Central Mersey Diabetic Retinopathy Screening Programme DRSS
Contents
1. d e n i e p d e x cl d e 1 Optometry Diabetic Retinopathy screening Log e 2 Practice Month jun 07 4 Grader 5 6 Date Surname uusnumber screened Graded 01 06 20 42 i i n 4 nNSheet1 Sheet2 Sheet3 Ie gt SCRL ee 8 Ty 0855 manual full Mi EG Microsoft Excel DRS There is also a Works Spreadsheet available to record the monthly activity It is completed in a similar way as the Excel sheet However you will need to make a separate file for each month if you want to save it 44 Payments for screening and grading The Screening Centre will also produce a report of the numbers you have screened and graded If there is any discrepancy between the figures you may be asked to submit your DRSS log You should receive the payment the following month and the amount should be stated on the next monthly payment agency statement Check that this item on your payment statement tallies with your own figure If there are any discrepancies you may be asked to submit your activity log for comparison Any adjustments will be made with your next payment 45 Appendix 1 Central Mersey DRSS Slit Lamp BIO Grading Form Patient s Name NHS Number Date Screening Practice SL BIO Grader Right Gradina Left RO None No retinopathy R1 Background Microaneurysm s or small retinal haemorrhages lt2. ok m ERES setup Bob Wikes Rainhil G RSS manual ful mi Image Transfer Completed EE 4 Repeat for any other clinics that you want to cancel 5 Close Appointments Window NOTE you cannot cancel a clinic which contains patients who have already been screened Patients who have not been screened will be returned to the Due for screening list Chapter 3 Booking Cancelling and Moving Appointments Many screening venues initially make appointments in paper diaries and or on practice administration systems The screening appointment is then transferred to the DRSS appointment some time after often in batches Sometimes there is a considerable gap between physically making the appointment with the patient and it appearing in the venue s DRSS diary This has led to several patients receiving a further invite letter and the Screening office handling several complaints from disgruntled patients It also causes considerable extra work to rectify the situation Once the patient has contacted the screening venue the appointment must be made in DRSS within 48 hours unless this was not possible If it is not possible this should be flagged up to the Screening office and the reasons must be clearly stated in Episode notes in the patient s DRSS record Procedure for booking appointments on the DRSS system You should already have clinics set up in the DRSS system for each day which you expec
3. Find Wednesday 13 June 2007 Wilkes Optometrist Ltd I ppointments nt lt gt Test Vision Warr2 2112 Central Optometrist Service set up Bob Wilkes Rainhill 8 Click on the patient s old appointment and it will be outlined in Blue Move the mouse over the thick Blue line to the Left of the patient s name and the mouse cursor will turn into a cross shape Click and hold the mouse button and drag the patient across from the Left hand pane to an appropriate time in your clinic on the Right The exact time is not critical to the DRSS system just the correct day for the appointment NOTE If the patient has already been screened or set to DNA Did not attend you will not be able to move the appointment and you will sometimes but not always get an error message to this effect Revision 12 logged on as RWILKES Appointments and Schedule Schedule Screening Days RD Wikes Optometrist Ltd gt Bob Wilkes Rainhill 2007 31 a 19 06 2007 1705 2007 RD Wikes Optometrist Ltd gt Bob Wikes Rant 13 06 2007 Wednesday 13 June 2007 Wilkes Optometrist Ltd Test Vision Warr2 211 16 Procedure for Cancelled appointments If a patient cancels an appointment
4. book them a new appointment 1 Select the Patients and Contacts Screen from the Tabs on the Left 2 Click on the Appointments button 3 On the Schedule Screening Days Tab Select the day of the patients old appointment 4 Click on the Patient Appointments Tab 5 The patient s appointment should be visible on the Left hand panel 6 In the Right hand pane you will see the word Ignore Use the drop down arrow to change this to On and then in the next box set the date when you want to make the patient s appointment and click on Search 7 Your appointment diary for that day should appear below If it doesn t you may not have an active clinic set up for that day you will need to return to the Schedule Screening Days Tab and set up a clinic for that day see overleaf you can then return to step 1 above and continue Orion DRSS 3 7 Revision 12 logged on as RWILKES Central Mersey Database Appointments and Schedule Schedule Screening Days J Patient Appointments RD Wilkes Optometrist Ltd gt Bob Wilkes Rainhill Search Clinic Wednesday 06 June 2007 30 appointment slots available gt Clinics A Location Al i Bob Wilkes Rainhill i On 13 06 2007 atier PATIENTS intr g RD Wilkes Optometrist Ltd gt Bob Wilkes Rainhill 13 06 2007
5. 3 In the next available row of the table area type in the date patient s name and NHS number 4 If you have only screened the patient type 1 in the Screened column 5 If you have only graded the patient type 1 in the Graded column 6 If you have both screened and graded the patient type 1 in each box 7 You can add extra rows by highlighting an unused row within the table area selecting the Insert drop down menu and click on Rows NB If you add extra lines and wish to print the form it will now print over more than 1 page PEE E er um i ITIN TEW T YET e Fo nO gt 21 21 EZ I m 47 Screened 0 48 Graded 0 4 gt MNSheet1 Sheet2 Sheet3 lt gt Ty DRSS manual full Mi aao 8 Aslong as you have added a 1 for each task performed the columns will automatically total at the bottom 9 Once you have completed the months activity the Log can be used to reconcile with figures supplied with the Screening centre Microsoft Excel DRSS monthly log Oy w File Edit View Insert Format Tools Data Window Help PDF Create T f SMS IPS gsHadlaa amp xan amp r 1158 07 oBuus Arial T1 BIU SSBB 3 H 9 A B bd f B EC pa 5558 EE
6. The most likely reasons are a The patient already under the HES specifically for diabetic retinopathy This does NOT apply to patients under the HES for other conditions such as Glaucoma who should be screened as usual b The patient is too infirm to be treated if needed and so should not be screened rare c The patient has opted out of the screening service They may withdraw this opt out at any time by contacting the DRSS Admin Team Screening pregnant ladies with diabetes To conform to NICE guidance on the screening of pregnant ladies the Central Mersey Screening Programme has established the following protocol Pregnant ladies with diabetes should be offered digital screening a soon as possible after their first antenatal clinic appointment and again at 26 weeks if the first assessment is normal and doesn t require referral If any diabetic retinopathy is present an additional assessment is required at 16 weeks The risk of development and the progression of existing diabetic retinopathy during pregnancy are greater than average Also treatment may be required early before later stages of pregnancy make treatment more difficult Therefore if the pregnant lady is found to have retinopathy of a degree of R2 1 or above they will be referred to the HES urgently Additionally pregnant ladies with referable retinopathy should be followed up at a hospital eye department for at least 6 months following the birth When a lady with
7. 0855 No Name DOB Time PIN Location All v Search Resource Bob Wilkes Rainhill m dear Patient Data Diabetes Care Data Eye Screening Eye Screening Summary Ethnicity Religion Date v 06 06 2007 1 05 2007 Language Not Stated Language RD Wikes Optometrist Ltd gt Bob Wilkes Rainhill 06 06 2007 Reg Blind n Diabetes County Extra ID 1 appointments 27 05 2007 Clinics Wednesday 06 June 2007 Wilkes Optometrist Ltd Reg Part Sighted C Diagnosed GP Details Not Entered Test Vision Sth 2100 Diabetologist Not Entered Ophthalmologist Not Entered Optometrist Not Entered Test Vision Warr 2111 Measured Allergic to drops Phenylephrine Hydrochloride _iCyclopentolate Hydrochloride Screen Loc Under care of Patient under sole care of screening service Add Edt archive SetFlag Save Show patients who already have a time scheduled Update Due Date 8 gt Logged on as RWILKES Unknown User Authority Central Optometrist Service set up Bob Wilkes Rainhill Image Transferfs Completed 10 You may get one of 4 things at this stage a b The Patient is correctly due for screening etc The App
8. 2007 D nd PATIEN wy Test Vision warr2 2112 Pease confirm that you wish to delete the episode for patient Test oon Sth 2100 By provider reason not specified By patient reason not specified Delete Appts Tstat OF 9 Select which reason most closely fits the reason for cancellation the choice is not very helpful so usually it will be By patient reason not given which you will select and click 10 The patient is now returned to the due for screening list and can be re booked in the usual way 11 Close Appointments Window 18 Acceptable access Anybody using the DRSS software is accessing patient sensitive information as with all aspects of work in the practice They should act responsibly at all times e g only searching patients you are booking for a screening not divulging patient information to other sources Transgressions will be monitored by the screening centre and could lead to suspension or removal from the screening programme e Access to a patient s DRSS record card is acceptable only by a registered member of staff and up to 3 months after the screening date This will be required for the following o Making and altering appointments o Reviewing screening outcome e Access to a patient s DRSS record card 3 months after the screening date is considered unacceptable and could lead to
9. 4 blot retinal haemorrhage s Any exudates outside the arcades R1 5 Background 6 cotton wool spots CWS R2 Pre proliferative Venous beading loop or reduplication Intraretinal microvascular abnormality IMRA gt 4 deep round or blot haemorrhages gt 6CWS R3 Proliferative New vessels on disc NVD New vessels elsewhere NVE Pre retinal or vitreous haemorrhage Pre retinal fibrosis tractional retinal detachment MO No Maculopathy MO 5 Maculopathy Circinate or group of exudates entirely within the arcades 1DA in size and more than 1DD from the centre of the fovea M1 Maculopathy Exudates within 1 disc diameter DD of the centre of the fovea L1 Circinate or group of exudates gt 1DD from the centre of the fovea but entirely within the arcades and 1 disc area DA in size L1 Any microaneurysm or haemorrhage within 1DD of the centre of the fovea ONLY if associated with a best VA of 6 12 or worse None No photocoagulation P1 Photocoagulation Focal grid to macula P2 Photocoagulation Peripheral scatter 0000 0000 oO Annual Review Requires urgent referral for Retinopathy R3 Requires routine referral for Retinopathy R2 or M1 I am referring to the HES for Cataract Extraction I am referring to the HES for another eye condi
10. Episode page Logged on as RWILKES Unknown User Authority Central Optometrist Service set up Bob Wikes Rainhill Image Transfers Completed 4 DO NOT UNDER ANY CIRCUMSTANCES CHANGE ANY DATA ABOVE THE LINE OF TABS This data e g name address NHS Number etc is critical to maintaining data integrity between the DRSS and GPs Hospitals It should only be changed by the Admin Team If a patient reports an error in this data e g a change of address report the error to the Admin Team DO NOT CHANGE THE DATA YOURSELF 5 Enter the Patient s 1 Recorded VA In the first box set the type of measurement e g Spectacles Pinhole etc then the VA itself in the second box Repeat for Left eye NOTE the VAs are recorded with a Log MAR and Snellen equivalent for each level You may need to scroll down a little way to find the one that you want If 21 6 7 exceptionally it is a contact lens VA use the Spectacles option You should not normally need to enter a 274 Recorded VA but may do if you feel it appropriate The VA should be measured using an appropriate test chart which must be set at the correct working distance VA should be recorded in the patient s DRSS record in all cases Please give best VA only and use the various sub levels to assist with audit The best VA will be e With spectacles if brought e With Contact lenses if wearing e After refraction if patient
11. Phenylephrine Hydrochloride Cydopentolate Hydrochloride Screen Loc Under care of Patient under sole care of screening service Set Flag Save om et Logged on as RWILKES Unknown User Authority Location Al Resource Bob Wilkes Rainhill f Clear Date Ignore 31 05 2007 y st osi2007 Show patients who already have a time scheduled Update Due Date Delete Appts Set Appointment Boundaries Report Suspend Transfer an Central Optometrist Service set up Bob Wilkes Rainhil 9 Click on the Jump to Next Appt button on the Top Right of the window 12 Image Transfers Completed EA Orion 085 Patient Demograp anged o 05 2007 09 42 48 Patient ID 2112 Local Auth Last attended NONE Next Appt Jump to Next Appt Tile Mr First Name Vision warr2 Initial surname Test Print Report Type Correspondence Name No Sex Street Home Tel oce Mobile Schedule Screening Days Patient Appointments Post Town Hospital 1st Appointment Bucket gt Central Server Whiston E Search Clinic _Openschedle Postcode L78XP Patient Contacts Extra ID
12. View 4 View 1 Capture Capture Source RDWilkes lt Directory Watch External 4p Connect Green lt Plane RGB Crop Gamma Box Enhance Annotation Zoom Resize 100 Fit to MERCIER True Size Mot urgent Lirgent Fairly Urgent Incomplete Image Upload Requested Screening Details P Grading CURRENT uit Print Exit gt 2 Chose and highlight the correct flag apice ROVWilkes Directores External p 3 Close the drop down menu monmeck 4 Click on save cre Gamma 5 Ensure the correct flag is still present Box Enhance Annotation omnee RESET True Size 6 If not repeat procedure 1 to4 7 Click on episode again before exiting the capture screen Screening Details Grading CURRENT Lib ee JD 1 46 30 Poor quality images The screener should make a comment in the patient s DRSS record card unless the images are at least fair If possible e g obvious cataract take an external image but still make a comment The main reasons for poor quality images include Cataract Poor dilation Ptosis External ocular condition Learning difficulties Artefacts If there is an obvious artefact make comments in the patient s DRSS r
13. and does not re book you will need to cancel the patient from your clinic in the DRSS system otherwise they will not be seen as due for screening when they do attempt to re book Even if a patient cancels on the day of the appointment itself you should still cancel their appointment using this procedure as setting a patient to Did not attend will block further appointments until the Admin Centre has re set them to Due for Screening 1 Select the Patients and Contacts Screen from the Tabs on the Left 2 Click on the Appointments button 3 On the Schedule Screening Days Tab Select the day of the patients appointment 4 Click on the Patient Appointments Tab 5 The patient s appointment should be visible on the Left hand panel 6 Click on the patient s appointment and it will be outlined in blue 7 Right Click on the patient s appointment Cem _ Report Suspend cinic Transfer All 17 8 From the drop down list select Delete Appointment Patient and Contacts Jg jul Schedule Screening Days 8 RD Wilkes Optometrist Ltd gt Bob Wikes Rainhill n Sopas Hd e Bi les Wednesday 06 June 2007 31 appointment slots available ind PATIENTS Bob Wikes Rainhil Ignore 31 05
14. diabetes becomes pregnant please inform the Screening Administration Centre to ensure they send the necessary invite letters Although the NSC guidance advises that digital screening after mydriasis should be used in pregnancy it also states that only registered doctors should use Tropicamide in pregnant ladies Therefore as no screeners in the programme would satisfy this requirement and we are advise that NSC insurance would not cover it s use by lay screeners or optometrists the best images possible must be obtained without dilation Booking appointments You may book a screening appointment locally on your practice appointment system without checking first with the DRSS appointment system BUT you must transfer that appointment on to the DRSS appointment system within 48 hours If there is a problem identifying the patient on the DRSS database you will need to resolve the problem before the screening appointment and this may be easier to do if the patient is still there It is not possible to screen a patient without first booking an appointment though the appointment could be booked on the same day as the screening if all the patient s details are correct If there are any difficulties booking an appointment for a patient you will almost certainly need to contact the Central Mersey DRSS Screening Centre on 0151 495 5100 to get the problem resolved Note the Admin Team works Mon Fri 9 00 to 5 00 No queries can be resolved outside these hou
15. disciplinary action e If you need access contact the Screening Office o Putthe request in writing o State the reason why you require access o The Management committee will make the final decision to grant access o The Patient may need to give additional consent 19 Chapter 4 On the day of appointment When the Patient Attends for Screening 1 Select the Photographer screen from the Tabs on the Left 2 Click on the Capture button 3 The Capture Query window will open Click on the Browse button NB the correct date will be pre selected by default Do not change the date if a patient with an appointment tomorrow were to attend a day early You should transfer their appointment to the correct day as per the instructions in Chapter 3 Booking Cancelling and Moving appointments 4 A list of today s patients will appear below NB this list does not refresh itself so you need to press Browse every time you use it to keep it up to date and remove completed patients as RWILKES Central Mersey Database updated 31 05 07 18 05 Capture Query appointments that have been set up ions use the search criteria below You can then select the appointment that you wish on To find capture sessi to capture images for from the resulting list and double click on it to proceed to the patient information screen An exclamation mark the status column indicates that the patient has arrived a tear dro
16. for further guidance 5 NOTE if the Comments button is pink or mauve rather than the usual grey there are already notes about this patient on the system and it important to check these 6 Record the Image Quality in the drop down boxes for each eye Note that if you record an image as Inadequate you will not be able to grade that eye Remember that ANY eye where referable retinopathy R2 R3 or M1 is visible is always defined as Adequate no matter how bad the image 7 If you graded either eye as Inadequate you should complete the grading of the other eye if possible Tip If when performing a Second Full Disease Grade you see an external eye photograph it is likely that the first grader considered that eye s images to be inadequate If however you disagree and feel that the images are gradable go ahead and grade them an Arbitration Grader will make the final decision 8 Record the gradings for each eye separately by clicking the relevant boxes You MUST record a value for M and P for both eyes unless Inadequate Hint If you double click on the text between 2 boxes both boxes will be crossed automatically 9 Do NOT cross the Other Conditions boxes You should deal with these lesions as per the Other Conditions Protocol 10 Once you have finished grading Click on the Summary Tab 11 Check that both Right and Left Eyes show a value for all 3 of R M and P If any are missing go back to th
17. grade i e you will not be offered gradings above your grader level or that you have already first graded g Patients will be offered in priority order with the most urgent at the top of the list so start at the top 33 h Double Click on the Patient that you want to grade i The Imaging Screen will appear and the images will be loaded this will take about 30 60 seconds j Click on Grading Current Go to the Performing a Grading instructions NOTE in the case of a Second Full Disease Grade you will NOT be able to see the outcome of the First Full Disease Grade This is to ensure that you are not influenced by the first grader s decisions Note that when you return to the Grading list after completing a grading it may well have changed as other graders may well be grading images too so you should return to step d and Click on the Browse button again to refresh the list rather than selecting another patient from the list since they may already have been graded by someone else Performing a Grading 1 2 3 4 If you have a dual monitor PC move the Grading Window onto the second monitor If you do not have a second monitor the Grading Window will disappear behind the imaging screen when you click on the imaging screen to work on photos This is normal and the Grading Window can be restored instantly by clicking once on the Grading Current button again Examine the photos for each eye as
18. imaging programme and import the images into it Don t forget to delete the images from the desktop once you have imported them otherwise the desktop will become very cluttered 11 Click on Save Episode This will take at least 2 minutes after the progress bar has finished indicating that local save is complete You may not be able to continue working with DRSS until the images have all been sent to the server 12 Always double save each image set by clicking Save Episode again This should be completed quicker than the first time 13 If there is significant Non Diabetes Related Pathology visible on any of the pictures AND you know that the problem is under management either by yourself or the patients GP or the HES or is of long standing add a comment to that effect using the Comments button bottom Right You may prefer to defer this step until you do the grading if you feel that would be best however remember that it may be difficult to resolve some issues once the patient has left the premises See the instructions in Chapter 8 on Non Diabetic related Pathology for further guidance NOTE if the Comments button is pink or mauve rather than the usual grey there are already notes about this patient on the system and it would be advisable to check these 14 If you are a grader and using a grading quality monitor as supplied by the PCT then you may click on Grading CURRENT proceed to first grade the images See Grading
19. is having an eye test at the same time e With Pinhole if no visual correction brought i e spectacles or contact lenses e With Pinhole if no current visual correction If the patient no longer has vision at all in an eye due to ocular disease or has a false eye please mark the VA as Opaque eye This will automatically go to Unassessable in the grading form and assist workflow If the eye has no vision or it is impossible to measure VA e g Learning Difficulties but images can still be taken mark the VA as No VA In both of these cases clearly state the reasons in comments Enter the type of First Dilation Drug used the normal case should be 1 Tropicamide number of drops used their batch Number and Expiry date the expiry date on Minims is only month and year so use the last day of the relevant month NB the batch and expiry date remain as defaults so long as you do not log off DRSS so you probably only need to enter this info once a day If exceptionally you need to use a second set of drops e g after 15 20mins if they haven t dilated enough use the Second Dilation Drug option in the same way as above The drop of choice for dilating is 1 Tropicamide Although 0 5 can be used it is not quite as effective particularly in older patients It is recommended to instil one to 3 drops of 1 Tropicamide depending on age and initial pupil size Details of the drops used should be recorded on the patient s DRSS r
20. mostly it will need setting Enter the Patient s Consent Ideally this should be Consent given for screening and Research so that we can use the images anonymously for research training purposes etc but if the patient specifically does not want their images used for research or training purposes the Consent Given for Screening is acceptable If the patient does not give consent for screening you cannot proceed You should explain to the patient the necessity for screening and the risks of opting out and that they cannot participate in the screening programme at all if they do not give consent including that their data will be held on the PCT s server etc If however they insist that they do not wish to give consent that is their right Set them as a cancelled appointment See Booking Appointments card You should advise the Admin Team so that they can be set as excluded Inform the patient that they may change their mind about this at any time and if so they should contact the Admin Team NOTE If a patient has been screened before their consent information from their last screening will already be shown in this field and probably won t need changing 10 Enter the appropriate value in the Eye Test box The important thing is to ensure that you select Eye test carried out if you did an eye test at the same time If you do not carry out an eye test you may use your judgement as to whether you recommend an eye test or no
21. records found Name Appointment Date Time Flag 5 The patient will then disappear from the list 6 The patient can still be found in the capture list if you deselect the Exclude patients who have DNA d tab and browse again They will have and x in the status bar 7 This will allow the Screening office to audit those patients who have not attended 8 If the patient attends later for screening you should be able to make an appointment again following the usual procedures If this is not possible contact the Screening Office 9A Capture Query To find appointments that have been set up for capture sessions use the search criteria below You can then select the appointment that you wish Ee sn EET I tcd i c buco page TD eR column indicates that the patient has arrived a tear drop indicates that they have been dilated and a tick mark indicates that they have been Resource Bob Wikes Rannit Patient ID Surname Location RD Wikes Optometrist Ltd Date of Appt 19 11 2009 and 19 11 2009 Filter Exclude patients who have been captured C Exclude who have DNA d it records found s PalientID Name sous Tast updated Status zii NOTE If a patient cancels the appointment ra
22. the screening venue should flag them up within the capture screen This will mostly apply to screening centres where the patient is having a sight test at the same time or to Screener Graders Please note that the Screener or venue will not be audited for accuracy but it is merely to improve and speed the flow of more serious retinopathy through the grading process It will also enable correct referral as appropriately as required e Fairly urgent Vessel abnormalities widespread and large haemorrhages particularly in the centre macular area If this is required phone or email the Screening Office and Bob Wilkes Clinical Lead e Urgent New vessels vitreous haemorrhage or signs of retinal detachment If this is required phone the Screening Office urgently and send an email immediately to Bob Wilkes Clinical Lead Missing incomplete images Images should always be double saved before exiting the capture screen Also regularly check equipment and connections If image sets are incomplete e Flag as Incomplete images e Inform the Screening Office e The screening office will request download of images from the screening venue and flag the images as Download requested e Once the images are complete they will be re flagged for grading 299 How to flag up images 1 In the capture screen select the image flag drop down menu Resource Unknown Date 00 00 00 Right Left
23. C folders for the images you took earlier NB It is very difficult to find images direct from the large image library of your imaging software so it is advisable to follow step 2 above Select and highlight each jpeg file at a time and import it NB It is not possible to import all at once Each image will drop into the space below as though you had just captured them Once each image is added proceed with steps 8 to 15 above NB This procedure must only be used when you are temporarily unable to capture images in the usual way using the DRSS software It must never be used to add other images to the patient s DRSS record even old images Camera settings The Cheshire digital imaging document demonstrates the correct camera setting Image positions The NSC policy document states the following Macular e Centre of fovea X1DD from centre of image and vessels clearly visible within 1DD of centre of fovea e Vessels visible across gt 90 of image Adequate e Centre of fovea 22DD from edge of image e Vessels visible within 1DD of centre of fovea Nasal e Centre of disc lt 100 from centre of image and fine vessels clearly visible on surface of disc e Vessels visible across gt 90 of image Adequate Complete optic disc gt 2DD from edge of image e Fine vessels visible on surface of disc 28 Flagging up Image sets Referable Retinopathy Where there appears to be gross or significant retinopathy on the images
24. Central Mersey Diabetic Retinopathy Screening Programme DRSS User Manual Edited by Bob Wilkes Optometric Lead Version February 2009 Review Due August 2009 Index Chapterl Appointments for Diabetic Retinopathy screening Chapter 2 Procedure for Setting up Clinics Chapter 3 Booking Cancelling and Moving Appointments Chapter 4 On the day of the appointment Chapter 5 Image Capture Chapter 6 Grading images Chapter 7 Slit Lamp BIO for Poor Images Chapter 8 Non Diabetes Related Retinal Pathology Chapter 9 Keeping a log of patients screened and graded Appendix1 Central Mersey DRSS Slit Lamp BIO Grading Form Appendix 2 Useful contacts Chapter 1 Appointments for Diabetic Retinopathy Screening Who can be screened Three conditions must be met to enable a patient to book a screening appointment 1 They must be registered with a GP in the Halton amp St Helens PCT Knowsley PCT or Warrington PCT areas 2 They must be on their GP s local Diabetic Register These local registers have been used to create the DRSS master register which holds the screening data NOTE newly diagnosed patients may take a week or two before their details are available on the DRSS register 3 They must have been set as Due for Screening by the DRSS admin team This is sometimes referred to as in the bucket clinic A few patients will have been excluded form the screening service and will not appear on the database
25. Images instructions 15 Otherwise exit the Imaging Screen and the close Patient Demographics window If you refresh the Capture Query list click on Browse the patient just photographed should have disappeared from the list 16 Thank Patient and inform them that they should get their formal results letter in a couple of weeks GRADERS ONLY may inform the patient of their Provisional results subject to the formal letter if they wish to Other members of staff should not comment on the results Downloading Images to DRSS It may be necessary occasionally to download images taken using your usual software e g if there is a temporary break in DRSS or VPN connection if your own server goes down while the patient is ready for imaging 1 Take images using your usual software and save them into the patient s record in the database The patient can then leave the practice 2 Import the images into a folder on the Desktop or in My Documents and name them so you can find them easily later 3 When you are able to access DRSS again if necessary go through the usual procedures for Booking cancelling and deleting an appointment in Chapter 3 and the day of the appointment in Chapter 4 4 Follow steps 1 to 4 of the procedure for Image Capture earlier in this chapter but do not click connect and connect to the camera 27 5 6 7 8 Click on the button You can then browse in the P
26. a set usually 2 photos but exceptionally there may be 3 a Use True Size or Zoom in to at least 90 on each image and scroll across whole image b View each image using the Green button and in G Plane view which gives a Black and White image These tend to enhance the haemorrhages on the images You can also still use zoom in these settings or switch to these after zooming in on features c You may also enhance Contrast and or Brightness using the button etc as you feel helps but be aware of the risk of introducing artefacts by over enhancing an image especially with increased contrast d Be particularly aware NOT to record dust spots etc on the camera as lesions These will be obvious because they will appear identically on all 4 photographs e NOTE If you have lost the Grading Window whilst doing this you can get it back by clicking on the Grading Current button again If there is significant Non Diabetes Related Pathology visible on any of the pictures AND you know that the problem is under management either by yourself the patients GP or the HES or is of long standing add a comment to that effect using the Comments button bottom Right This may already have been done at the Photography stage but it is worth remembering that it may be difficult sd to resolve some issues once the patient has left the premises See the instructions in Chapter 8 on Non Diabetes Related Retinal Pathology
27. an arbitration grade for a final decision If the final grade agrees that the images are ungradable the patient will be sent a second letter by the screening centre with a list of providers asking them to book for SL BIO assessment The whole process may take some time Therefore only book a SL BIO screening appointment after the patient has received a letter requesting them to book one There are 2 possible modes for screening and grading using SL BIO 1 If the patient s images cannot be graded due to cataract and you are accredited to the St Helens and Knowsley Cataract Assessment Scheme then perform a Cataract assessment which includes SL BIO with Volk lens examination Grade the patient for retinopathy and also decide whether to refer the patient for cataract surgery using the usual protocol The current assessment fee can be claimed using the usual forms but no additional grading fee 2 If the patient doesn t have cataract or you are not accredited to the St Helens and Knowsley Cataract Assessment Scheme perform a screening and grading using SL BIO assessment with Volk lens There will be a screening fee for this service but no additional grading fee die SL BIO Screening procedure l If the patient has been set to have Slit Lamp screening with Volk lens they will receive a second invite from the screening centre with a list of locations they can attend Dilate the patient with your usual mydriatics NB Even i
28. e Grading Tab and finish the grading 12 Click on the Save Tab 13 Make a final check of the result summary 14 If absolutely necessary change the Review or the Referral type You should NEVER reduce the level of referral e g change an Urgent to a Routine or increase the Review or screening interval e g increase a 6 moth recall to 12 months You may in extremely unusual circumstances increase the urgency of a referral or shorten the recall interval You WILL be asked to explain why you made the change Remember that the second grader will need to agree with you as well 15 Click on Save button 17 Close Exit the Imaging Screen 35 Chapter 7 Slit Lamp for Poor Images SL BIO grading should only be necessary on patients where you cannot obtain a gradable image If one eye is gradable and the other Unassessable then the gradable eye should still be graded from the photographs Any eye with Unassessable images should also have an external eye photograph taken showing the red reflex in the pupil This is important as it gives the second arbitration graders a better idea of what the problem with the images is Note this requires particular care in a case where the Grader is not taking the photographs Every grading where the images for at least one eye are marked as Unassessable will go through secondary grading In some cases the second grader may set a grade and the images will go to
29. ecord Some patient records may be annotated to suggest that Phenylepherine is also required to achieve better dilation The Clinical Director and Clinical Lead believe that there are no significant risks in using 1 drop of 2 596 Phenylepherine additionally when there is poor dilation after 20 minutes We therefore advise that it is used by all Screeners and Screener Graders as required to achieve fuller dilation This should also be recorded on the patient s DRSS record card Drops should be procured stored and used according to NSC protocol as well as City amp Guilds training for lay Screeners and Screener Graders and professional guidance for lay Screeners and Screener Graders Em 8 9 Any adverse reactions to drops should be reported in the patient s DRSS record and the Screening office should be informed If necessary the patient should be referred for medical attention Although the NSC guidance advises that digital screening after mydriasis should be used in pregnancy it also states that only registered doctors should use Tropicamide in pregnant ladies Therefore as no screeners in the programme would satisfy this requirement and we are advise that NSC insurance would not cover it s use by lay screeners or optometrists the best images possible must be obtained without dilation Set the patient s Attendance to Attended on time or If late was still seen NOTE It may already be set to this in some cases but
30. ecord card If there is a persistent artefact the front of camera will probably need cleaning If this doesn t solve the problem contact your equipment provider for maintenance The main reasons for artefacts include Dust Dirt Condensation Smudge Hrs Chapter 6 Grading images Ways to get to the Grading Screen 1 Asa First Full Disease Grade immediately following Image Capture a Click on Grading Current from the Imaging Screen Go to the Performing a Grading instructions 2 Asa First Full Disease Grade after the Imaging Screen has been closed Query Builder for Captured Images Please select the criteria For the images which you would like to view and then cick on PERFORM SEARCH to see a st of all episodes which match the selected criteria Patient ID Surname Date of Capture Resources Al Patient GP Image Status my level or below lindude urgent cases only Jump to Patient Perform Search Name Urgency Resource Episode Date a Select the Grading screen from the Tabs on the Left Click on the Grade Images button The Grading Query window will open Select YOUR OWN resource i e practice name from the drop down box on the top Right of the list selector Click on the Perform Search button Grade all patients flagged as Urgent first Grade all patients who are
31. een Transfer All User Authority Central Optometrist Service set up Bob Wilkes Rainhill 11 In the Right hand pane you will see the word Ignore Use the drop down arrow to change this to and then in the next box set the date when you want to make the patient s appointment and click on Search 12 Your appointment diary for that day should appear below If it doesn t you may not have an active clinic set up for that day you will need to enter the main Appointments window and set up a clinic see overleaf This cannot be done whist the Appointments and Schedule window is still open Close this window follow the instructions for setting up clinic dates and then return to the Patient Demographics window and proceed from step 7 13 Drag the patient across from the Left hand pane to an appropriate time in your clinic on the Right The exact time is not critical to the DRSS system just the correct day for the appointment 14 14 Close all the open windows If a patient changes the day of their appointment If a patient changes the time of their appointment on the same day you do not need to take any action as the DRSS system does not take account of time of appointment only the day date NOTE You cannot move an appointment that is in the past has already been screened or set to DNA Did not Attend If a patient has previously DNA then you should re
32. f only 1 eye had poor images and only that needs SL BIO screening it is still advisable to dilate both eyes as some patients may have more difficulties with monocular dilation Examine the patient using SL BIO and Volk lens Complete a paper grading form A copy can be printed from this manual at Appendix 1 Record all features seen during the examination Ensure that you have set a grade for Retinopathy R Maculopathy M and Photocoagulation P Fax the completed report form to the Central Mersey DRSS Screening Centre on 0151 420 4157 Ifthe grading indicates that the patient require referral for diabetic eye disease the screening centre will contact the patient direct and make the necessary arrangements If you have carried out a cataract assessment follow the usual protocol regarding referral and recall If you judge that the patient requires referral for cataract refer using the cataract assessment form If they require referral for other conditions other than diabetic eye disease refer the patient in the usual way NB The screening centre will not make appointments for non diabetic eye conditions 27 Chapter 8 Non Diabetes Related Retinal Pathology Inevitably some patients will present with pathology visible on their photographs which is not related to Diabetic Retinopathy This Service is specifically and only intended to screen for Diabetic Retinopathy and is not a general eye test service Patients are speci
33. fically advised in all letters sent them by the Service that they should also have a normal sight test regularly with their own Optometrist as well and that the DR Screening Service is not a substitute for a sight test Most pathology should not be managed via the DRSS or its software and would generally result in advising the patient to attend their regular optometrist for a sight test eye examination However a very few conditions Melanoma Retinal Detachment and possibly early Wet AMD are both so obvious that they cannot be missed and so serious that they cannot be ignored and need a different approach Note the Other Eye Disease tick boxes on the Grading Form have no effect on the outcome of the screening at all Ticking these boxes is acceptable if you wish to BUT will not cause the condition to be referred or reviewed There are also significantly fewer options available to Second Graders as they do not have the patient present to ask questions etc and in fact cannot even see the patient s name Because of this the Photographer First Grader must handle such patients correctly to avoid placing any colleagues who subsequently grade the images in a difficult position First Grader or Photographer The screener will at least have the patient present to ask questions etc and often also have sight test records as well They are also in a position to refer the patient to their GP or the HES if appropriate The decision as to whether the P
34. flagged as Fairly Urgent second Grade second grades next Double Click on the Patient that you want to grade The Imaging Screen will appear and the images will be loaded this will take about 30 60 seconds cB og 2523 Episode Number 1 Click on Grading Current Go to the Performing a Grading instruction If image sets are incomplete flag as Incomplete images and inform the Screening Office The office will request download of images from the screening venue and flag the images as Download requested Once the images are complete they will be re flagged for grading Ww 3 For extra gradings to make up your 500 gradings per year remember this is around 42 per month or 10 per week not allowing for holidays These may be any level of grade though most will probably be Second Full Disease Grades a Select the Grading screen from the Tabs on the Left b Click on the Grade Images button The Grading Query window will open c Select resource i e practice name from the drop down box on the top Right of the list selector NB is the default so this should be already set d Click on the Browse button e You will not be offered ANY patient identification data Name or NHS Number for patients that are not already in your local database i e patients that you have already made an appointment for or screened f Patients will be displayed that YOU are eligible to
35. have set up a clinic for the wrong day e g a holiday it doesn t matter just don t book patients into that day No one but your practice staff can book appointments into your clinics 7 Close Appointments Window To Delete a Clinic Mostly this is not worth the effort just don t book any patients into the clinic and leave it empty WARNING if you delete a clinic you may not be able to re book another clinic on the same date in the future This is a bug that will be fixed in due course but in the meantime it would be best NOT to cancel a clinic at all to avoid the issue Just cancel any patients that are booked in that day and leave the clinic empty If you absolutely have to cancel a clinic proceed as follows 1 follow steps 1 and 2 as above 2 This will show the Schedule Screening Days Tab Double click on the Clinic that you want to cancel 3 Select Delete on the dialogue box The Click on Yes to confirm the deletion are listed the current details for the selected clinic Change the clinic by clicking in the Clinic List below and modify and settings that you need to IF any settings are not available it is likely that patients have already been assigned to this clinic Clinic List Minute ME Minute iUc 06 06 2007 Fixed Schedule
36. hotographer or the First Grader deals with commenting on Non Diabetes Related Retinal Pathology will depend on how the practice manages their patient flows If the First Grading is done whilst the patient is present then these issues should be dealt with by the First Grader If however the Grading will not take place until sometime later then it is probably best for the Photographer to manage this process assisted by an optometrist if needed It is not possible to delete or edit comments once added though both the Photographer and First Grader could add separate comments if needed 38 If the patient is also having sight test at the same time Then the usual rules apply regarding detecting signs of disease and referrals should be handled via the usual routes etc This is entirely correct and does not affect the DRSS processes at all EXCEPT that the Second Grader will see the non diabetic pathology and be concerned that it has not been managed so you MUST make a Comment see below on the DRSS software to explain the situation If the patient has not been tested by you This situation is more difficult as you will not have access to the full patient records You should try to determine if the patient is already aware of the problem e g already been referred to the HES etc If not you should use your professional judgment to decide on the seriousness of the problem In the extremely rare case that you judge it to be a serious and u
37. ional consent Chapter 2 Procedure for Setting up Clinics Setting up clinics You should set up a separate Clinic for each day that the practice is open 1 If itis not already showing select the Patients and Contacts Screen from the Tabs on the Left 2 Click on the Appointments button Orion DR 7 Revision 12 logged on as RWILKES Central Mersey Database 5 Appointments and Schedule Schedule Screening Days Sn show oniy selected resources C Schedule 3 This will show the Schedule Screening Days Tab 4 Drag your Location and Resource from the bottom of the window to the day when you want to set up the clinic Click on Yes on the resulting Dialogue box Show only selected locations Select All Go To Date Cental Optometrist Service set up Bob Wikes Rainhil E O ee 5 Repeat the above for all days in the month that you expect to see patients There is no penalty for setting up too many clinics and it is an irritation if you find half way through booking an appointment that there isn t already a clinic on the correct day so it is best to pre set clinic for every day when the practice is open 6 You may do this for as many months ahead as you like If you turn out to
38. nditions are not being screened subject to National Screening Committee standards NSC national policy is that all patients under the HES for conditions other than Diabetic Retinopathy should be screened as normal If in any doubt please contact the optometric lead Bob Wilkes on 0151 426 2214 Searching for patients For access to the patient s DRSS record at an optometry site you will require the following information e NHS Number e Patient s date of birth For access to the patient s DRSS record at an NHS site you will require the following information e NHS Number The patient must give consent for screening This is usually given by the patient handing over the screening invitation to the screening venue to book an appointment or passing on this information to a member of staff over the phone Acceptable access e Access to a patient s DRSS record card is acceptable only by a registered member of staff and up to 3 months after the screening date This will be required for the following o Making and altering appointments o Reviewing screening outcome e Access to a patient s DRSS record card 3 months after the screening date is considered unacceptable and could lead to disciplinary action e If you need access contact the Screening Office o Putthe request in writing o State the reason why you require access o The Management committee will make the final decision to grant access o The Patient may need to give addit
39. od enough view of the small vessels at the macula and disc as bare a minimum then you should also take an external eye photo showing the red reflex to illustrate the degree of lens opacity Click Disconnect to disconnect from the camera Drag any unwanted photos to the Recycle Bin in the bottom Right hand corner Right click on each of the thumbnail images in the bottom Left hand corner of the screen in turn and select the correct label i e Right Macular Right Nasal Left Macular Left Nasal and any additional ones e g 3 photo or external photo as Right Other or Left Other NOTE that the Disc Centre field is somewhat perversely labelled as Right or Left Nasal Imaging should conform to the Screening Protocol and NSC requirements for image positions 10 Saving Images to your usual Software You may export a copy of a set of images to store on your practice imaging system e g Eyecap Imagenet Optisoft etc IF a You are performing some other service for the patient e g sight test AND b The Patient consents to you making storing the copy To export a copy drag any of the images into the main viewing window Right Click on the image and Select Export all images Confirm Patient consent Select the location for the images to be exported to usually the desktop is easiest and click on Save in the dialogue box 296 Once you have finished using DRSS minimise close DRSS and enter your usual
40. of patients There are 2 options for recording the data Use one file for each month e Highlight the file and right click e Select copy and ok e You can rename the copy for the required month Use one file for the whole year 1 Create a new file for the year 2 Create a worksheet within the file for each month by clicking on the Sheet 1 tab choose move or copy 3 Check create a copy and move to end Excel DRSS monthly log Screened Graded 4 Click ok 5 You can rename the sheet by right clicking on the sheet tab choose rename and then type something like June 2007 41 DRSS monthly lo SABRES I i s i o N gsm a Screened 48 Graded 0 52 Select All Sheets Tab Color ESSE EIE STE SERES 1 Js i xl sd Filling in the DRSS Monthly Log 1 Type in the practice name and any specific grader you wish to log in the area at the top 2 Add the relative month e g February 2009
41. ointments Schedule window will open with the patient in the Left hand pane You will be able to recognise this situation as the Left hand pane will be mostly white with the patient s name in a pale yellow strip at the top and the location shown at the top of the Left hand pane will be CCPCT Server Go to instruction 10 below The patient already has an appointment with you The Appointments and Schedule window will open showing the patient s appointment in the Left hand pane This situation will be apparent as the Left hand pane will be mostly pink and or purple in colour rather than white in case a above The location shown at the top of the Left hand pane will be your practice You could then use this window to transfer the appointment to a different day if you wish Go to instruction 6 in the section If a patient changes the day of their appointment NOTE if the patient has already been screened or set to DNA Did not attend you will not be able to move the appointment you will sometimes but not always get an error message to this effect If this happens go to 12 You may need to ring the Admin Team to get this resolved The patient has an appointment with a different practice You will get a dialogue box saying that the patient already has an appointment in a clinic at another resource You will need to resolve this problem with the patient and possibly get the other practice to cancel the other appointment 13 d The pa
42. p indicates that they have been dilated and a tick mark indicates that they have been captured Location RD Wikes Optometrist Ltd E Resource BobWikes Ramnhil v Date of Appt On m 13 06 2007 and 81 05 2007 Patient ID Filter Exclude patients who have been captured Z Exclude patient s who have DNA d D 1 records found Logged on as RWILKES Unknown User Authority Central Optometrist Service set up Bob Wilkes Rainhil start Orion DR R 5 Double Click on the correct patient The Patient Demographics screen will appear Go to the instructions below for Preparing the Patient for Photography 6 If the patient doesn t attend DNA follow the instructions below for If a patient fails to attend their appointment 23 7 Refresh this list by returning to instruction 4 above which will remove patients who have been screened or Do Not Attend Preparing the Patient for Photography 1 the Patient Demographics screen should already be showing with the Eye Screening Tab showing 2 Confirm the patient s identity before proceeding 3 Click on Edit Orion DRSS v 3 7 Revision 12 logged on RWILKES Central Mersey Database Capture Query last updated 31 05 07 18 06 Capture Query To find appointments that have been set up for capture sessions use the search crite
43. rgent problem Melanoma or visible Retinal Detachment or possibly early Wet AMD then you should refer the patient appropriately If the problem is less immediate e g suspicious Naevus substantially cupped disc say 0 8CD or worse you should advise the patient to have a sight test as soon as possible If you think it appropriate you could also give the patient a note of your findings to take along to their own optometrist Whatever the outcome you must remember that the Second Grader will see the non diabetic pathology and be concerned that it has not been managed so you MUST make a Comment see below on the DRSS software to explain the situation Making Comments 1 Whilst on the Image screen either during Photography or subsequent First Grading click on the Comments button bottom Left 2 Click on Add Note 3 Type whatever note is appropriate and click on Save This note may be a one such as Don t worry about Disc cupping patient is on treatment for Glaucoma 4 Please keep comments as short as possible and limit comments to one of the following c Already on treatment for 222 5 These notes cannot be edited or deleted once saved Any number of individuals who see the images for whatever reasons may add comments but PLEASE only add comments that are necessary e g not still got of similar comments 6 The Comments attach to the patient rather then the specific set of images so they will alway
44. ria below You can then select the appointment that you wish to capture images for from the resulting list and double click on it to proceed to the patient information screen An exclamation mark in the status column indicates that the patient has arrived a tear drop indicates that they have been dilated and a tick mark indicates that they have been captured Location RD Wilkes Optometrist Ltd Resource Bob Wilkes Rainhill Date of Appt 13 06 2007 v ana 44052007 Patient ID Fiter Exclude patients who have been s 13 06 2007 10 15 Patient ID 1 Melon warr NemejNo sex 0 0 8 01 05 2007 Work Tel Extra ID 1 17 Patient Contacts Extra ID 3 Patient Data Diabetes Care Data Eye Screening Eye Screening Summary Ophthalmology Review Patient Notes Episode Notes 1st Recorded VA RE 1st Recorded VA LE 2nd Recorded VA RE 2nd Recorded VA LE First Dilation Drug Second Dilation Drug Batch Number Expiry Batch Number Expiry Episode Type Normal Diabetic Retinopathy Screening Episode Driving Visual Field Eye Test Concurrent Examination Patient capture issue mages Capture Episode 1 of 1 13 06 2007 10 15 00 ad cx setro o cance Create
45. rs or on a Saturday Therefore if a patient makes an appointment after 5 00pm or on a Saturday it is important to ensure that you set up their appointment on the system in advance as you won t be able to resolve any problems when the patient actually attends for their appointment Possible appointment booking scenarios Patients with a letter from the DRSS inviting them to make an appointment These should be easy to identify and are already set due for screening NOTE check spelling of name against the letter if you have any problems identifying the patient on the DRSS system Patients who try to book for screening but have no letter You will need to phone the Admin Team to find out why they haven t received a letter of invitation There may always be exceptional cases where in your clinical judgement a patient presents with symptoms signs which make an additional screening episode advisable In such a case contact the Admin Team for authorisation You should be aware that such requests will be audited by the clinical lead Newly diagnosed patients These cannot be screened until their GP has notified the DRSS Admin Team of their diagnosis These patients should be automatically set due for screening once received by the Team Remember that this process may take a few weeks Please notify the Admin Team if you come across a case where this delay exceeds 4 weeks If a patient attends your practice having been asked to by the doctor wi
46. s be visible at all future viewings gradings of any images for that patient 7 You only need to Comment on pathology that is visible on one of the photographs Pathology outside this area is irrelevant 39 Second Grader A Second Grader does not have access to the patients name or any records other than the images on the DRSS system If you see any Non Diabetes Related Retinal Pathology on an image that you are grading firstly check the Comments button bottom Left of Images screen TIP the Comments button is Pink or Purple if there are any Comments on this patient s records Hopefully the Comment s will explain the situation and resolve the issue If there is not a Comment to explain the pathology and you feel that it requires investigation ring the Central Mersey Admin Team on 0151 495 5100 and quote the patient s ID Number Top Right of Images screen Give a brief explanation of the problem This will be passed on to a clinician who will have access to the Patient s name and other details and will check with the First Grader and or Optometrist to ensure the problem is dealt with Alternatively the Screening centre could contact the patient and ensure they obtain further assessment 40 Chapter 9 Keeping a log of patients screened and graded There is an Excel file available for keeping a log of patients screened and graded in each calendar month The file has a worksheet to maintain details and total numbers
47. t based on their circumstances e g date of last test 11 Press Save to store the data You could swap between Edit and Save modes several times if needed e g save after First Drops then return to Edit to add Second Drops and the Save again 12 Once all the required fields VA First Drops Attendance Consent and Eye Test are completed and saved click on Images Capture and you will be transferred to the Imaging Screen 13 See instructions in Chapter 5 on Image Capture EL If a patient fails to attend for their appointment 1 Select the Photographer screen from the Tabs on the Left 2 Click on the Capture button 3 The Capture Query window will open 4 Right click on the patient who failed to attend and select Did not attend no warning given option n as RWILKES Central Mersey Database last updated 19 11 09 13 05 tanum Qum find appointments that have been set up for capture sessions use the search criteria below You can then select the appointment that you wish Semana ome es to epe dn screen An exclamation mark in the status patient has arrived a tear drop indicates that they have been diated and a tick mark indicates that they have been 2 RD Wilkes Optometrist Ltd x Resource Bob Wilkes Rainhill on 91009 ond 9112009 v Exclude patients who have been captured v E Exclude patient s who have DNA d Ce Browse 1
48. t to do screenings on See separate instructions for Setting up Clinics in Chapter 2 1 If itis not already showing select the Patients and Contacts Screen from the Tabs on the Left 2 Click on the Find Patients button and the Patients Query Builder should appear T0 Orion DRSS 3 7 Revision 12 logged as RWILKES Central Mersey Database Patient Query Builder Patient gt Patient Search Search Criteria mer Enter the details of the patient or patients you want to search for in the boxes below Searchiand Report E o ert EU Hospital Number Other ID New Query Preview Report Surname Forename L _ Close Query Edit Report Address containing CI Dont show episodes Tel No containing Available Reports Sex Ignore ory invalid t your system admin Date of Birth On Appointment Date Ignore X Search for Search for Surgery _ Ignore Jump to Next Appointment Patient ID Other ID Central Optometrist Service set up Bob Wilkes Rainhill Image Transfer s Completed 3 Enter the patient s NHS number and click on Browse 4 Enter the patient s Date of Birth then click on Browse 5 NB Ensure both fields are completed Access to
49. the record card will be denied with the NHS number alone 6 The patient should appear in the list below If no patient appears in the list then check that the date of birth and details spelling with the patient invitation letter are correct If you still cannot find the patient then contact the Central Mersey DRSS Screening Centre on 0151 495 5100 7 Double Click on the patient in the list A progress bar appears at the bottom of the screen 8 The Patient Demographics window should appear Make sure that this is the correct patient 11 Patient ID 2112 Local Auth Patient Appointments Search Clinic Openscedue Clinics Schedule Screening Days Post Town Hospital 1st Appointment Bucket gt Central Server Whiston County Extra ID 1 appointments 27 05 2007 Postcode 17 8XP i Patient Contacts Extra D m Patient Data Diabetes Care Data Eye Screening Eye Screening Summary Ethnicity Religion Language Not Stated Language Reg Blind o Diabetes Reg Part Sighted C Diagnosed GP Details Not Entered Diabetologist Not Entered Ophthalmologist Not Entered Optometrist Not Entered x Measured Allergic to drops a d
50. ther than just fails to attend you should follow the procedures in the Booking Appointments section of these instructions either to cancel or change the appointment as setting a patient to Did Not Attend blocks further appointments until the patient is re set to Due for Screening by the Admin Team 25 Chapter 5 Image Capture 1 2 3 4 5 6 7 8 9 If your camera is shared between 2 computers ensure that the camera is connected or switched to the correct computer If required ensure that Nikon capture is running and DRSS Image capture Link is open This is mostly for Topcon cameras using ImageLink software Once all the required fields VA First Drops Attendance Consent and Eye Test are completed and saved click on Images Capture and you will be transferred to the Imaging Screen Check the patient s name and NHS number again Top Right hand corner Click Connect to connect to the camera Take the 4 required photographs a Right Macular Macula in Centre b Right Nasal Disc in Centre c Left Macular Macula in Centre d Left Nasal Disc in Centre If any are inadequate poor quality re take them If exceptionally you feel that a 3 picture of an eye would be of value e g if all the required areas would be gradable off 3 images rather than 2 images then that is acceptable If an eye cannot produce a set of images which are acceptable for grading purposes in effect a go
51. thout having first received an invitation letter from the DRSS admin team contact the GP either directly or via the patient and remind the GP that a patient cannot be screened until the GP has informed the DRSS Admin team that the patient is now diabetic NOTE Newly diagnosed patients especially type 2 diabetics must be screened as soon as possible after diagnosis You may or may not wish to perform a GOS test at this time depending on your professional judgement However if you wish to delay the GOS test until the blood sugar is more stable that is ok BUT do not delay the retinal screening because of concerns over when to do the GOS test It is quite in order to do the screening straight away and the GOS test a few weeks or months later if you feel that is best for the patient but the screening must be done ASAP If a patient is under the care of an Ophthalmologist 1 Specifically for assessment treatment of Diabetic Retinopathy then they should not be screened These patients will be excluded from recall letters and should not present for screening but the admin team are relying on information from the HES If you come across a patient who in your opinion is under the HES specifically for Diabetic Retinopathy who has received an invitation for screening letter please contact the Admin Team so that they can block further reminders until the patient is discharged 2 For any other reason Patients attending an eye specialist for other eye co
52. tient is not set due for screening by DRSS system You will get a dialogue box saying appointment available for this patient Check that the patient really is due for screening and if necessary contact the Central Mersey DRSS Screening Centre on 0151 495 5100 to get the problem resolved Remember the DNA did not Attend patients are not returned to the Due for Screening list until the next weekday morning when the Admin Team will re set them First Nam Correspondence Appointments and Schedule Schedule Screening Days 1st Appointment Bucket gt Central Server Whiston 0 appointments 27 05 2007 L7 8xP Patient Contacts DRSSNo Name DOB Time Diabetes Care Data Eye Screening Eye Screening Summary Ol 81 05 2007 Not Stated RD Wilkes Optometrist Ltd gt Bob Wilkes Rainhill 06 06 2007 9 a Wednesday 06 June 2007 Wilkes Optometrist Ltd press vision sth 2100 Test Vision Warr 2111 Phenylephrine Hydrochloride enylep _ Cyclopentolate Hydrochloride Patient under sole care of screening service Show patients who already have a time scheduled Update Due Date Show Full Scr
53. tion Oooo oo 46 Appendix 2 Useful Contacts Central Mersey DRSS Screening Office Manager Paula McGarry Direct Line 0151 495 5104 Address Mill Brow Widnes Cheshire WAS 6RT Tel 0151 495 5100 Fax 0151 420 4157 paula mcgarry nhs uk Orion Clinisys Helpline 01633 486 399 diabetessupport clinisys co uk VPN Connection issues All areas 0151 676 5678 St Helens and Knowsley IT helpline 0151 430 1172 andrew nicholson sthkhealth nhs uk Halton IT helpline 01928 593080 helpdesk hsthpct nhs uk Warrington IT helpline 01925 843620 dean eyre warrington pct nhs uk 47 Clinical Clinical Director Prasad Palimar prasad palimarQ nch nhs uk Clinical Lead Bob Wilkes Tel 0151 426 2214 bob rdwilkes co uk Warrington Optometric Lead Finlay Rosenburgh Tel 01925 721071 frosen fsbdial co uk Commissioning Halton and St Helens Deborah Leigh 01928 593717 deborah leigh hsthpct nhs uk Knowsley Sharon Glynn 0151 443 4911 sharon glyn knowsley nhs uk Warrington Helen Pressage 01925 843720 helen pressage warrington pct nhs uk 48
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