Article

An Action Plan for Reopening

As restrictions are removed, state by state, and practices can get back to business, how can you successfully—and safely—return to delivering eye care and eyewear in the midst of the coronavirus pandemic? Bridgitte Shen Lee, O.D., FBCLA, FAAO, and Optical Manager Sheena Taff share their plans and strategies on the next four pages.

The Covid-19 pandemic has knocked the wind out of the world’s cities, communities, schools, health care systems, businesses, and more.

As of press time on April 27, 2020, the confirmed number of Covid-19 cases was 2.9 million worldwide and 965,933 in the U.S., with 49,465 deaths nationwide.

Across the country, weeks-long shelter-in-place and stay-at-home orders from March into April and even May have shuttered businesses, including tens of thousands of eyecare practices and optical shops.

According to data from GPN, the total number of exams reported from more than 2,900 U.S. practices in the first three weeks of April 2019 dropped 94% for the same timeframe in 2020. [See additional GPN statistics on page 21.]

In Houston (5,628 confirmed Covid-19 cases at press time), where Bridgitte Shen Lee, O.D., FBCLA, FAAO’s Vision Optique practice is located, a Stay Home, Work Safe Order was in place from March 24 to April 30. With plans to reopen her practice’s doors to patients on May 1, Dr. Shen Lee shares her path to restarting her business and delivering eye care safely—in the face of Covid-19—right here.

PART ONE: ACTION PLAN FOR PATIENT CARE

BY BRIDGITTE SHEN LEE, O.D., FBCLA, FAAO

The Covid-19 pandemic is unprecedented in our lifetime. It has impacted all of us professionally and personally. As we transition back to providing eye care, it is important that we make the safety of patients and team members our top priority.

Our practice, Vision Optique in Houston, has followed the Centers for Disease Control and Prevention (CDC) and Texas governor’s public health guidelines and has been closed from March 23 to April 30.

Our virtual office was open and our doctors delivered care for urgent matters and eye emergencies. 70 percent of our team members worked safely from home during the closure.

For reopening the office, we have adopted the following important procedures to employ principles of social distancing, limiting gatherings, and infection prevention.

THE PROVIDER TEAM

We will have rotating teams with three doctors and seven team members.

  1. Three Doctors: #1 Monday/Tuesday, #2 Wednesday/Thursday, #3 Friday/Saturday
  2. Two Staff Teams: Team A Monday through Wednesday, Team B Thursday through Saturday
  3. If a team member is exposed or becomes infected, that team will go into quarantine for at least two weeks. Noninfected members under quarantine can work “virtually.”

EXTENDED OFFICE HOURS

We extended office hours to allow greater separation between patients while restoring some exam counts and revenue levels.

 Extended Hours: Mondays through Fridays, 9 a.m. to 5 p.m., and Saturdays, 9 a.m. to 3 p.m.

[Previous hours: Tuesday/Thursday 8:30 a.m. to 5:30 p.m., Wednesday 8:30 a.m. to 7 p.m., Friday 8 a.m. to 4 p.m., and Saturday 8 a.m. to 1 p.m.]

Transmission electron microscopic image of an isolate from the first U.S. case of Covid-19. PHOTO: CDC

VIRTUAL + PHYSICAL OFFICES

Our virtual office operation is achievable through secure remote access to EMR and transferred calls; it was already set up during the Covid-19 closure.

  1. Virtual Office: calls, insurance verifications, appointments, medical consults, contact lens orders, marketing and training assignments.
  2. Physical Office: direct patient care, routine and medical exam services, optical sales, dry eye treatment procedures.

PATIENT CARE

The focus is on scheduling, disinfection, and patient screening aimed at limiting exposure and creating a sustainable situation and safe environment.

Schedules

  1. Book one patient every 45 minutes for the months of May and June to minimize occupancy at any one time.
  2. Priority scheduling for frontline health care providers.
  3. Each child can be accompanied by only one adult; may consider a separate day or time block for seniors.

Additional Disinfection Guidelines

  1. Strict full disinfection between every patient; daily temperature and pulse oximetry will be taken on all team members and patients.
  2. Frames: no self-browsing; disinfect every frame touched. [See page 18 for a 12-point Covid-19 checklist for the optical dispensary.]
  3. Masks: matching cloth masks for staff members; every patient receives a disposable mask or they can bring their own.
  4. Shield for slit lamp. Doctors will wear a mask, face shield, and disposable gloves.

Extended Questions to Identify Covid-19 Exposure

  1. Screening scripts will be provided to staff and will be addressed at scheduling, check-in, and pretesting.
  2. A prescreening call will be scheduled on all conjunctivitis and therapeutic exam requests.
  3. For infected patients, we will extend prescriptions, ship needed products, and offer telehealth consults, with no in-office exam.

PART TWO: ACTION PLAN FOR THE OPTICAL

A 12-POINT CHECKLIST TO PREPARE YOUR OPTICAL DISPENSARY FOR BUSINESS POST-COVID-19 CLOSURE

BY OPTICAL MANAGER + OPTICIAN SHEENA TAFF

The optical shop is a touchy, feely, try-it-on place, where we as eyecare professionals work face-to-face with our patients.

Yet we are living in a new era, one that has both prospective buyers and opticians looking at this process through a different lens. It will be necessary to adapt our approach, and there is no better time to start than now.

Here, a 12-point checklist to follow when reopening the optical dispensary for frame and lens dispensing at your business.

#1:
SAFETY PROTOCOL TRAINING.

Train each employee on the new safety procedures in disinfecting and patient interaction. Wearing a mask, cloth or medical (N95 optional), shows your commitment to keeping your patients safe. Gloves are only safe if a new pair is used each time we touch a new patient. Proper handwashing is the best, easiest, and least expensive disinfecting procedure.

#2:
SET A CODE OF CONDUCT.

Create a code of conduct for patients and staff to follow. It will set the precedent of how staff and patients alike will view the changes in your service procedures. Examples:

Do not come in if you feel at all ill.

Sanitize your hands prior to touching products.

Come in wearing a mask.

Come with as few people as necessary, etc.

#3:
BOOK APPOINTMENTS.

Encourage patients to book an appointment, even if they are interested only in browsing for eyewear. This will help control the number of patients in the shop at any given time. Send an appointment confirmation text and/or email and share your Covid-19 safety procedures and code of conduct.

#4:
SCHEDULE STAFF APPROPRIATELY.

Create a schedule that has half of the staff members booked with appointments while the other half are available for walk-in patients and instant cleanup.

#5:
SET UP A HAND SANITIZING STATION.

Set up a hand sanitizing station front and center at the entrance to your optical shop or practice. Post a sign that encourages patients to communicate what makes them most comfortable.

#6:
PRE-SELECT FRAME OPTIONS.

Select frames that meet the needs and wants of the patient, and have them ready in an acrylic tray prior to the appointment. This will set the tone and demonstrate the value of your expertise as an optician.

Welcome patients to browse frames on display, but set some ground rules by telling them you will handle any frames they would like to try to ensure nothing goes back on the board without being properly disinfected.

#7:
LIMIT FITTING TABLES.

Reduce the number of fitting tables in your optical to add extra space for social distancing. If you have a waiting room, repurpose it to add more room for one-on-one fittings.

#8:
DISINFECT ALL FRAMES.

To disinfect frames before adjustments and after try-ons, use a frame wash bath, ultrasonic cleaner equipped with Sweep System Technology (for 10-15 minutes), or thoroughly wash in the sink with cool water and mild dish soap. This is safe for acetate and metal frames. Metal frames can also be disinfected with minimum 70% rubbing alcohol. If you have concerns about specific frame materials, request a recommendation from the frame manufacturer.

For patient’s own frame, ask them to place frames into the tray and drop the glasses into the cleaner for a full cycle or hand wash with soap and water before any adjustments.

#9:
DISINFECT ALL TOOLS.

Keep a bottle of minimum 70% isopropyl alcohol next to all your tools. Place each tool in a tray after use and be sure to disinfect them before another staff member uses them.

#10:
LIMIT PAYMENT CONTACT.

Contact your debit/credit machine company and request the tap limit to be increased to reduce the need for customers to have to touch the device. Disinfect the keypad with alcohol or virus-killing sanitizing wipes after each customer touches it.

#11:
COMMUNICATE WITH PATIENTS.

Ask patients to put the glasses on themselves, ask them to turn or move their head to do a thorough visual assessment, make the adjustments required, and ask that they share how it feels after you have stepped back.

There is no getting around that we must be closer than 6 feet to do an adjustment or to check the fit on a new frame. Wearing a mask and/or PPE and reducing the proximity of conversation reduces the risk of infection.

#12:
PUT AWAY THE PUPILOMETER.

Using a freestanding measuring system, such as a Visioffice or smart mirror, or marking a patient’s lenses will allow you to have greater distance between you and the patient. If you must use a pupilometer, add a plexiglass breath guard and ensure both patient and optician are wearing a mask.