI, CT, and X-ray) pre-scheduling questionnaires are provided by the referral service. Questionnaires and location maps are in the specialized testing area. For assistance contact the Clinic Manager or the Lead Ophthalmic Techinician.

Laboratory Testing For those patients who are eligible to make use of Sonoran Laboratory, a phlebotomist is available in the MWU Multispecialty Clinic, for blood draws.

Microbiology Cultures Culture materials, transport media for viruses Chlamydia, bacterial transport material such as agar plates, broth, and slides for stains can be obtained in the pharmacy room. Label any cultures or stains appropriately with patient name, clinic number and site of sample. Remember to take two samples if you want identification and culture and sensitivity. All cultures should be placed in a biohazard bag and given to the Clinic Manager for transport to the lab.

Ocular Emergencies All ocular emergencies should be seen on the same day as first contact. Appropriate referral should be made as soon as it is known to be warranted by the patient’s ocular condition. If an emergent walk-in patient presents to the front desk, triage should take place as soon as the Lead Faculty of the Day is notified.

Pharmaceutical Samples Policy Pharmaceutical samples will be stored in the pharmacy room. All samples shall be documented and appropriate patient education will accompany any dispensed samples. As a standard protocol, whenever a sample is given, appropriate student education will be given regarding drug selection and rationale.

Prescribing Controlled Non-Narcotic Medications Electronic prescriptions will be utilized at all times if possible. Written prescriptions should be avoided.

Prescribing Narcotic Medications Electronic prescriptions will be utilized at all times if possible. Written prescriptions should be avoided. Narcotic medication should not be refilled after hours or on weekends without the patient being seen by the provider at the time the prescription is given.

Sterilization and Disinfections Procedures The autoclave is located in the surgical suite. The Lead Ophthalmic Technician will be responsible to run the autoclave at the end of the clinical day. A tray with Cidex solution (or equivalent) is located on the counter adjacent to the autoclave for placement of contaminated instruments.

Therapeutic Drug Policy

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Ophthalmic drugs for in clinic use only will be kept in the pharmacy room. Access to and for the pharmacy room key can be obtained from the faculty of the day, the Assistant Dean of Clinic Education, or the Clinic Manager. Medications removed from this location require the signatures of the student clinician and the attending clinical optometrist and/or the faculty of the day on the inventory sheet posted.

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APPENDICES APPENDIX I - PATIENT CARE POLICIES Clinical Services and Referrals Clinic services include: complete primary eye care, pediatric eye evaluations, binocular vision assessment and vision therapy, contact lens evaluation and fitting, electro-diagnostic testing and reporting, low vision evaluation and management, ocular disease evaluation treatment and management, sports vision evaluation and therapy, and full optical services.

Release of Information Policy See HIPAA section

Release of Prescription Policy Spectacle prescriptions will be released to each patient at the completion of the examination and when fees are paid. Additional copies may be released with the notation of the date of the examination and the name of the examiner and clearly marked, “DUPLICATE”. Copies of spectacle prescriptions that are older than one year shall be clearly marked “EXPIRED”. Contact lens prescriptions will be released when all fees are paid and appropriate follow-up associated with the fitting has been completed. The Arizona Practice Act has prescription standards that are included in their entirety below.

Optometric Prescription Standards; Release to Patients R4-21-306. A. When a licensee completes an eye examination and generates an optometric prescription, the licensee shall provide the patient with a copy of the optometric prescription without charging a fee other than the examination fee. B. A licensee shall ensure that an optometric prescription written by the licensee includes: 1. For ophthalmic lenses other than contact lenses: a. Name of the patient; b. Refractive power of the lenses; c. Interpupillary distance; d. Printed name, office address, telephone number, and signature of the licensee; and e. Date of the examination and expiration date of the prescription; 2. For contact lenses, including plano lenses: a. Name of the patient; b. For a patient who has not completed a trial period appropriate under the circumstances and desires to have a prescription, the information required for the patient to purchase trial lenses at another optical establishment or location; c. For a patient who has completed a trial period appropriate under the circumstances for the lenses prescribed, all information necessary to reproduce the contact lenses accurately; d. Printed name, office address, telephone number, license number, and signature of the licensee;

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e. Date of the examination and the issue and expiration date of the prescription; and f. Information regarding the prescribed contact lenses: i. Refractive power; ii. Base curve or other appropriate designation; iii. Diameter, if appropriate; iv. Tint, if applicable; v. Material, manufacturer, or both; and vi. In the case of private-label contact lenses, manufacturer, trade name, and, if applicable, trade name of equivalent brand name; and 3. For pharmaceutical agents: a. Name and address of the patient; b. Date the prescription is issued; c. Name, strength, and quantity of the pharmaceutical agent prescribed; d. Directions for use of the pharmaceutical agent prescribed; e. Name, office address, and telephone number of the prescribing licensee; f. DEA number of the prescribing licensee; g. Two adjacent signature lines with the following printed words: i. “Dispense as written” under the left signature line, and ii. “Substitution permissible” under the right signature line; and h. Original signature of the prescribing licensee on one of the signature lines; and 4. Additional information that the licensee considers necessary. C. A licensee who dispenses or directs the dispensing of ophthalmic materials shall ensure that a prescription is filled accurately. D. A licensee shall be available to verify that a prescription written by the licensee, but filled by another provider of ophthalmic goods, is accurately filled. The licensee may charge a fee for verifying the accuracy or quality of ophthalmic goods dispensed by another provider.

Letter Writing Guidelines When information is needed for letter writing, the patient’s electronic health record (EHR) should be sourced. No information from the patient’s EHR is to be photocopied. It is Eye Institute policy that any identifiable information may only be stored on University-owned computers. No Faculty, Staff or student will store or access any protected information either remotely or from within the college via any computer system that was not specifically purchased by the University. This includes home access, any storage media, or personally owned laptop. Remote access for clinical faculty is provided by password and access given by Information Technology Services. Please review the Remote Access policy for greater detail. Letters will be written from the Compulink® system and saved to the patient‘s EHR. The Clinical Faculty preceptor will review the correspondence, approve the content and edit it, if indicated. Hard copy can then be printed, signed and mailed. Letters should be completed at the end of the clinical session within which the patient was examined.

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Patient Complaint Procedure A patient may call, write, or present in person to the Clinic Manager or Assistant Dean of Clinical Affairs an issue or complaint relating to care received at the Eye Institute or the handling of Protected Health Information (“PHI”). In this event of a complaint, the Assistant Dean of Clinical Affairs will notify the Dean, Arizona College of Optometry, the Vice-President and Chief Academic Officer, the Vice-President for Finance, Senior Vice-President and Chief Financial Officer, the Executive Vice-President and Chief Operating Officer, and the President and Chief Executive Officer of Midwestern University. The Assistant Dean of Clinical Affairs will review and investigate the issue or complaint raised and make reasonable efforts to resolve the matter formally, including, when appropriate, inviting the patient to meet in person to discuss the matter. If the complaint can be resolved by the Clinic Manager, the complaint will be forwarded to that person to resolve. At the Assistant Dean’s discretion, the Department of Risk Management may be contacted to assist with any investigation. Risk Management must be notified of any matter that could reasonably result in either a complaint being filed with the State Board of Optometry or litigation. The HIPAA Privacy Officer should be notified regarding any concerns or complaints raised and relating to the handling of PHI. If a matter is not resolved within 24 hours, the Assistant Dean of Clinical Affairs should consult with the Department of Risk Management regarding preparation of a written response to the patient. A written response must be provided to the patient within 5 days from the date of issue or complaint is raised. A patient is permitted to have a non-legal representative of their choice to represent their interests during the process. If a patient prefers representation by an attorney, Midwestern University’s attorney must be present. The Patient Accounts Manager will be notified of any determination by the Assistant Dean of Clinical Affairs resulting in a refund of monies previously paid to the Midwestern University Eye Institute. If the complaint is elevated to the level of formal grievance, the Assistant Dean of Clinical Affairs will refer the grievance to the most appropriate division of the University. If the grievance concerns sexual harassment or racial discrimination, the grievance will be forwarded to the University office of Human Resources for investigation. If the grievance concerns quality of patient care, the Assistant Dean of Clinical Affairs will form an ad hoc medical review board committee, whose membership will include the Assistant Dean of Clinical Affairs, the Vice President of Clinic Operations, and at least two other clinical faculty members with no conflict of interest. The ad hoc medical review board committee will review the complaint and the medical record. If necessary, the ad hoc committee will collect additional information from the clinic faculty. A written response to the complainant must be provided within 7 working days.

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If a mutually satisfactory resolution is not reached between the patient and the Assistant Dean of Clinical Affairs, the matter will be referred to the Dean, College of Optometry. The Dean should be notified of any unresolved matters within 7 days of the date the concern or complaint is raised. If the Dean, Arizona College of Optometry, cannot reasonably resolve the grievance within 14 days from the referral date, the Dean will notify the Vice President and Chief Academic Officer, at whose discretion, may notify the President and Chief Executive Office of Midwestern University. The Assistant Dean of Clinical Affairs will send a monthly report of patient complaints and grievances to the Dean, Arizona College of Optometry, the Vice President and Chief Academic Officer, the Vice President for Finance, Senior Vice President and Chief Financial Officer, the Executive Vice President and Chief Operating Officer, and the President and Chief Executive Officer of Midwestern University.

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APPENDIX II - MWU CLINIC POLICIES To view a full copy of each policy, please go to: http://www.midwestern.edu/protected-pages/policies/arizona-eye-institute-policies.html Accidental Blood or Other Potentially Infectious Material Exposure Policy Authorship Policy Breach Notification Policy Charge Entry Timeframe Policy Clinical Faculty Remote Access to EHR System Policy Code of Conduct Policy Collection Agencies Policy Commercial Support of Continuing Education (CE) Policy Compulink Charting Policy Contact Lens Patient Care Policy Credit Balances on Patient Accounts Policy Credentialing Policy Cross-Clinic Dismissal Policy Daily Reconciliation of Over-the-Counter Payments Policy Data Collection for Educational Purposes Policy De-identification of Protected Health Information Policy Dismissal from Clinic Due to Non-Payment Policy Documentation and Disclosure of PHI Policy Education of Students Regarding Interaction with Pharmaceutical and Healthcare Equipment Industry Policy Emergency Protocol Gifts and Meals from the Pharmaceutical and Medical Device Industries Policy Gifts from Patients Policy HIPAA Annual Training for Clinic Providers and Staff Policy HIPAA Personnel Designations Policy Home Visit by Eye Institute Provider Policy Identifying Patients with Financial Hardship Policy Immunization and Tuberculosis Testing for Clinic Employees Policy Industry-Funded Speaking Relationships Policy Industry-Supported Fellowships and Scholarships Policy Licensed Provider Clinic Privileging Policy Mandatory Complementary Ocular Function and Health Examinations for the First Year Student Policy Minimum Necessary Use of Protected Health Information (PHI) Policy Notice of Privacy Practices Policy Patient and Third Party Refunds Policy Patient Cancellation and No-Shows Policy Patient Complaints - Policy for response timeline and notification of others Patient Registration - Legal Name Policy Patient Registration, Payment and Discharge Process Policy Patient Rights Concerning PHI Policy

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03/11/13 01/08/14 10/16/13 08/08/13 07/12/12 08/2011 11/07/12 01/22/14 05/30/12 08/22/12 08/17/10 07/22/13 10/06/10 08/17/10 11/14/12 04/03/13 08/17/10 03/21/14 01/17/13 05/09/11 01/22/14 01/27/11 06/11/13 03/21/14 01/30/12 04/02/14 06/10/11 01/22/14 01/22/14 10/16/13 12/17/10 11/16/11 10/16/13 10/11/13 08/09/13 08/22/12 12/11/08 08/17/10 03/21/14

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Payment for Patient Services by Someone Other than the Patient Policy 10/16/13 Payment Plan Policy 08/17/10 Pharmaceutical and Medical Device Purchasing Policy 01/22/14 Pharmaceutical Samples Policy 01/22/14 PHI Safeguards (Security Rule) Policy 06/19/13 Registration, Licensure, Continuing Education, Medical Liability Insurance, Board 08/01/11 Certification and other Certification Requirements Policy Requesting Restricted Access Designation on Employee of Student Medical Records 06/10/13 Policy Research Patients in the Eye Institute Policy 10/16/12 Responses to Social Media Reviews Policy 04/04/13 Return and Exchange Policy 01/04/12 Securing Protected Health Information (PHI) Policy 11/16/11 Security Incidents (HIPAA) Policy 10/24/12 Sensitive Information Protection Policy 05/01/12 Site Access by Medical Device Equipment and Medical Supply Company 01/22/14 Representatives Policy Site Access by Pharmaceutical Representatives Policy 01/22/14 Small Balances Policy 08/30/12 Sponsorship of Attendance at Medical Device and Supply Companies and 01/22/14 Pharmaceutical Industry-Sponsored Educational Events Policy Standardized Patients in the Eye Institute Policy 08/22/12 Student Vision Therapy in the Eye Institute Policy 10/16/12 Transmission/Communication of PHI Policy 10/24/12 Types of Accepted Patient Payments Policy 08/17/10 Vision Screenings and Health Fair Policy 11/08/11 Waiver and Discount of Co-Payments, Co-Insurance, and Deductibles for Patients Policy 11/07/12 Additional Links for Policies Centralized Office of Experiential Education (COEE) Human Resources Office of Research and Sponsored Programs If you have any questions about this page, please contact University Administration at 623-572-3403.

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APPENDIX III - QUALITY ASSESSMENT PROGRAM The Quality Assessment Program of the Eye Institute is designed to identify, resolve, and improve processes that could enhance patient care outcomes. Each member of the College’s faculty, staff, and student body will participate in the recognition and acknowledgement of health care trends and best practices. The Eye Institute Quality Assessment Program will incorporate the following philosophical bases and actions:      

The initiation of actions to improve eye care services The internal reporting of what has been found and the actions taken A focus on processes and systems A non-punitive culture with minimization of individual blame or retribution for involvement in a less than optimal area of care delivery Organizational learning about eye care best practices Support and sharing of knowledge from other health care organizations and programs within the Arizona College of Optometry

The Eye Institute actively engages in safety initiatives such as hand hygiene awareness, improvement of teamwork, appropriate responses to emergent phone calls, adverse effects from medications, and contact lens-related infections. Compliance and standards of care are monitored via a quarterly quality assessment program implemented by the Best Practices Committee. The Quality Assessment Program, utilizes metrics that include (but are not limited to) reviews of the number of patients seen, the number of patient complaints, the number of prescriptions written, and the number of reported adverse outcomes, such as the number of refraction rechecks. Patient satisfaction surveys are distributed for completion to patients and their families to evaluate the clinic faculty, staff and facilities after a recent visit to the Eye Institute. These survey results are also used in the Quality Assessment Program.

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APPENDIX IV - COURSES DELIVERED IN PART OR WHOLE WITHIN THE EYE INSTITUTE There are several courses that will require time spent within the Eye Institute. These courses will include the clinical science sequence, ophthalmic optics, low vision, ocular prosthetics and electrodiagnostics. Each course director will require introduction and possibly mastery of a specific skill set. Examples of the activities for those courses are found here.

Clinical Services I-III EXAMPLE OPTICAL Name If able to aid in a spectacle order: What was the spectacle Rx? What was the purpose or use for the spectacle Rx? What style of frame was chosen and why? Take all necessary measurements. Measure a patient for bifocals and record all necessary measurements. Measure a patient for progressives and record all necessary measurements. Adjustments What was the complaint and how was it fixed? (If there is not a patient available for this, have your partner pretend to be a patient with a complaint and use practice frames.) Types of progressive lenses Name 3 progressive lenses that are good for extensive computer use. Name 3 progressive lenses that are recommended for smaller frames. List 5 PAL symbols and identify the type of progressive lens. Business questions What information is required on a spectacle Rx in Arizona? What information is required on a spectacle Rx from your home state? (List the state.) Is there an expiration date requirement for AZ and/or your home state? If so, what is it? What information is on a frame tag? How do you decide on the number of frames to purchase for an optical? What is the approximate total cost of an inventory for a private practice? Optician Signature PC EXAM OBSERVATION Name Attending Doctor Signature

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Analysis of the exam List the order of tests performed during the exam. Did the exam flow in a smooth manner? How could the student doctor have been more efficient? Describe the communication between the student doctor and the patient? Was any jargon used in communicating with patient? If so, what terms were used? Write out how you would have presented the case to the attending doctor. What ancillary testing, if any, was done and why? List two things you learned from observing this exam? 1. 2.

EXAMPLE SPECIALTY TESTING Name Corneal Mapping 1. Questions: a. When fitting a contact lens for keratoconus patients, why is corneal topography beneficial? b. Name the 3 topographers found within the MWU Eye Institute. c. Which corneal mapping device can assess anterior chamber depth? d. Which machine primarily maps the front surface of the cornea curvature? e. Name two clinical situations in which topography would be useful. Auto refractor/Ks 1. Perform manual Ks and auto Ks on your partner and compare them. Are they within reasonable agreement (±0.75 D and ±30°)? Manual Ks: OD: ____________________________________________________________________ OS: ____________________________________________________________________ Auto Ks: OD: ____________________________________________________________________ OS: ____________________________________________________________________

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Fundus Camera 1. Take a fundus photos of your partner a. Assess C/D ratios b. Assess A/V ratios c. Assess the macula d. Assess an irregularities 2. Questions a. When would you use “stereo” mode? b. Name two conditions that you would document with fundus photos. c. What is the smallest acceptable pupil size for a non-mydriatic camera? Visual Fields 1. Perform a Humphrey 30-2 Sita Standard on your partner (attach results) a. Label the following on your test results: A. Test name B. Reliability indices C. Test duration D. The eye tested E. The Rx used F. The test strategy G. Raw numeric sensitivities H. Total deviation numeric plot I. Pattern deviation numeric plot J. Total deviation probability plot K. Pattern deviation probability plot L. Glaucoma hemifield test (GHT) M. Visual field indices b. Was the test reliable? c. How many fixation losses were there? d. How long did the test take?

2. Questions: a. What is a false negative? b. What is a false positive? c. What information do the total deviation plots tell you? d. What is the mean deviation? e. What is the pattern standard deviation? f. What is the difference between static and kinetic visual fields?

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g. What is the smallest acceptable pupil size to ensure accuracy during the Humphrey visual field test? h. Why is the patient’s age required data information? i. How are fixation losses tested? j. Why is proper patching of the eye so important? Optical Coherence Topography (OCT) 1. Observe a technician perform an RNFL OCT and a macula OCT. 2. List 2 indications for performing each type of scan. RNFL: Macula: 3. Define the difference between tomography and topography. 4. What is the difference between Fourier and Spectral Domain OCT? 5. Label the layers of the retina on the macula OCT below.

Hand-held Tonometry 1. Perform at least one type of hand-held tonometry on your partner. 2. Record your measurements OD OS 3. Name of device Ophthalmic Technician Signature

EXAMPLE LOW VISION SERVICES 1 . 2 . 3 .

Be able to apply epidemiologic aspects of visual impairment, appropriate terminology and classifications of visual impairment in order to communicate with patients, the public and other health care providers. In addition to performing a standard case history, be able to ask basic questions about symptoms, functional difficulties, and rehabilitation goals to anticipate the level of care that patients with visual impairment may require. Be able to recognize functional implications, hereditary factors and prognoses of common causes of visual impairment and explain them in language

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4 . 5 .

6 . 7 .

8 . 9 . 1 0 . 1 1 . 1 2 . 1 3 . 1 4 . 1 5 . 1 6 . 1 7 . 1

understandable to patients, families and other care providers. Be able to recognize psychological factors (e.g. depression, grief, motivation) that may affect adjustment to vision loss and the potential for rehabilitation. Be able to recognize pertinent social factors (e.g. social support system, education level, vocation, physical environment) and how they may influence the rehabilitation plan and process. Be able to recognize significant physical and neurological co-morbidities (e.g. Parkinson disease, stroke, dementia) that influence low vision rehabilitation and modify evaluation strategies and rehabilitation. Be able to perform visual acuity testing at both distance and near on patients with visual impairment using appropriate charts (e.g. Fienbloom, ETDRS, BaileyLovie) with proper documentation (e.g. working distance, eccentric viewing, illumination). Be able to perform trial lens refraction and modify refractive techniques for the patient with visual impairment (e.g. bracketing, hand held Jackson cross cylinder). Be able to recognize common symptoms of contrast sensitivity loss, screen for loss, recommend basic modifications (e.g. filter, lens, lighting and environmental options) and refer for comprehensive low vision rehabilitation when indicated. Be able to detect scotomas of the central visual field, understand their impact on visual acuity and visual function, and educate patients about their implications for activities of daily living. Understand optical principles of near low vision rehabilitation devices (e.g. hand held magnifiers, stand magnifiers) and distance low vision rehabilitation devices (e.g. telescope, bioptic fitting) and be able to predict magnification levels needed to achieve patient goals. Be able to prescribe basic optical and non-optical low vision rehabilitation devices, provide training in their use, and refer for comprehensive low vision rehabilitation when indicated. Be able to recognize availability of and indications for use of adaptive technology (e.g. video magnification, software). Be aware of the latest technology and have the ability to train individuals in its utilization. Be cognizant of rehabilitation strategies for visual field deficits (e.g. sighted guide technique, orientation and mobility, visual field enhancement devices (e.g. sector and EP prism) and equipment, scanning training). Develop an understanding of the special considerations for examining children, the elderly, and the multiply handicapped and educate about referral options and potential for rehabilitation. Understand relevant vision standards for driving, provide necessary assessment and documentation, bioptic telescope fitting, and be able to refer for driver evaluation/training, and medical evaluation when indicated. Be aware of the criteria for legal blindness determination and be able to educate patients on the basic social and legal ramifications of legal blindness certification. Understand that the needs of patients with visual impairment may require

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8 . 1 9 . 2 0 .

professional collaboration and be able to coordinate care with available rehabilitative, educational and social service resources. Identify governmental, private and consumer organizations that offer support and information to individuals with visual impairment (e.g. NEI, Veterans Administration, state rehabilitation agencies, foundations for the blind, consumer advocacy groups and support groups). Be familiar with third party reimbursement for low vision rehabilitation services and materials.

EXAMPLE OCULAR PROSTHETICS Midwestern University Eye Institute Arizona College of Optometry OCULAR PROSTHETIC SERVICE EVALUATION Student Name: ____________________ ______________________ Category Preparation

Exceptional 

Satisfactory 

Attending

Minimal 

Faculty

Unacceptable 

Name:

N/A 

*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Identification of Patient Needs



















*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Technical Skills







*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Data Interpretation







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*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Management of Patient Needs















*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Communication/ Letters/Reports







*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Coding and Billing











*COMMENTS: (Mandatory for Minimal or Unacceptable ratings) Professionalis m











*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)

EXAMPLE ELECTRODIAGNOSTICS Goals of the Students Rotating in the Electrodiagnostic Clinic 1) Learn about clinical applications of electrodiagnostic tests 2) Learn the essential information that the tests provide 3) Learn to identify the kinds of patients which may need specialty testing and which tests are most appropriate 4) Broaden your exposure to ocular pathologies. Bring 1) A diagnostic kit, cover paddle, and one person should bring a BIO. (You can use my lenses). You won’t need anything else so please leave the rest of your equipment in your morning exam room or locker. (There is not enough space for 4 of us the patient and 8 suitcases of equipment.) 2) Your questions and some excitement for learning!

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Check out Evaluation 1) Why did the patient present to the EDx clinic today? 2) What test(s) were preformed for your patient today? 3) What cell groups do those procedures test? (I reserve the right to ask about more tests than just the tests that were performed that day) 4) Is there any other information you would like to know that we don’t have? 5) What is the working diagnosis of our patient? (if unknown a differential diagnostic list is alright) 6) What did you learn today?

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APPENDIX V- INCIDENT REPORT FORM

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APPENDIX VI - INTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM

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APPENDIX VII - EXTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM

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APPENDIX VIII – OPTO 1800-1830 CLINICAL SERVICES XI- XIV MIDTERM AND FINAL GRADING FORM

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APPENDIX IX - PRECEPTOR AND SITE EVALUATION Midwestern University Arizona College of Optometry Preceptor and Site Evaluation 4th Year OD Student Each student must complete an evaluation of their External Rotation Site and Preceptor(s). The evaluation is confidential and will be reviewed by the Assistant Director, Clinical Rotations and the Clinical Education Coordinator after each External Rotation for continuous quality improvement of sites and preceptors. A summary report will be distributed to the preceptors only after all external rotations have been completed for the academic year, and all student names have been removed to ensure confidentiality of the responses. 5 Strongly AGREE

4 Agree

3 Satisfactory

2 Disagree

1 Strongly DISAGREE

The preceptor was knowledgeable about the subject matter during patient encounters. The preceptor discussed information at a suitable level of understanding. The preceptor encouraged discussion and responded conscientiously to questions. The preceptor served as a professional role model to me. The site provided a good learning experience for me. The site was well organized and prepared for students. I would recommend this site to other students as a good educational experience. In what areas is the preceptor doing well? What improvements could be made to the optometry practice experience at this site?

Additional Comments:

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APPENDIX X- PATIENT LOG

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