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Analysis

Focus on 3 Areas When Caring for Vision-Impaired Hospital Patients

By Christopher Cheney  
   August 21, 2019

Measures designed for vision-impaired patients include focusing on discharge and medication management, patient safety, and special accommodations.

Caring for vision-impaired patients in the hospital setting poses several unique challenges that institutions and care teams can address.

Recent research found that vision-impaired Medicare beneficiaries and commercial health insurance patients had significantly higher healthcare utilization and costs during and immediately after hospitalization. Pitfalls for vision-impaired patients include difficulty following hospital routines and struggles reading discharge orders and medication instructions. The excess costs were estimated at more than $500 million annually.

It is imperative for hospital staff to actively engage vision-impaired patients and their families, says Lisa Allen, PhD, MA, chief patient experience officer at Johns Hopkins Medicine in Baltimore, which includes the Wilmer Eye Institute.

"The biggest issue is to ask the patient or the patient's family what they need to keep them safe. We need to ask that question to everybody, but that patient engagement question is the most important piece for visually impaired patients. When we assume there is a one-size-fits-all for the visually impaired, we are making a mistake," she says.

Vision-impaired patients are not monolithic, Allen says. "A lot of vision impairment happens late in life. So, you have age-related vision loss, and that's different than the experience of people who were either born blind and educated as blind students or lost their sight early in life and had more opportunities to adapt. In other words, if you are not a braille reader—and many blind people are not braille readers—then having braille is not going to help when you are in the hospital."

Johns Hopkins Medicine and Bascom Palmer Eye Institute share best practices for hospitals and health systems in caring for vision-impaired patients. The best practices include measures designed for three areas: discharge and medication management, patient safety, and special accommodations.

1. Discharge and medication management
 

In addition to providing discharge instructions in large font type, Johns Hopkins has the capability to audio-record instructions for vision-impaired patients, Allen says. "For people who may not feel comfortable using a smartphone or a computer, having a recording can be helpful."

Johns Hopkins also provides discharge instructions in a format that can be used with a screen reader.

Designing processes and aids for medication management can be vital for vision-impaired patients, she says. "There is special attention paid to the visually impaired patient to make sure they understand their medications and that medications are laid out correctly and patients understand the schedule. Most of the medication packaging has braille; but not every visually impaired patient knows braille, so medication boxes have large print."

2. Patient safety
 

Johns Hopkins staff are trained to promote safety for vision-impaired patients, Allen says.

"Our call button has braille on it, and it is a large button. Staff show visually impaired patients a couple of different ways to utilize it," she says.

After surgery, all Johns Hopkins patients have a staff member with them when they are getting up for the first time and when they are walking the hallways, which is important for early ambulation.

There is an extra step for vision-impaired patients, Allen says. "Our physical therapists and techs are all trained to ask the vision-impaired or the blind patient, 'How would you like me to best lead you?' It is really important to ask that question because people have different preferences depending on how long they have been blind, how comfortable they are, or their visual impairment."

At the University of Miami Health System's Bascom Palmer Eye Institute, stairwells are designed to lower fall risk for vision-impaired patients, says Eduardo Alfonso, MD, director and chief medical director. "To increase the safety of patients and companions who take the stairs, we lengthened the staircase guard rails so they extend beyond the bottom of the stairs."

3. Special accommodations
 

Johns Hopkins and Bascom Palmer have implemented a range of special accommodations designed to boost the patient experience of the visually impaired.

All Bascom Palmer and University of Miami Health staff members are trained how to help vision-impaired patients, Alfonso says. Staff members offer guidance to visually impaired patients from check-in to discharge, he says. "It's not just Bascom Palmer staff. Use of sighted guide techniques, providing verbal instructions as needed, and practices to assist people with guide dogs are part of orientation for all UHealth staff."

Johns Hopkins is implementing a Bluetooth way-finding app that can be used from home and while using public transportation, Allen says.

"We made sure when we bought the program that it had voice capability, so it can tell you to go to an elevator, it can tell you that you are at an elevator, it can tell you what floor button to push, and it can guide you throughout the inside of the hospital. It gives the visually impaired patient independence. Often for blind people, they have to wait for transport even though they are perfectly capable of getting around with a guide dog or a cane," she says.

At Johns Hopkins and Bascom Palmer, signage and patient-oriented displays have been designed with vision-impaired patients in mind.

"Updated signage with high contrast colors and consistent lighting, and door signage in braille are prime examples. In addition, we are updating patient surgical display boards to make them easier to read, including a different font and color enhancements," Alfonso says.

Room utilization is a key component of patient experience for vision-impaired patients, Allen says.

"All patients are oriented to their room; but, certainly with the visually impaired patient, we make sure that they understand how far the bathroom is, where the bathroom is located, and how to use the equipment in the room. The other piece is training our food service staff to announce when they come into a room. They need to make sure that food is within easy reach. We want to make sure that happens for all patients but especially for the vision impaired," she says.

At inpatient units, Johns Hopkins has clinical customer service coordinators whose training includes working with the visually impaired, Allen says. "For example, there was a visually impaired woman whose husband was having surgery. The customer service coordinator made sure she got to the cafeteria, made sure she had coffee or water if she wanted it, and helped her find a place to take her guide dog outside. So, we are very sensitive and want to make sure that people's needs are met."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Recent research found that excess costs in the care of vision-impaired hospital patients are estimated at more than $500 million annually.

Johns Hopkins is implementing a Bluetooth way-finding app that vision-impaired patients can use to navigate hospital facilities.

While braille is an essential component of serving vision-impaired patients, most people who experience vision loss late in life cannot read braille.


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