Clinic Handbook

Mission and Goals of NSUOCO clinics
NSUOCO Mission Statement
Mission Statement of NSUOCO Clinics
Goals of the Clinical Program
Patient Rights/Responsibilities
Patient’s Bill of Rights
Patient’s Bill of Responsibilities
Complaint Process
Notice of Privacy Practices
Student Clinician Responsibilities
Attendance Policy
Absence Request Process
Extenuating Circumstances
Start of the semester absences
Inclement Weather
Make-Up Clinics
Additional (Elective) Clinical Attendance
Student Travel Policy
Examination Room Protocols
Duties in Clinic
Student Clinic Assignments
First Year
Second Year
Third Year
Fourth Year
External Rotations
Evaluation and Grading of Student Clinicians
Counseling and Advisement of Student Clinicians
Grading of Clinical Performance
Daily Grading - The Closing Interview
Periodic Clinical Progress Review
Disciplinary Dismissal of Students from Clinic
Procedure for Student to File Grievance
Procedure for Faculty to File Grievances
Maturation of Clinical Proficiency
First Professional Year
Second Professional Year
Third Professional Year
Fourth Professional Year
Ongoing Assessment of Clinic Competency
Procedure for Third and Fourth Year "Proficiency Demonstrations"
Patient Logs
Clinic Protocols and Procedures
Titles to Be Used in Clinics
Professional Clinical Dress Code for All Clinics
Photo/ID Badges
Personal Hygiene
Food and Beverages
Optical Equipment Technician
Responsibility for Clinic Equipment
Care and Use of Equipment
Supplies
Diagnostic and Therapeutic Pharmaceuticals
Contact Lens Disinfection
Infection Control Policy
Ancillary Tests by Optometry
Building Security Policies
Building Security
Use of Clinics for "Special Exams" and "After Hours"
Access to Academic Areas
Clinic Operational Protocols
Waiting for Patients
Sign-in by Patient
Patient Tardiness
Patient Cancellations
Stand-by Patient Status
Overloads in Clinic
Hours of Clinic Operation
Documentation of Phone Consultations with Patients
In-Hospital Referrals
Outside Referrals - Cherokee Nation Contract Health
Return Visits to Clinic
No Show Policy
Patient Accident/Patient Illness While in Clinic
Intoxicated, Belligerent, Harassing Patients
Insufficient Pharmaceuticals
Dispensing of Pharmaceuticals
Fire Alarm While in Clinic
Take-Cover Alarm While in Clinic
Complaints and Directives from Health Center Staff and Administrators
Clinical Faculty Responsibilities
Role of Clinical Instructors
Faculty Assignments to Clinics
Teaching
Intercession into Exam by Faculty
Patient Records and Charts
Confidentiality of Patient Records
Medical Records Release
Administrative Protocols
Associate Dean
Assistant Dean for Clinical Affairs
List of Principal Clinics and Service Units
Clinic Chiefs
Service Unit Chiefs
Function of Principal Clinic Units

NSUOCO Mission Statement

The Northeastern State University College of Optometry (NSUOCO) provides an educational program leading to the Doctor of Optometry degree, post-graduate clinical residency certification, and continuing optometric education.

Our primary mission is:

The education of excellent optometric physicians who through excellence in academic and clinical instruction, are able to provide the highest quality clinical care and who emphasize an ethical and caring commitment for the welfare of patients.
To deliver quality clinical services to the patients served by NSUOCO.

To remain committed to a teaching environment conducive to excellence in education through faculty and students who are diverse, who embrace life-long learning, independent critical thinking, research and scholarly activity, and who have a desire to contribute to society through community.

The Optometry program is the sole doctoral program at Northeastern State University. Consistent with the mission of the University, the College of Optometry mission reflects the high aspirations and commitment to education made in 1846 by the founders of the original Cherokee seminaries.

Mission Statement of NSUOCO Clinics

The clinics of the College of Optometry have two primary missions which guide them:

- - To provide Optometry students, residents, post-doctoral fellows, and faculty with facilities, equipment, and patients which provide educational, research, and service opportunities to produce highly skilled optometrists, as well as opportunities for the advancement of the practice and profession of Optometry.
  - To provide patients with the highest level of preventive, diagnostic, and therapeutic eye health and vision care. The balance between educational objectives and patient service is delicate but must be maintained for the good of the students and of the communities which they serve. These primary missions are highly compatible and need not be mutually exclusive. An environment that fosters motivated clinicians who acquire and apply new knowledge and new techniques, under the guidance and direction of competent and interested faculty, results in a higher level of patient care.

Goals of the Clinical Program

Educational

1. To provide facilities and opportunities for students and residents to develop the understanding and skills needed to practice comprehensive, full-scope, primary care optometry.
2. To provide an environment conducive to learning and mastery of the science and the art of optometric practice.
3. To provide a forum for the sharing of ideas and experiences relating to the practice of optometry.
4. To provide an atmosphere of professionalism, and to convey a sense of those standards, ethics, and obligations that should govern health care professionals.
5. To provide students and residents with guidance, support, and assistance as they acquire and enhance their clinical skills.
6. To encourage creative thinking and productive clinical research.
7. To provide students and residents with timely and appropriate criticism and advice, while emphasizing and encouraging positive growth and development.
8. To provide access to new and current knowledge, theories, and techniques which relate to the diagnosis and management of eye and vision problems.
9. To allow for a degree of flexibility which enables motivated students and residents to pursue areas of special interests and study.
10. To encourage students and residents to continually strive for excellence.

Service to Patient

1. To provide comprehensive, full-scope primary optometric care and services.
2. To protect the welfare and confidentiality of the patient, and to respect the patient’s rights and personal wishes.
3. To treat each patient as an important person.
4. To foster a sense of confidence and trust by the patient.
5. To provide appropriate examination, diagnosis, management, and treatment services to patients.
6. To protect patients from inappropriate and/or harmful or useless medications, prescriptions, treatments, and therapies.
7. To provide appropriate communication, guidance, and counseling to patients with hereditary or acquired disorders or diseases.
8. To fully and properly advise patients about their eye health and visual system problems and the options available to them for the management and treatment of those problems.
9. To seek to obtain appropriate consultation and referral services when this is in the patient’s best interest.

Patient’s Bill of Rights

The Northeastern State University College of Optometry recognizes and affirms the rights of its patients, as listed below.

1. The patient has the right to considerate and respectful care and to receive the institution’s highest efforts at providing quality care regardless of race, creed, religion, age, or national origin (consistent with Federal and Cherokee Nation organizational guidelines for facilities which serve Native Americans).
2. The patient has the right to obtain from his or her doctor complete, current information concerning diagnosis, treatment, and prognosis in terms that the patient reasonably can be expected to understand. When it is not professionally advisable to give such information to the patient, the information should be made available to an appropriate person in his or her behalf. The patient has the right to know by name the student doctor and faculty member(s) responsible for coordinating his or her care.
3. The patient has the right to receive information necessary to give consent prior to referral for additional care and prior to the implementation of any program of therapy. Except in emergencies, such information for consent should include, but not necessarily be limited to, the specific procedure and/or treatment, the health-related risks involved, and the probable duration of treatment. When significant alternatives for care or treatment exist, or when the patient requests information concerning alternatives, the patient has the right to know the name of the person(s) responsible for the procedures and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the consequences of his or her action.
5. The patient has the right to every consideration of his or her privacy concerning his or her own health care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discretely. Those not directly involved in that patient’s care must have at least the implied permission of the patient to be present in the examination room.
6. The patient has the right to expect that all communications and records pertaining to his or her care should be treated as confidential.
7. The patient has the right to expect that the optometry clinics will make a reasonable response to a request for services. The clinics must provide evaluation, service, and/or referral as indicated by the urgency of the need. When necessary, a patient may be referred to another facility or provider of health services only after he or she has received complete information and explanation concerning the needs for and alternatives to such a referral. The provider or institution to which the patient is to be referred should receive full information regarding the need for additional consultation and treatment upon the consent of the patient.
8. The patient has the right to obtain information as to any relationship between the optometry clinic and other care providers to which he or she is referred. The patient has the right to obtain information as to the existence of any professional relationship among the individuals who are treating him or her.
9. The patient has the right to be advised if the optometry clinic proposes to engage in or perform human experimentation affecting his or her care or treatment. The patient has the right to refuse to participate in such research projects and to receive more traditional care, or be referred for such, if it is available.
10. The patient has the right to expect reasonable continuity of care. He or she has the right to know in advance what appointment times and services are available and where. The patient has the right to expect that the optometry clinics will inform him or her of any continuing health care requirements following treatment.
11. The patient has the right to be informed of all professional fees prior to the provision of such services. He or she has the right to examine and receive an explanation of the bill, regardless of the proposed source of payment.
12. The patient has the right to know what institutional rules and regulations apply to his or her conduct as a patient.
13. The patient has the right to know that review procedures exist and has the right to be advised of how they may be initiated. These rights are stated in the expectation that all clinical faculty, staff, and students will support them, and thereby respect the individual dignity of each patient. It is only in the atmosphere of such respect that the best vision care can be provided.

Patient’s Bill of Responsibilities

The Northeastern State University College of Optometry defines the responsibilities of its patients, as listed below. (Adopted from the Cherokee Nation Patients’ Bill of Rights and Responsibility)

1. The patient has the responsibility to treat the staff, students and faculty of the college with consideration and respect.
2. The patient has the responsibility to take an active part in their own health care.
3. The patient has the responsibility to follow the treatment plan they agree to with their eye care provider and if for some reason they cannot, the patient has the responsibility to let their eye care provider know.
4. The patient has the responsibility to observe the rules of the program and facility, which are for the safety and consideration of all patients and staff.
5. The patient has the responsibility to respect the property and not to deface or destroy any part of it.
6. The patient has the responsibility to provide the clinic staff and providers accurate information regarding their overall health, the specific eye care problem they are seeking treatment for, and any medical insurance they may have or may be eligible for.

Process for Patient to File Complaint

The clinical staff provide first contact with a complaining or hostile patient. Staff, faculty and students should remain polite and respectful when encountering a patient perceived to be hostile. If the complaint is beyond the scope of responsibilities of that person, they should provide access for the patient to the appropriate Clinic Office Manager. Each facility has a process by which a patient can file a complaint. All clinical support staff at each site must be familiar with the process for their location.

The Clinic Office Manager at the particular site should hear the patient’s complaint and may be able to offer a solution (for example, opportunity to reschedule). The Clinic Office Manager should politely offer the patient the opportunity to contact the Assistant Dean for Clinical Affairs to discuss the problem. If the patient so wishes, this contact should be arranged immediately.

The Clinic Office Manager should direct the patient to the Cherokee Nation employee designated to respond to patient complaints (the Patient Advocate). This Patient Advocate documents the complaint and does all follow up until the issue is resolved.

If a patient’s complaint involves concerns about the patient’s privacy and/or a possible violation of HIPAA, the complaint is processed consistent with NSUOCO’s HIPAA compliance policy.

Notice of Privacy Practices

Effective Date 04/14/2003

Northeastern State University Oklahoma College of Optometry 1001 N. Grand Avenue

Tahlequah, OK 74464

Tel: 918-444-4000

Fax: 918-458-2104

Public Information Officer: Ms. Jennifer Jones, Coordinator of Clinical Management This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.

Treatment, Payment, and Health Care Operations

The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations" mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.

We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.

Uses and Disclosures for Other Reasons Without Permission

In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all.

Such uses or disclosures are:

When state or federal law mandates that certain health information be reported for a specific purpose.
For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices.
Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence.
Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws.
Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies.
Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else.
Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations.
Uses or disclosures for health-related research.
Uses and disclosures to prevent a serious threat to health or safety.
Uses or disclosures for specialized government functions, such as for the protection of the president or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service.
Disclosures of de-identified information.
Disclosures relating to worker’s compensation programs.
Disclosures of a "limited data set" for research, public health, or health care operations.
Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures.
Disclosures to "business associates" who perform health care operations for us and who commit to respect the privacy of your health information;
Uses and disclosures to be utilized in our facility directory. Our facility directory is used to let someone that came with you to your appointment know the status of your care within our facility that day. For example, if your friend or family member asks how much longer you will be with your appointment.

Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eye care.

Appointment Reminders

We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.

Other Uses and Disclosures

We will not make any other uses or disclosures of your health information unless you sign a written "authorization form." The content of an "authorization form" is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it’s your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours.

If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this notice.

Your Rights Regarding Your Health Information

The law gives you many rights regarding your health information. You can:

Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the office contact person at the address or fax shown at the beginning of this notice.
Ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using E mail to your personal email address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person at the address or fax shown at the beginning of this notice.
Ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30-day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to the office contact person at the address or fax shown at the beginning of this notice.
Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons whom we know received the wrong information, and others that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30-day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the office contact person at the address or fax shown at the beginning of this notice.
Get a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include: disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30-day extension of time if we notify you of the extension in writing. If you want a list, send a written request to the office contact person at the address or fax shown at the beginning of this notice.
Get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the office contact person at the address or fax shown at the beginning of this notice.

Our Notice of Privacy Practices

By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we

change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.

Complaints

If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person at the address or fax shown at the beginning of this Notice. If you prefer, you can initiate your complaint in person or by phone, to be followed by a written statement.

For More Information

If you want more information about our privacy practices, call or visit the office contact person at the address or phone number shown at the beginning of this notice.

Acknowledgment of Receipt

I acknowledge that I received a copy of NSU College of Optometry’s Notice of Privacy Practices.

Patient Name
Signature	Date

Attendance in Clinics

Students enrolled in clinical courses are required by the Oklahoma State Regents for Higher Education to be in attendance for a designated amount of time. In addition, as health care providers, patient care is a primary responsibility of the College, its faculty, and its students. Effective fall semester 2023, the clinical absence policy is as follows.

Clinic Swaps

Students will be allowed to swap clinics with the following requirements:

Documentation in advance via email addressed to the other student involved in the swap, all attending doctors involved and all clinic chiefs involved in the swap.
Both students in the swap must be in the same year of the program.
Both clinics must be equivalent as defined below:
- 1G = 2G = PC
- OD = DD
- WI = WIS
- SF = DSN = DS
- Las = SP = ODSx
- GL = DM = Ret = DC = EDx
- IV = NVR = VT
- PV = LV
- BA = REP
All other clinics not listed above can only be swapped clinic for clinic. (E.g., CL can only be swapped for CL.)

If an absence occurs in the swapped clinic, both students must report to the Assistant Dean for Clinical Affairs to determine the appropriate action.

Clinic Absences

Students will be allowed the following clinical absences that don’t have to be made up
1^st year: 1 clinic absence
2^nd year: 1 clinic absence
3^rd year: 2 clinic absences
4^th year: 4 clinic absences

Each clinic is a four-hour block. The students will need to request clinical absences 28 days in advance. Requests for absences with less than 28 days of advanced notice may be denied.

At the beginning of each summer semester each student will be allocated their number of absences allowed during that clinical year. Any unused absence allowance from previous semesters will not be rolled forward.
The purpose of the different number of allowed absences based on the student’s year in the program is two-fold. The students are assigned more clinics per week as they advance through the program. Because of the heavier clinic schedule, there will be fewer opportunities for swaps as students progress through the program.
When a student is absent from their scheduled clinic, the student’s available absences must be applied first. If the student’s absence balance drops into the negative, the student will be required to make up two clinics for each subsequent clinic missed while in the negative.

- For example, if a student has exhausted their allowed clinical absences and is absent for 1 entire clinical day (2 clinics), the student will be required to make up 2 clinical days (4 clinics). Students will be informed that these make up clinics likely will be during breaks (i.e. Fall Break, Thanksgiving Break, Spring Break, Winter Break, etc.) and will likely be made up at an REP clinic.
- Exceptions to the 2:1 make up are:
  - Absences that are medical related (doctors note required)
  - Absences that are inclement weather related where NSU is closed
  - Both of these exceptions will remain 1:1 make up
- When a student does not give 28 days of advance notice and still has absences available, the absences will be docked at twice the normal rate.
  - For example, if a 4^th year student with all 4 absences remaining chooses to be gone for 1 entire clinical day (2 clinics) and does not give 28 days of advance notice, the student will be docked 4 clinical absences and will then have 0 clinical absences remaining.
  - Exceptions to the 2:1 make up are:
    - Absences that are medical related (doctors note required)
    - Absences that are inclement weather related where NSU is closed
    - Both of these exceptions will remain 1:1 make up
  - When a student is absent from their scheduled clinic without 28 days of advance notice, and has exhausted their allowed clinical absences, the student will be required to make up three clinics for each clinic missed.
    - For example, if a 3^rd year student has exhausted their 2 clinical absences and is absent for 1 entire clinical day (2 clinics) and does not give 28 days of advance notice, the student will be required to make up 3 clinical days (6 clinics). Students will be informed that these make up clinics likely will be during breaks (i.e. Fall Break, Thanksgiving Break, Spring Break, Winter Break etc.) and will likely be made up at an REP clinic.
    - Exceptions to the 3:1 make up are:
      - Absences that are medical related (doctors note required)
      - Absences that are inclement weather related where NSU is closed
      - Both of these exceptions will remain 1:1 make up
    - The purpose of the “2 for 1” and “3 for 1” clinic absence makeup is due to the fact patients are scheduled for visits during clinic. Missing a clinic on short notice will cause a significant inconvenience for the patient, and likely will cause the need for rescheduling of that patient. This could lead to significant ocular health issues for a patient having to be rescheduled for an appointment. For that reason, 28 days’ notice is required when requesting clinical absences. If 28 days’ notice is not provided, then the clinic missed will be required to be made up 2 for 1. If a student has already used up all of their clinical absences, and still chooses to be gone with less than 28 days’ notice, then the clinic missed will be required to be made up 3 for 1. Exceptions to this policy will be instances where the student could not have reasonably provided 28 days’ notice, for example deaths in the family (which are discussed elsewhere in the policy) and illnesses (which require doctors notice and are also discussed elsewhere in the policy)
    - Excused absences are absences that will not reduce a student’s absence total. Absences that are considered excused include:
      - American Academy of Optometry Meeting
      - American Optometric Association Meeting
      - State Optometric Association Meetings, Limit 2 state meetings per year
      - Heart of America Meeting
      - Required meetings for students in optometric leadership positions
      - National Board of Examiners (NBEO) Part 3 testing. Students may request a maximum of 4 clinical absences (2 days) for NBEO Part 3 testing. 28 days of advance notice must still be provided.
      - Death of an immediate family member (parent, stepparent, grandparent, sibling, spouse, children)
      - The above listed excused absences will be granted without any adverse effect on the student’s clinical absences allowed based on their year in the program, and no clinics will have to be made up, as long as 28 days of advance notice is still given when possible and applicable.
      - As a reminder, a special student clinic schedule is created for AOA, Academy and OAOP fall and spring meetings.
    - A student should not come to clinic ill when putting the health of others in danger. The clinical absences allowed based on their year in the program are to be used in the case of illness. The following rules apply for illness:
      - If a student comes to clinic ill and is sent home by the attending doctor the clinical absence policy will apply and the student will be docked 1 absence for each clinic missed.
      - If a student calls in sick the clinical absence policy will apply and the student will be docked 1 absence for each clinic missed, provided that the student provides a doctor or nurse’s note documenting the illness. The note must be given to the Associate Dean or Assistant Dean of Clinical Care within 3 days after returning to clinic.
      - If a student calls in sick and cannot provide a doctor or nurse’s note documenting the illness, the clinical absence policy will apply and the student will be docked 2 absences for each clinic missed.
    - Students have the opportunity to bank/increase their absences according to the following rules:
      - Students can only bank (increase their absence balance beyond the year’s allowance) if impending medical events are anticipated. Using make-up clinics to increase the balance above zero needs to be discussed with and approved by NSUOCO administration.
      - Clinics can be banked only in the REP clinics or CNOHC when space allows.
      - Clinics can be banked only between semesters or during breaks during the semester (ex spring or fall break).
    - Taking more than 2 absences for the same clinic (for example CL or VT, etc.) in one semester requires approval by the Clinic Chief.

Make-Up Clinics

If a student’s absence balance is below zero at the end of their academic year, an incomplete grade for that clinical course will be assigned and will revert to a failing grade (F) if not made up. Arrangements must be made with the Associate Dean or Assistant Dean to make up absences in excess of the allowed absences.
An opportunity is given to utilize make-up clinics to allow students who have experienced attendance hardships or other unusual events to meet their clinical obligations. This opportunity is also afforded the students to allow and encourage student travel to and participation in professional meetings. Clinic rotations used for make-up must meet the educational requirements of regular clinic rotations in patient care and supervision.
Make-up clinics will be used to return the student’s absence balance to zero. Students will not be allowed to use make-ups to increase their absence balance above zero unless approved for extenuating circumstances by NSUOCO administration.
Students will sign up for available clinic opportunities. Make-up clinic assignments will be approved by the Assistant Dean for Clinical Affairs prior to the student scheduling the make-up clinic. At the completion of each make-up clinic, students must have the supervising faculty person document their attendance and the student is responsible for submitting that documentation to the Assistant Dean or College Administration Office.
Students are not allowed to use make-up clinics to shorten their final semester.

Punctuality and Professionalism

Attendance and punctuality are required in meeting all clinical assignments. Students should report to the supervising faculty at the beginning of each clinic assignment. Any student reporting later than 5 minutes after the start of their assigned clinic will have a tardy noted on their clinic grade slip for that clinic session, for the purpose of monitoring for trends. Any student reporting later than 15 minutes after the start of their assignment to clinic will have an absence reported, pending evaluation of the Absence/Lateness Report.
Students are required to be present 5-10 minutes prior to the start of their clinic. For example, 8:00 clinics necessitate a student being in their exam lane by 7:50-7:55. 1:00 clinics necessitate a student being in their exam lane by 12:50-12:55. The purpose of this is so the student is ready to go and has their exam lane and equipment ready to go for their first scheduled patient which usually is at 8:00 or 1:00. A student not meeting this time criteria may be given a tardy for the clinic by their attending doctor.
Students who arrive more than 15 minutes late after the start of the clinic (after 8:15 or after 1:15) will be required to make up the clinic.
Anyone who will be absent from an assigned clinic without being previously excused must notify the appropriate Clinic Chief, clinic staff person, or the Assistant Dean either by phone call (no voice mail) or in person or text message. This needs to be done before the clinic start time, if at all possible, and needs to be followed by an email to the Assistant Dean for Clinical Affairs immediately. In addition to clinical management and patient care issues, the College is concerned for the welfare of the student. If someone is absent for an unknown reason, the faculty and staff will attempt to locate the student to ensure that there is no cause for concern. Clinic Staff must file an Absence/Lateness report on any student who fails to arrive at their clinical assignment. At his/her discretion, the Associate Dean or Assistant Dean may require the student to make up two or more clinics for each one missed. Students dismissed from clinic for any reason will be assigned an absence to be made up. All such absences must be made up and will be brought to the attention of the SAEC for possible disciplinary action.
(Note: Students may be "released" from clinic without penalty but only by the faculty member and only when all clinical obligations are met for that session.)

A maximum of 2 absences can be used the last week of 4th year clinic.

Absences During 4^th Year Externship

Students are allowed 2 clinical absences (1 full day) per 8 weeks. Beyond that, days must be made up.
Must be approved by the following individuals (in order):
- Director of externship
- Externship site supervisor.
Students must provide 28 days’ notice (when applicable) and if not, the days must be made up 2:1. This includes requesting an absence for boards. There is not a reason for less than 28 days for boards.
No study days given for Part 1 and Part 2 boards (or days have to be made up). 2 days given for Part 3 as per current policy.
Same excused absences will apply as mentioned above.
At the discretion of the Director of Externships and Assistant Dean for Clinical Affairs, externship absences, including the 2 allowed absences, may be required to be made up for a variety of reasons, including, but not limited to, unprofessional conduct, tardiness, excessive absences, etc.

Student Swap Request Process

Clinical duty swaps should be clearly described by submitting a "Clinic Swap Request" email consisting of the standard format shown below. The email is to be addressed to the other student, both attending doctors and both clinic chiefs for the clinics to be swapped. The other student must reply-all to confirm their commitment to swap. Each clinic chief will reply-all and add the appropriate clinic scheduler to the email so the proper documentation of swapped clinics for that student can take place. The list of approved clinics which can be swapped is located earlier in the section entitled “Clinic Swaps”.
Recipients:
Student B, both clinic chiefs and both attending doctors

Subject line:
Format: Student Swap Request (Student A, Clinic A abbreviation, Date, AM or PM/Student B, Clinic B abbreviation, Date, AM or PM)

Message:

Format:

Hello Dr. Clinic Chief 1 and Dr. Clinic Chief 2,

Student B and I would like to initiate a clinic swap.
Student B will be covering my Clinic A abbreviation clinic on Clinic A day of week AM or PM on date.
In exchange I will cover their Clinic B abbreviation clinic on Clinic B day of week AM or PM on date.

Please let me know if you approve this swap. Thank you for your time. Have a great day.

your name

Please see the list of clinic chiefs and faculty directory link below.

Student Absence Request Policy

Students may request permission to be absent from an assigned clinic session by submitting a "Student Absence Request" email consisting of the standard format shown below. The email is to be addressed to the Attending Doctor and the Clinic chief for the clinic to be missed based on the following list. The Clinic Chief has the authority to approve/disapprove requests and has the option of making alternate arrangements with the student to make-up an absence. If approved, the clinic chief will reply-all and add the Assistant Dean for Clinical Affairs to the email as well as the staff person responsible for scheduling the clinic. The Assistant Dean for Clinical Affairs will approve/disapprove the request and assign the number of clinics to be docked. The Assistant Dean will reply-all and add the Clinical Absence Coordinator to the email so the proper documentation of missed clinics for that student can take place. A clinic chief’s decision to disapprove an absence request will be honored by the Assistant Dean.

Recipients:
Clinic chief and attending doctor

Subject line:
Format: Student Absence Request (clinic abbreviation, e.g. WI) - your name absence date AM and/or PM

Message:
Format:

Hello Dr. Clinic Chief,

I am respectfully requesting a clinic absence from stated clinic on Day, AM or PM, Date for the following reason: stated reason. Please let me know if you ok this absence request or if I need to make other arrangements. Thank you for your time. Have a great day.

your name

Clinic Chiefs:
All CNOHC Clinics Dr. Earlena McKee (mckeeef@nsuok.edu)
All REP Clinics Dr. Ryan Fenska (fenska@nsuok.edu)
CL Clinic Dr. Latricia Pack (packl@nsuok.edu)
IV Clinic Dr. Alissa Proctor (proctor1@nsuok.edu)
VT Clinic Dr. Sarah Krein (gallaghs@nsuok.edu)
EDx Clinic Dr. Neal Whittle (whittle@nsuok.edu)
Spec Care Clinic/ODSX Clinic Dr. Nate Lighthizer (lighthiz@nsuok.edu)
NSU LV/Parkview/BA LV Dr. Jonathan Hatley (hatleyjm@nsuok.edu)
NVR Clinic Dr. April Parker (deloacaj@nsuok.edu)
DS/DSN/SF Dr. Alan McKee (mckeeag@nsuok.edu)
All other NSU clinics not listed here Dr. Joseph Shetler (shetler@nsuok.edu)

Other faculty email addresses can be found in the NSUOCO Faculty Directory.

Extenuating Circumstances

If a student believes he or she is experiencing extenuating circumstances causing absence from clinic, the student may appeal to the Dean’s Council (or a committee appointed by the Dean) for special consideration. This may include a situation where a student is undergoing an extensive illness, or other situation where special considerations need to be made.

Start of the Semester Absences

In regard to students requesting clinic absences at the start of the semester where 28 days’ notice may not be possible due to when the schedule was released, the following rule applies:

A student will have three business/school days after the schedule is released to send the Student Absence Request email to request a clinic absence with less than 28 days’ notice without penalty.
- For example, if the schedule is released on Monday May 1st, and the student requests a clinic absence for May 22nd, that student will have until the end of the day on Thursday May 4th to submit a request for a clinic absence for May 22nd without penalty.
If the request is submitted after that, standard penalty rules for lack of 28 days’ notice will apply.

Inclement Weather

As public health facilities, the University Clinics have an obligation to remain open for patient care, even in the event of bad weather. Therefore, all students assigned to any of the Optometry Clinics (including Pheiffer (CNOHC), the Rural Eye Program, and the Lesley L. Walls Vision Center) should make every reasonable effort to be at their scheduled clinics in the event of inclement weather. In cases of hazardous conditions which prohibit students from traveling to the clinic where they are scheduled, or to determine if the clinic is open for patient care, please contact the clinic staff supervisor. Students should be aware that some clinics may be open even though the University (NSU) has officially closed or cancelled regular classes. While students are urged to avoid unnecessary risks, particularly if they have to travel a long distance to the clinic site, they are urged to make every reasonable effort to be at any clinic that remains open. It is imperative that the students call the clinic at which they are scheduled to determine the clinic’s status or to report their absence or late arrival.

Additional (Elective) Clinical Attendance

Students wishing to assume additional (elective) clinical assignments may request this through the Assistant Dean for Clinical Affairs. All extra assignments in clinic (make-up or elective) must receive approval from the Assistant Dean for Clinical Affairs prior to being performed by the student.

Student Permission for Professional Travel Policy

In order to have clinical absences excused, students must first meet with the Assistant Dean for Academic Affairs to explain the purpose of their attendance and what additional knowledge and experience they expect to gain to offset the missed time in clinic and class.
This meeting requirement is waived if the student has a 3.20 GPA or higher AND has passed all parts of NBEO examinations which he/she is eligible to take. This requirement is also waived if the student is attending in an official capacity (e.g. AOSA officer) or presenting a poster or other submission.
All classroom absences must also be cleared with the individual course professors regardless of the status of clinical absences. Students must still complete the appropriate clinical absence requests.
In addition, attendees must complete and verify attendance of 2 hours of continuing education for every half-day of clinic or class missed.

Failure to adhere to the above will result in an unexcused clinic absence for the days in question and possible referral to the Committee on Ethics and Professionalism.

Examination Room Protocols

- For security and continued quality and performance of clinic equipment, students should complete the following tasks before the examination.

1. 1. Begin with complete inspection of room and equipment. The area should be clean and uncluttered. All instruments should be sanitized and in proper working order.
  2. Check to see that personal equipment is charged and all diagnostic equipment, tests, and or agents to complete the examination are readily available.
  3. Check the expiration date of all diagnostic pharmaceuticals in the exam room and dispose of, and replace, any with expired dates.

During the examination:

During examinations at the Pheiffer Clinic all pharmaceuticals must be kept secured per hospital policy. They should be placed in a drawer, in your pocket or returned to your attending doctor throughout the clinic assignment. They must not be set on the exam room countertop. This rule applies to saline as well as diagnostic eye drops.

At the end of each clinic session:

1. Clean and cover all instruments with their appropriate dust covers. Report any missing dust covers to the Equipment Technician.
2. Dispose of trash in appropriate waste or hazardous waste containers.
3. Report any equipment/furniture needing repair or maintenance to the Equipment Technician via the "Work Order" form available at every clinic.
4. Turn off all electric instrumentation.

All students are responsible for following proper guidelines for cleanliness and hygiene of examination areas as defined by Cherokee Nation policy. Students failing to meet the appropriate standards will be evaluated by the staff coordinator of the clinic who will file a written report to the Coordinator of Student Evaluation or the Clinic Supervisor.

Student-Supplied Equipment:
- Students are required to bring the following equipment, in working condition, to all clinical assignments:

1. 1. Direct Ophthalmoscope
  2. Retinoscope
  3. Transilluminator
  4. Cover Testing Paddle
  5. PD Rule
  6. Nearpoint Test Cards
  7. Water Soluble Marker (for marking major reference points)
  8. BIO
  9. Indirect Lenses
  10. Gonioscopy Lens
  11. Trial Lenses and Trial Frame
  12. Broken Wheel Acuity Test
  13. Stereo Test

- Students who repeatedly fail to bring required equipment to clinical assignments will be evaluated negatively during semester grading.

Duties in Clinic

Students must remain available for duty in their assigned clinical service, even in the event of patient no-shows. They may only assume other duties or be released from clinic for that session upon the approval of their assigned faculty supervisor. Clinic staff persons do not have the authority to release a student from clinic.

- Change in Clinic Assignment
  - Situations may arise that warrant a reassignment of duties and responsibilities for student clinicians. The faculty optometrist supervising a student may deem it necessary to assign other patient care duties or clinical activities for that student because of illness, emergency, overloads, or other special situations which may arise. The cooperation of students is expected at such times, and clinical faculty are urged to use their best judgment when redirecting clinicians in order to meet other needs.
  - Duty Doctor Student Assignment
  - In anticipation of emergency absences of assigned student clinicians due to illness, or other unforeseen events, the position of Duty Doctor has been created. The duty is rotated among assigned clinicians as scheduled. Only third- or fourth-year students can be assigned as Duty Doctor.
  - A student designated as the Duty Doctor for a particular clinic session does receive clinical credit for the assignment, and is expected to remain readily available in the assigned clinical facility to answer any call to duty.
  - The Duty Doctor should remain in the designated area of the Clinic throughout the four-hour clinic session, keeping the appropriate clinic manager aware of his/her presence. The Duty Doctor is released at the end of the clinic by the faculty supervisor and should not leave without expressed permission.
  - The clinic manager on site or the supervising faculty are authorized to call the Duty Doctor into service whenever circumstances necessitate activating an additional clinician. In cases of emergency absence from an assigned clinic, the Duty Doctor may be called to provide coverage for that student forced to be absent.
  - The Duty Doctor may be utilized within any of the clinic’s service units, and should help ensure sufficient student staffing to meet patient needs and avoid overloading of other students. In the event that the designated Duty Doctor is not assigned a specific assignment by the Clinic Office Manager or supervising faculty, that student is authorized to utilize the time for studies, literature review, etc., but is expected to remain readily available in the clinic. Students are encouraged to assist other students with patient care duties.
- Dismissing Patients from Clinic

Students should release patients from clinic only upon receiving permission from the supervising faculty. The role of the faculty is not only that of an instructor, but also as a licensed optometric physician. In addition to the educational need to close cases, there is a medical and legal need for the physician of record, the faculty, to provide a final disposition opportunity for each case prior to dismissal of each patient. Failure to receive permission from the supervising faculty will result in an unsatisfactory evaluation for that clinic.

- Dismissing Students from Clinic

In some instances, a student may finish a patient early or they may have had a patient "no-show." A student is absolutely not allowed to leave the clinic until both the faculty supervisor and staff supervisor have agreed that the student may be dismissed. The faculty member may have a "grand rounds" scheduled, or the staff may have an extra patient who needs to be seen or a chart which must be completed. Students are strongly encouraged to use any time, when not assigned with a patient, to the advantage of their education. This may include shadowing or scribing for another student or practicing clinical skills.

Student Clinic Assignments

A student who has earned a Bachelor’s degree, satisfactorily completed the full four years of the professional optometry curriculum, and met any special requirements set by the Dean shall be eligible to receive the Doctor of Optometry Degree. The curriculum for the professional optometry program includes the requirement that students must obtain passing grades for all clinical course work.

First Year

All first-year optometry students will be required to obtain a passing grade in Optometry 4184 (Optometric Clinical Methods I) before entering Clinic. During Spring Semester of the first professional year, students will be assigned to clinical screening duties and/or observation of examinations by senior optometry students or quality assurance reviews. [Opt. 4291: Introduction to Clinic I]

Second Year

In order to progress into second year clinics, students are required to satisfactorily pass Optometry 4184 (Optometric Clinical Methods I), Optometry 4283 (Optometric Clinical Methods II), and Optometry 4291 (Introduction to Clinic I).

During the fall semester of the second professional year, students must be enrolled in Optometry 5183 (Optometric Clinical Methods III) in order to participate in clinics (Optometry 5191, Introduction to Clinic II). Assignments during this semester will include screening activities, observation of examinations by senior optometry students, and quality assurance reviews.

During the spring semester of the second year, students will be enrolled in 5291 (Clinical Practice I) and be assigned to clinical observations and direct examination of scheduled patients. Participation is contingent upon having successfully passed Optometry 5191 (Introduction to Clinic II). In addition, students must complete a proficiency check-out consisting of a comprehensive examination supervised and directly observed by a faculty member.

Third Year

In order to progress into third year clinics, students are required to have successfully passed all second-year clinical courses; Optometry 5191 (Introduction to Clinic II) and 5291 (Clinical Practice I).

During the summer semester of the third-year students are enrolled in Optometry 6093 (Clinical Practice II), under the supervision of clinical faculty in the screening, examination, diagnosis, treatment and management of vision conditions, ocular and systemic medical problems. Students must successfully pass this course to continue on to the Fall Semester of the third year.

During the fall semester of the third year, students will be assigned to Optometry 6195 (Clinical practice III) which includes supervised examination, diagnosis, analysis, management, therapy, and treatment of patients with eye and/or visual system disorders, as well as patients with histories of systemic medical conditions associated with ocular/visual system implications.

Clinical assignments in the spring semester of the third year will be covered under Optometry 6295 (Clinical Practice IV) and will represent a continuation of those activities listed above for Fall Semester of the third year. In addition, students must complete a proficiency skills check list. A number of clinical skills must be performed, observed, and approved by a faculty member.

Fourth Year

In order to progress into fourth year clinics, students are required to have successfully passed all third-year clinical course work.

Clinical assignments in the summer session of the fourth year will include supervised examination, diagnosis, analysis, management, therapy, and treatment of patients with eye and/or visual system disorders, as well as patients with histories of systemic conditions associated with ocular/visual system implications (Optometry 7095, Clinical Practice V).

The fall semester of the fourth year includes activities which represent a continuation of those listed for summer semester of the fourth year. Students are enrolled in Optometry 7196, Clinical Practice VI.

Curriculum for the spring semester of the fourth year includes Optometry 7293, Clinical Practice VII. Activities represent a continuation of those listed for fall semester, and may occur at both on- and off- campus locations. In addition, students must complete a proficiency skills check list.

External Rotations

Students participate in an eight-week external rotation during the spring of the fourth year of the curriculum. These are arranged with the Associate Dean and the Coordinator of External Rotations. The following is the goal and objectives of the extern program. These published goal and objectives are distributed to the Faculty Coordinator at each extern site as well as to the students.

Goal

Provide optometric students with the quantity and quality of clinical experiences necessary to develop the professional competence to diagnose, treat, and manage eye and vision conditions and to deliver care and services unique to the profession of optometry.

Objectives

During the clinical externship rotations, the student will:

Experience a diverse clinical population that provides different demographics from the college clinical population
Experience new practice management modalities

The Externship Program Coordinator communicates with the on-site externship faculty on a regular basis. Each site director is required to provide a written performance evaluation of the student clinician, and each clinician is required to maintain a patient encounter log and complete a rotation evaluation. All external sites are under a memorandum of agreement (MOA) signed by the chief officer (Dean), the Externship Program Coordinator, and the supervising optometrist at the external clinical site. These documents as well as other externship policies are on file in the office of the Coordinator of Externship Program.

Evaluation and Grading of Student Clinicians

The College of Optometry recognizes its responsibility to encourage and educate students, while insuring that patients receive a consistently high standard of care. The College also has a responsibility to the general public, and must convince itself of complete competency before conferring the degree of Doctor of Optometry. It is therefore necessary and desirable that the clinical curriculum include frequent and on-going evaluation of student performance, development, and level of competence.

Clinical faculty and students are urged to view the evaluation process as a mechanism for uncovering and rectifying clinically-related problems and weaknesses, and thus for insuring against incompetency. The evaluation, however, should also emphasize and encourage clinical strengths demonstrated by the students. Timely input should be given so that errors in thinking and/or technique can be corrected. At the same time, recognition of a good performance will serve to bolster confidence and competency, while encouraging students to pursue excellence.

Counseling and Advisement of Student Clinicians

Counseling and advisement sessions may be arranged upon the request of the student or the faculty. The faculty, after reviewing student clinical evaluations, may determine the need for counseling. They may ask the Associate Dean, Clinical Grading Coordinator, or other faculty to provide counseling or remediation. Further counseling sessions, if warranted, may be scheduled with the Student Academic Evaluation Committee.

The following represents a partial listing of the functions expected of the counseling and advisement relationship:

Provide a communication link between clinical faculty and student clinicians.
Serve as a resource/reference center for students with questions and concerns regarding clinical policies, protocols, procedures, etc.
Provide a focal point for purposes of direct counseling relative to performance in clinic.
Provide a focal point for designing, communicating, and directing problems of clinical deficiency and programs of remediation.
Provide a communication link (in addition to direct discussion with the Associate Dean or Coordinator of Clinical Evaluations) for handling problems or concerns arising over student grading in clinics.
Provide an additional communication link between student clinicians and the Coordinator of Clinical Evaluations, the Associate Dean, and the faculty.

Grading of Clinical Performance

All students are assigned grades of Passing (P), Failing (F), or Incomplete (I) upon completion of each semester of clinical assignment. Final semester grades will be determined by faculty consensus after discussion of each student’s clinical performance at student clinical evaluation meetings scheduled during and at the end of each semester.

Daily Grading - The Closing Interview

Upon completion of each session of assigned clinic, the student should meet briefly with his/her faculty supervisor for that session. Teacher and student should discuss the events of that session, and should provide one another with a candid assessment of both the positive and negative aspects of the session. Specific strengths and weaknesses should be discussed. The faculty member will have taken notes on patient encounters which have occurred during the session and will review these comments with the student. In addition, remarks should be made as to learning objectives which will facilitate the on-going improvement and advancement of the student’s clinical skills. Both the faculty member and the student should sign the evaluation. If there are any comments the student wishes to add to the evaluations, (s)he should do so as it is a process for the student’s development and improvement. Both student and faculty member should utilize this format to help advance and improve skills.

It is the student’s responsibility to be sure (s)he has met with the faculty supervisor before leaving the clinic for the day. In the event that a faculty supervisor has left the clinic prior to the conclusion of the patient examination, the student shall inform another supervising faculty or the Clinic Chief.

Following the closing interview, the student may be allowed to leave the clinic.

Periodic Clinical Progress Review

The daily clinical evaluations are compiled for each student two to three times during each regular semester and twice during the summer session. Clinical evaluations are reviewed by the Clinical Grading Coordinator. During this review, daily clinical evaluations are monitored for trends and concerns which are discussed in a confidential clinical grade conference attended by all clinical faculty. Based on the student’s clinical performance, a grade of satisfactory, unsatisfactory, or incomplete is assigned to each student by the clinical faculty following the clinical grade conference. A final grade of pass (P), fail (F), or incomplete (I) will be determined at the clinical grade conference held at the end of each term.

Following each clinical grade conference, the Clinical Grading Coordinator will provide each student with a written notification of his/her status in clinic. Each student will be advised of any and all relevant comments from the faculty regarding his/her strengths and/or weaknesses.

The Clinical Grading Coordinator and the Associate Dean remain responsible for all relevant documentation, recording, and distribution of information necessitated by this process.

Disciplinary Dismissal of Students from Clinic

Each supervising faculty member retains the right to expel a student from an assigned clinic session for disciplinary reasons. The severity of this action is obvious, and this course is to be followed only when gross violations of established standards and protocols occur. The supervising faculty member will be responsible for seeing that the patient assigned to the dismissed student is reassigned to another student or is re- scheduled for an appointment.

A detailed written report of events leading to the dismissal from clinic must be presented by the faculty member to the Associate Dean, or in his or her absence, to the Clinical Grading Coordinator within 24 hours of the occurrence.

A meeting of the Student Academic Evaluation Committee (SAEC) will be arranged with utmost urgency, and the involved student will be contacted in order that (s)he may address any and all complaints either personally, or through a written statement addressed to the Committee.

The SAEC will decide upon the appropriateness of the dismissal, and will make recommendations relevant to the incident. The committee’s purpose is to objectively evaluate the roles of both the student and the supervising faculty member involved in the incident.

Procedure for Student to File Grievance

Inevitably, situations and conditions related to clinic functions will arise which confuse, frustrate, and/or anger students. When questions, concerns, or problems develop, the student is urged to quickly arrange an appointment for discussion with the Associate Dean. If desired, the student may lodge a complaint or grievance (preferably in writing). If the student prefers to do so, (s)he may choose to act through his/her class president; however, the concern or grievance should be submitted in writing to the class president. Individual problems will be addressed, and if warranted, will be brought to the Student Academic Evaluation Committee (SAEC), the faculty, and/or the Dean for further discussion and action.

It is hoped that small problems can be dealt with quickly, and that major controversies can be avoided by following the policies as described.

Any general grievances not resolved through the above College of Optometry procedures, Title IX, and harassment reporting procedures can be addressed through the NSU Student Affairs’ student grievance policies.

https://offices.nsuok.edu/studentaffairs/Compliance/
https://www.nsuok.edu/ReportConcern.aspx

Procedure for Faculty to File Grievances

Just as students will at times find that clinically-related questions, problems, and concerns can arise, faculty members will undoubtedly experience similar episodes. Faculty are urged to bring their concerns (preferably in writing) to the attention of the supervising Clinic Chief, Residency Director (if a resident is involved), Associate Dean, and/or the Dean, in that order. Further discussion and action can be most effectively initiated by following this protocol.

It is important to keep foremost in any thoughts and actions the following:

Keep small problems small
Other people are impacted by your actions
Patient care and education of students are the primary activities in the clinic

Maturation of Clinical Proficiency

In an effort to minimize misunderstandings, reduce apprehensions, and help insure consistency and fairness in the evaluation of student clinicians, the following list of expectations and requirements is provided. This is an attempt to define the minimum criteria which must be met in order to progress through the clinical curriculum. Where individual tests and procedures are indicated, it is anticipated that they will be reliably performed, and that the data obtained and recorded will be consistently accurate. It also is anticipated that when a student records a finding on a patient’s exam form, and therefore into the patient’s medical record, that the student understands the results of the test and its implications.

It should be recognized that other non-specified problems, events, occurrences, etc., could potentially result in a failing grade for clinic.

The student is encouraged to refer to this list frequently, and to assess student performance based upon these specific objectives, established for specific points in the clinical curriculum.

Requirements are listed under the following headings:

Technical Skills
Organizational Ability
Analysis and Diagnosis
Formulation of Management Plan
Communication

Note that the expectations and requirements are designated as being "by completion" of the semester being described, but proficiency is expected to develop during the semester. Students should be able to meet the specified standards without assistance, unless otherwise noted. It is evident, to ensure competency by the end of the optometric curriculum, each semester’s skills must build upon those of the previous semester. It is therefore important to note, that as the student progresses through the clinical program all skills within each heading listed in the previous semester are expected to be maintained, performed consistently and improved upon.

Please refer to the Appendix for a copy of the Proficiency Skills Check Lists.

First Professional Year

A student who does not successfully pass the designated class, Optometry 4184, Optometric Clinical Methods I, cannot participate in first year clinics, including screenings. Students must have a current CPR certification prior to participating in clinics and providing care in the spring semester of the first year.

By completion of the spring semester, first year:

Technical Skills

Case history
Visual acuities
Cover testing with neutralization (lateral and vertical)
Near point of convergence
Interpupillary distance determination
Ocular motility (ductions, versions, convergence)
Keratometry
Distance retinoscopy (static and cycloplegic)
Nearpoint (dynamic) retinoscopy
Monocular subjective refraction
Refractive balance
Distance Binocular Subjective Endpoint
Crossed Cylinder Tests
Distance lateral phoria
Distance vertical phoria
Near lateral phoria
Near vertical phoria
Distance lateral and vertical fusional ranges
Nearpoint lateral and vertical fusional ranges
Donder’s amplitude of accommodation
AC/A ratio determination (response and gradient methods)
Eye dominancy (preference)
Subjective tests of accommodation (amplitude and facility)
Determination of appropriate spectacle add for presbyope

Organizational Ability

Perform a logical, orderly, sequential examination routine on non-complicated cases
Be knowledgeable of the S.O.A.P. record-keeping format
Complete examination of non-complicated patient (excluding ocular health assessment) within 90 minutes

Analysis and Diagnosis

Identify and communicate to the instructor the patient’s Chief Complaint or Reason for Presentation
Identify and communicate to the instructor any problems encountered during performance of the examination (patient variables which may have impact upon testing and data reliability; for example: used eccentric viewing and head tilt during monocular acuities)
Detect major deviations from normal findings
Arrive at an accurate refraction for non-complicated patients

Formulation of Management Plan

Demonstrate an interest in discussing the management plan determined by the supervising faculty member
Determine the patient’s recall/disposition by documenting in the appropriate place on the exam form.
Complete any required referral letters/forms in a timely manner if patients are referred to any other service - both internal and external referrals

Communication

Establish effective rapport with patient
Establish effective interaction with clinical instructor

Check - Out At the end of the first semester first year students must pass a proficiency examination (practicum) for Methods I before (s)he can be assigned to school screening clinical activities during the second semester.

Second Professional Year

A student who does not successfully pass the designated classes (Optometry 4184, Methods I; 4283, Methods II; and 4291, Intro to Clinic I) cannot participate in second year clinics, including screenings. Students will be enrolled in 5183 (Methods III), and 5191 (Intro to Clinic II).

By completion of the fall semester, second year:

Technical Skills

All 1st year requirements
Nearpoint (dynamic retinoscopy)
Biomicroscopy (anterior and posterior segment)
Tonometry (Goldmann, N.C.T., and hand-held)
Gonioscopy
Visual fields analysis (manual, automated, and Amsler Grid)
Sphygmomanometry
Auscultation of neck and orbit
Exophthalmometry
Lid eversion
Pressure patching
Glucometry
Indirect ophthalmoscopy with scleral indentation
Ocular smears
Ocular cultures
Basic ocular cytology
Lacrimal system evaluation
Lacrimal system irrigation
Superficial foreign-body removal
Binocular indirect ophthalmoscopy
Corneal Evaluation with fluorescein and yellow filter

Organizational Ability

Select and perform appropriate ancillary tests, when indicated
Consistently establish a thorough listing of patient problems, medications and allergies by the end of an examination
Bring all required equipment to clinic

Analysis and Diagnosis

Provide clinical instructor with a tentative diagnosis for a broad range of refractive anomalies
Consistently address the patient’s problems and complaints in the assessment portion of the examination
Detect and observe major pathologies, binocular anomalies, visual dysfunctions, and deviations from normal expected findings
Identify and communicate to the instructor relevant findings of previous examinations (demonstrate the ability to review patient charts and records)

Formulation of Management Plan

Clearly, concisely, and accurately document the management/treatment plan in all patient records, including patient recall.
Complete all required referral letters/forms
Always obtains faculty permission to dismiss any patient from clinic

Communications

Communicate significant observations, findings, concerns, etc., to supervising faculty in a timely and organized fashion throughout the examination
Demonstrate effective communication and description of final diagnosis and management plan to the patient following consultation and discussion with supervising faculty.
The student is expected to clearly convey a sense of professionalism in interactions with patients, faculty, peers, other health care providers, etc. A sense of professionalism should permeate every aspect of the student’s life, including punctuality.

A student must successfully pass the designated classes (Optometry 5183 - Methods III, and 5191 - Intro to Clinic II) to participate in second year Spring clinics.

By completion of the spring semester, second year: Technical Skills

Improved efficiency with all previously identified skills
Photo documentation
Seidel testing
Insert and remove GP and soft contact lenses on routine patients
Clean, edge, polish and modify contact lenses

Organizational Ability

Complete examination of non-complicated patient including fundus evaluation within 120 minutes

Analysis and Diagnosis

Provide clinical instructor with a tentative diagnosis for a broad range of refractive anomalies.
Detect and observe major pathologies of both anterior and posterior segments as well as deviations from normal expected findings in all areas of the examination

Formulation of Management Plan

Actively discuss management and treatment options with supervising faculty member
Demonstrate knowledge of basic science involved in approaches
Demonstrate an interest in understanding the management plan designated by the supervising faculty member
Complete all required referral letters/forms
Checks with faculty at beginning of each clinical session regarding dilation policy
No contact lens is removed prior to consulting with faculty
Student is never allowed to release patient from clinic until advised to do so by the consulting faculty member.

Communication

Demonstrate an improving ability to talk and listen to patients
Demonstrate an ability to "focus" case presentations to faculty, and to select key findings of the examination process during the consultation
Demonstrate effective use of the problem-oriented examination form - SOAPE - (Subjective, Objective, Assessment, Plan) in discussions and for entries into patient records

Clinical Skills Competency Evaluation

Approximately midway through the Spring semester, each student is required to perform a comprehensive examination on a first-year optometry student while being observed by a clinical faculty member. The faculty member uses a checklist adapted from Part III of the NBEO to assess the student’s performance and give the student immediate feedback. Following this assessment, remediation programs are initiated, if indicated.

Third Professional Year

A student who does not successfully pass the designated class (Optometry 5291, Clinical Practice I) cannot participate in third year clinics.

By completion of the summer semester, third year:

Technical Skills

All 2nd year requirements
Perform and evaluate non-complicated contact lens fittings
Identify, record, and analyze pertinent history and problems presented by the patient.
Accurate and quick radiuscope analysis of GP contact lenses
Teach insertion and removal of contact lenses to patients without difficulty
Accurately acquire computerized topographical map

Organizational Ability

Complete examination of non-complicated patient including dilated fundus evaluation within 90 minutes (student may be required to complete 21 point analytical or graphical exam)
Complete a routine contact lens examination and initial trial lens fitting within two (2) hours.

Analysis and Diagnosis

Provide clinical instructor with a tentative diagnosis for a broad range of patient problems
Provide differential diagnosis for anterior segment pathologies, including contact lens complications

Formulation of Management Plan

Provide instructor with appropriate suggestions for management/treatment for many specific patient problems
Complete all required referral letters/forms

Communications

Following consultation with supervising faculty, demonstrate clear and effective description of findings and recommendations to the patient

A student must successfully pass the designated class (Optometry 6093, Clinical Practice

to participate in third year fall clinics.

By completion of the fall semester, third year: Technical Skills

All previous level skills
Perform and evaluate wide variety of contact lens fittings
Remove superficial corneal foreign bodies
Complete routine examination of variety of anterior segment "walk in" patients within 45 minutes
Complete examination of non-complicated patient including dilated fundus evaluation within 90 minutes
Perform trial lens refraction including using hand held JCC
Perform lensometry, tonometry, and slit lamp exam using hand held instruments
Perform a complete examination on a patient who is confined to a wheel-chair or bed
Utilize COVD Quality of Life checklist in patient care
Perform and evaluate all diagnostic skills listed on the Vision Therapy summary sheet

Organizational Ability

Complete specific ancillary test procedures (short exam) within 30 minutes (examples: reevaluate refraction, perform automated visual fields testing)
Complete the examination of patients with a broad range of ocular and visual system pathologies within 2 hours
Be able to complete patient superbill for billing, including finding and selecting appropriate CPT and ICD 9 codes with minimal help from supervising faculty.
Complete a routine contact lens progress examination within one (1) hour.

Analysis and Diagnosis

Provide clinical instructor with a tentative diagnosis for a broad range of patient problems

Formulation of Management Plan

Provide instructor with appropriate suggestions for management/treatment for many specific patient problems
Complete all required referral letters/forms

Communications

Following consultation with supervising faculty, demonstrate clear and effective description of findings and recommendations to the patient
Use techniques to communicate with patient with certain physical limitations such as hearing impairment, aphasia or dementia

A student must successfully pass the designated class (Optometry 6195, Clinical Practice

to participate in third year Spring clinics.

By completion of the spring semester, third year:

Technical Skills

Improved efficiency with previously mentioned skills. Skills are expected to be performed correctly consistently.
Perform and evaluate contact lens fittings for presbyopes and patients with significant astigmatism.
Complete evaluation of patients presenting for acute care other than anterior segment problems within 45 minutes

Organizational Abilities

All previously listed tasks, in a consistent reliable, manner

Analysis and Diagnosis

Anticipate test results and clinical findings based upon previous data, patient complaints, history, and referral information (begin advanced formulation of differential diagnosis)
Demonstrate the ability to develop a problem-oriented diagnostic strategy, directly related to the differential diagnosis of patient signs and symptoms
Arrive at a logical tentative diagnosis consistent with the results of a differential diagnosis process, and present it to the supervising faculty member

Formulation of Management Plan

Following discussion of diagnostic possibilities, and designation of a "final" diagnosis by supervising faculty, demonstrate a knowledge of therapeutic and treatment options appropriate to the final diagnosis
Complete all required referral letters/forms

Communication

Clearly and logically list diagnostic possibilities for the supervising faculty member based upon patient presentation, complaint, history, previous data, referral letters, chart entries, etc.,
Clearly outline an approach to problem-solving (i.e. describe the steps of a differential workup) for the supervising faculty member, before performing the tests
Demonstrate the ability to recognize and investigate problem-specific elements of the patient’s history throughout the examination process
Clearly and logically discuss and provide preventative care, patient education and counseling.

Fourth Professional Year

A student who does not successfully pass the designated class (Optometry 6295, Clinical Practice IV) cannot participate in fourth year clinics.

By completion of the summer semester, fourth year:

Technical Skills

All designated 1st, 2nd, and 3rd year skills
Improved efficiency. Skills must be successfully performed consistently in every clinical encounter.
Assessment of primary and secondary angles of deviation
Evaluation of comitancy
Krimsky and reverse-Krimsky neutralization
Four Prism Diopter Base-Out test
Park’s Three Step Method of Vertical Analysis
Spatial localization testing
Tests of sensory fusion
Determination of intensity of suppression
Tests of anomalous correspondence
Kinetic cover testing
Bagolini Lens Testing
Kinetic cover testing
Tests of fixation (eccentricity, steadiness, etc.)
Tests of visual perception

Organizational Ability

Complete a sequential in-depth assessment of binocular visual function within 90 minutes. Appropriately describe treatment for abnormalities found within such exam.
Complete a routine evaluation of anterior segment "walk in" patients within 30 minutes
Described all items pertaining to informed consent for surgical procedures including anterior segment laser and minor surgical procedures.

Analysis and Diagnosis

"Tentative diagnosis" proposed by student should closely and clearly approximate "final diagnosis" reached following consultation with supervising faculty. In other words, the student should be able to demonstrate the necessary skills to examine and evaluate the patient to arrive at a rational diagnosis.
Recognize when it is necessary to obtain a consultation with minimal coaching from supervising faculty.
Formulate treatment plans for binocular vision anomalies including if office therapy and home support programs.

Formulation of Management Plan

Actively describe options for patient management for supervising faculty, including post-operative care for anterior segment laser and minor surgical procedures
Provide specific recommendations regarding the implications of various treatments and prescriptions for consideration by supervising faculty
Complete all required referral letters/forms. The student must be able to coordinate care provided by others.
Complete all phone calls and/or correspondence back to any referring provider to ensure patient continuity of care.

Communication

Convey a sense of professionalism and confidence in all aspects of interaction with patients, other students, optometry and hospital staff, other health care providers, and faculty preceptors
Begin to show the ability to effectively advise and counsel patients, and to maximize the likelihood of compliance with recommendations and prescriptions
The student should be able to effectively communicate orally and in writing with other healthcare professionals and patients.

A student must successfully pass the designated class (Optometry 7095, Clinical Practice

to participate in fourth year Fall clinics.

By completion of the fall semester, fourth year:

Technical Skills

Increased efficiency in all previously mentioned skills. Skills must be successfully performed consistently in every clinical encounter.
Assessment of sensory motor skills
Assessment of perceptual skills
Assessment of strabismus evaluation
Assessment of amblyopia evaluation
Diagnosis and treatment of visual dysfunctions listed above
Be familiar with the operations of the retinal imaging equipment available in specialty care and imaging clinics.

Organizational Ability

Complete most examinations within 60 minutes
Show the ability to logically prioritize the patient’s problems
Show the ability to logically allocate emphasis and time throughout the examination
Demonstrate the ability to designate appropriate intervals and directions for follow-up examinations and patient recalls to clinic

Analysis and Diagnosis

Specify an appropriate diagnosis for the majority of patients seen
Reach a "tentative diagnosis" which in most cases should be largely in agreement with the "final diagnosis" reached through consultation with supervising faculty
Be able to analyze results from retinal imaging equipment

Formulation of Management Plan

Be able to detail a logical course of management for the majority of cases encountered
Complete all required referral letters/forms

Communication

The student should demonstrate knowledge of professional, ethical, legal, practice management, and public health issues applicable to the delivery of optometric care.

A student must successfully pass the designated class (Optometry 7196, Clinical Practice

to participate in fourth year Spring clinics.

By completion of the spring semester, fourth year:

Technical Skills

Demonstrate mastery in many areas and techniques

Organizational Ability

Demonstrate skills which are consistently efficient and effective
Reliably complete examinations "on time"

Analysis and Diagnosis

Consistently reach logical conclusions
Demonstrate reliable diagnostic capabilities

Formulation of Management Plan

Develop, prescribe, and administer appropriate therapies and treatments
Request appropriate consultations and referrals
Clearly define needs and requests in making referrals and obtaining consults
Make appropriate and well-guided referrals
Schedule appropriate follow-up examinations at appropriate times

Communication

Demonstrate excellent and professional communication skills in any and all areas of patient care

Ongoing Assessment of Clinic Competency

In order to assure maintenance of proficiencies in essential optometric skills, the following regimen of "Practical Demonstrations" is intended to insure minimum proficiency in techniques and procedures considered basic to a complete and thorough eye examination and vision analysis. Through these demonstrations, students will be motivated to review and refine their clinical methods. As all procedures will have been previously evaluated in formal practical ("Check-out") exams incorporated within the Clinical Methods courses, these third and fourth year "practical demonstrations" represent an effort to encourage review and to prevent any acquired "bad habits" from becoming firmly ingrained. An additional benefit to the student will be the opportunity to be closely evaluated during performance of a clinical procedure; in essence a form of "dress rehearsal" for the licensure examinations (s)he can anticipate taking.

Each third- and fourth-year clinician will be issued a Clinical Proficiency Checklist at the beginning of the Spring semester that must be successfully completed prior to the end of that semester in order to receive a passing grade in clinic. The checklists include approximately fifteen clinical skills considered essential for the student’s level in the program. Students who are unable to successfully demonstrate all of the proficiencies will be assigned an incomplete or failing grade by the faculty.

Procedure for Third and Fourth Year "Proficiency Demonstrations"

Each student is to bring the checklist to clinic each day (see Appendix for sample form). When time is available in clinic, the student will ask one of the clinical faculty members if (s)he is free to check the student out on a procedure. The procedure may be demonstrated on another student or on a patient if it is appropriate to do so.

Once the student has demonstrated proficiency in performing a procedure, the faculty member will sign the form next to that procedure. If the student does not demonstrate proficiency, the procedure must be demonstrated again (not necessarily on the same day) until it is performed satisfactorily. Unsuccessful attempts will be noted by the faculty.

Once the form is completed, it must be returned to the Clinical Grading Coordinator’s mailbox by the due date listed on the form.

Failure to successfully demonstrate all items of proficiency will result in notification of the Student Academic Evaluation Committee by the Clinical Grading Coordinator. The SAEC will meet and formulate a recommendation regarding appropriate remedial action or assignment of a clinical grade (Pass/Fail/Incomplete) to the Dean for final approval

and implementation.

Other forms of ongoing clinical assessment include:

Quality Assurance/Quality Improvement Studies performed by the Clinical Grading Coordinator.
Spectacle Reorder Form. A copy of which is given to the initial prescribing faculty and student. These are also reviewed by the Clinical Grading Coordinator to look for trends by any individual student and/or faculty member.
Daily clinical grade reports which are then reviewed for each student as a whole to look for trends of deficiency in any area including skill, knowledge base, attitude and professionalism.

Patient Logs

All students are encouraged to use the electronic Clinic Grade System to serve the function of log books. They are to document their patient encounters in a way they find useful. This same system allows feedback from their attending doctor about their clinical performance during those encounters. All students are advised of and aware of HIPAA regulations in regards to the log entries they make in this system.

The purposes of the patient logs are to:

Allow students and faculty to obtain an accurate picture of how many patients of various types (i.e., glaucoma, pediatric, contact lens, etc.) were seen. This can also be accomplished via a report from the NSU College of Optometry practice management software. The information can be obtained by request through the Associate Dean. The information can also describe what CPT codes the students have provided to patients and what diseases (ICD10) the student has encountered.
Enable students to follow up on patients of special interest.
Educate students in methods and skills of maintaining documentation which may be useful for the students in their practices. It is explained to students that this information may be vital to them, such as when requesting hospital or insurance privileges.

During the semester as part of their clinical education, faculty may require students to follow up on a particular patient, or students on their own my wish to remind themselves to check on a patient’s condition at a later date. In either case, a notation should be made so that the student can remind themselves to perform the follow up. If the faculty member is requiring the follow up, the faculty member should also make a notation to themselves to check on student compliance with the task assigned. The student should examine the medical record (or perform other follow up as required) and report back to the faculty member. If the task (follow up) is not completed, the faculty member should report so through the Student Clinical Grade process. This deficiency will then be discussed through the grade meeting process.

Clinic Protocols and Procedures

Titles to Be Used in Clinics

1. Faculty, Residents, Post-doctoral Fellows, and Student Clinicians
  In order to minimize patient confusion, maximize patient rapport and compliance, and enhance a sense of professionalism and pride, it is desirable for supervisory faculty, residents, and postdoctoral fellows to be referred to as "doctor" in discussions before patients. Students should be referred to as "clinician ________".
2. Clinical Support Staff
  Please refer to all members of the clinical support staff as "Dr.", "Mr.", "Mrs.", "Ms.", or "Miss" in discussions before patients.
3. Patients
  As the majority of data collected through patient satisfaction surveys indicate that patients generally prefer to be addressed through the designation of "Dr.", "Mr.", "Mrs.", "Ms.", or "Miss", it is clinic policy to address all patients with appropriate titles. In the event that a patient specifically requests to be addressed on a first- name basis, then it becomes appropriate to do so. Routinely using the patient’s first name is many times interpreted as a lack of appropriate respect toward the patient. Student clinicians should always introduce themselves to the patients, giving both the first name and the last name; i.e., Clinician Jason Smith.

Professional Clinical Dress Code for All Clinics

Faculty, staff, and student clinicians represent Northeastern State University Oklahoma College of Optometry as well as the profession of optometry. Patients and hospital personnel will be forming opinions about our care and professionalism by the way we present ourselves in action and in appearance. Personal appearance, hygiene, appropriate language and mannerisms, and professional demeanor combine to create a positive impression. Because of this, faculty, staff, and student clinicians are expected to adhere to and encourage others to adhere to the dress code in all clinical areas.

All faculty, staff and student clinicians are always expected to maintain an orderly appearance and good hygiene; common sense and professionalism should prevail.

- - - - All clothes must be clean and wrinkle-free
      - Hair: Clean, well-groomed, and natural looking
      - Beards and moustaches: Permitted if neat and maintained
      - Jewelry: Modest and appropriate for a health care provider
      - Jewelry worn in piercings other than ear is not permitted
      - Deodorant: Strongly encouraged. Perfumes or colognes are to be worn in moderation or not at all
      - Artificial nails: Not allowed. Fingernails must be no longer than ¼ inch. Nail polish must be conservative and in good repair
      - Tattoos visible to patients are to be covered
      - Makeup and contact lenses: Natural looking
      - Identification: CNOHC badge must be worn at all Cherokee Nation clinics; NSU name tag or name embroidered on scrubs is acceptable for non-Cherokee Nation clinics
      - Shoes: Comfortable closed-toe shoes, including clean athletic shoes with scrubs, are acceptable
        
        Open-toed shoes / sandals are not permitted
        
        Socks / hosiery required
      - Scrubs: For faculty and students, approved styles and colors only along with approved NSUOCO logo embroidered on the scrub top; no visible fading, holes or worn spots; clinician name may be added (not required)
        
        Black
        
        Ceil Blue
        
        Dark Blue (navy, indigo)
        
        Dark Green (forest, jade, hunter)
        
        Gray
      - White lab coats: Students are expected to wear their short white coat (provided at the White Coat Ceremony)
        
        Worn in all clinics with the exception of those pertaining to pediatric patients
        
        Students may check with their faculty member for permission to remove their coats in situations where the temperature is poorly regulated

Faculty, staff and student clinicians not meeting the above dress code or who have poor personal hygiene will be considered unprepared for clinic. At the discretion of the clinic chief/ clinic manager/attending faculty member, you may be asked to leave and return to clinic appropriately dressed in such a way that is professional and meets the dress code. Student clinicians not following the dress code will be required to make-up an extra clinic. This dress code applies to direct patient care, research and preclinical laboratories during normal clinic hours. Questions concerning the dress code can be brought to the Assistant Dean for Clinical Affairs.

COVID-19 Dress Code Addendum (until the end of COVID-19):

- - - - Due to COVID-19, all clothing should be washable and laundered after wearing during a clinic cycle. Clothing should not be re-worn without washing. Scrubs are optional for all clinics. Dress clothes are allowed. All clothes must be washable and must be laundered after being worn in clinic. If exposed to a sick patient, you should consider changing between your AM and PM clinics.
      - White coats are not required at this time for hygienic reasons. If you wear your white coat, please launder it before your next clinic.
      - Scrubs should be embroidered by October 1, 2020.
      - Remember to disinfect your CNOHC badge and any wearable materials like lanyards.

Photo/ID Badges

All students, clinical staff, and faculty are required to obtain and wear photo/ID badges while in the clinics in order to insure security and to meet state and federal guidelines regarding patient records and confidentiality. Students in clinic must wear at all times their CNOHC photo ID badge. Students should not put stickers or pins on their badges that will hinder easy identification.

Personal Hygiene

Personal cleanliness is an important element in any practitioner of a health profession. The clinical faculty and staff, as well as your own classmates, should feel free to direct your attention to any shortcomings in this area. Continued inattention to personal hygiene will result in dismissal from clinical assignments and evaluation by the Committee on Ethics and Professionalism.

Food and Beverages

Please strive to keep the entire clinic clean and presentable! It is permissible to eat and drink ONLY in those clinic areas designated for Lounge/Consultation use. Please keep food and drink out of sight from patients, and do not carry it out into the hallways or examination areas. Try to avoid "in house" food preparation, microwaving, etc., that is likely to permeate the clinic with a heavy odor. Always remember the need to present a professional appearance when working with patients. Students, faculty and staff should keep in mind that eating and drinking in a clinical setting puts one at increased risk of

acquiring infection. When in Cherokee Nation clinical facilities, all faculty and students will follow Cherokee Nation policy regarding food and beverages.

Optical Equipment Technician

These individuals are responsible for assisting faculty and students with equipment needs or repairs. Duties include, but are not limited to, the maintenance and inventory of all clinic equipment, performance of regular checks on calibration and standardization of all clinic equipment, moving clinic equipment when requested by clinical faculty, ordering general clinic supplies, maintaining adequate inventories of diagnostic and therapeutic ocular pharmaceuticals, and performing prompt and appropriate repair of worn or damaged equipment.

The equipment technician should inspect all examination rooms on a daily basis to insure contents are complete, and in working order. The equipment technician is also responsible for daily cleaning and disinfection of the examination areas in the clinic. Chairs, headrests, counter tops, etc., which commonly come in contact with patients should be cleansed and disinfected with an acceptable hospital grade cleaner on a daily basis. This duty may be delegated to a specific student worker upon approval of the Associate Dean; however, the equipment technician remains responsible for seeing that the work is done properly and regularly.

Responsibility for Clinic Equipment

All students are responsible for ensuring that all equipment is in proper working condition prior to using for patient care. Also, students are responsible for turning off and covering all equipment prior to leaving the clinical session. Students are responsible for informing the equipment technician of any problems either immediately if the technician is present on site, or via the NSU College of Optometry Work Order form. This form is readily available in each clinic. It will otherwise be assumed that the equipment was complete and functioning when the student arrived and subsequently left clinic.

Students and/or faculty may be charged for missing or blatantly abused equipment. This action would only come upon recommendation of the Associate Dean, following an investigation of any complaint lodged by the equipment technician. Failure to pay costs assessed by the Associate Dean could result in a failing grade or referral to the Committee on Ethics and Professionalism with a recommendation of suspension from clinic.

To maintain the security of our computer system, students are not allowed to insert any USB drives into devices (computers or clinical equipment) in the clinical area unless authorized to do so by their attending faculty or the Computer Systems Manager

Care and Use of Equipment

Clinical performance evaluations are based in part on appropriate handling of equipment. Faculty and students must recognize the responsibility to assist in maintaining clean and functional clinical equipment. Please handle equipment with care. Student responsibility before leaving the room at the end of each clinic session include the following.

1. 1. 1. Return phoropter sphere and cylinder lens banks to plano and replace dust covers.
    2. Turn off all electrical equipment and lights (unless otherwise specified for a particular instrument.)
    3. Lower stand and chair to lowest position, lock chair, and turn all switches off.
    4. Replace dust covers on every piece of equipment.
    5. Return any borrowed equipment to main reception area or appropriate equipment storage area.
    6. Report all broken equipment to the Optical Equipment Technician for immediate repair by completing a work order form - these are available from the main clinic office at each site.
    7. Report any areas needing special cleaning attention by the custodians to the main clinical staff person.
    8. Rooms should be kept tidy and neat throughout all exams. Students should clean their exam room before leaving it. Students must ensure that they have locked all cabinets that are required to be locked.

Supplies

Routinely used clinical supplies, including Kleenex, Q-tips, fluorescein strips, rose bengal strips, sterile saline, etc., can be obtained from the appropriate supply area and does not require sign out.

Diagnostic and Therapeutic Pharmaceuticals

Students are to observe the following policies regarding the use of pharmaceuticals in any and all clinics:

1. 1. 1. Students should always remember to check the name and expiration date on all pharmaceuticals when they first report to the clinic and are assigned a room. Expired bottles should be disposed of and replace with current ones.
    2. Do not apply, instill, or dispense any pharmaceutical agent without first getting permission from the supervising optometrist.
    3. Do not remove contact lenses without taking visual acuity, evaluating the contact lenses, and then checking with the supervising optometrist.
    4. Students are prohibited from taking pharmaceutical agents from the clinic.

Contact Lens Disinfection

1. 1. 1. Used disposable trial lenses should be discarded. Return all non-disposable used trial lenses to the Contact Lens Staff Assistant for cleaning and disinfection.
    2. Current contact lens service protocol involves disinfection through use of 3% Hydrogen Peroxide with appropriate neutralization and storage in appropriate sterile solution.

Infection Control Policy

The following policy was adopted by the College of Optometry in October, 1987, in response to the heightened awareness of the prevalence of HIV-II virus, and other serious infectious diseases, in the general population. This statement has been accepted by the CNOHC. The policy should be adhered to conscientiously by all students and staff doctors in all clinics.

Outline of Procedures for the Handling of Optometric Patients

- - - Gloves should be worn for touching body fluids and mucous membranes, as well as any non-intact skin.
    - Clinicians may use surgical gloves any time desired for a slit lamp examination as well as for additional procedures involving contact with the mucous membranes of the face or eyes.
    - The HIV virus and other serious infectious diseases are thought to be spread primarily through contact with blood or semen. Therefore, a clinician must wear gloves if contact is expected with any such body fluids. Also, gloves must be worn if the clinician has any cuts, lesions, or open abrasions on his or her hands.
    - Clinicians must dispose of used or contaminated gloves in appropriate bio-hazard receptacles.
    - Hands should be washed immediately before and following every patient exposure, especially when contact has been made with mucous membranes of the eyes.
    - If gloves were worn, hands should be washed immediately after these are removed. Available evidence suggests that this practice probably is the single most important measure that can be adopted for protection against any communicable infection, not just HIV.
    - Nitrile, rather than latex or plastic, gloves are preferred as plastic materials are porous to the HIV virus and latex allergies are prevalent.
    - Any equipment that comes into contact with mucous membranes should be washed with soap and water then rinsed with an appropriate anti-microbial agent after each patient exposure.
    - Before examining each patient, clinicians should assure themselves of the sterility of the tonometer tip for their Goldmann instrument.
    - Disinfection should be obtained by brushing the tonometer prism tip only across the surface of an alcohol swab following the use of the instrument upon a patient’s eye.
    - The tonometer prism should be allowed to air dry for at least two (2) minutes following alcohol disinfection.
    - Should a question arise regarding the sterility of a tonometer prism left in place on the biomicroscope, clinicians should assume contamination occurred and should disinfect the tip with an alcohol swab allowing it to air dry two (2) minutes prior to use.
    - A folded Kleenex should be used under an eyepatch during occlusion, such as when conducting visual fields or color vision tests or other monocular testing procedures, such as during VEP’s in electrodiagnostic procedures, etc.
    - Phoropter, slit lamp and keratometer chin rests, forehead rests, and similar areas which come into contact with different patients should be wiped down with an alcohol pad before calling a new patient into an examination room. Visual Field equipment should be cleaned before each new patient is examined.
    - Patient care hand-held instruments used in the walk-in room for foreign body removal, punctal dilation, etc., will be autoclaved by the CNOHC Sterile Processing Department. Sterilized instruments are available in the Medication Preparation area near the walk-in rooms, as needed. These instruments after use should be returned to the covered “dirty” instrument tray below the counter in the medication preparation area to be collected nightly by the Sterile Processing staff.
    - Disposable trial contact lenses will be immediately thrown away after patient use. Non-Disposable trial contact lenses will be disinfected appropriately. The contact lens receptionist/technician will be responsible for this function; no fitting lenses will be given to students for clinical use which have not been sterilized once the bottle has been opened previously.

Ancillary Tests by Optometry

Primary care optometry is regularly confronted by ocular signs and symptoms with actual or potential systemic implications. In addition, certain radiologic and laboratory tests, studies, and procedures can contribute directly to the process of differential diagnosis and the formulation of an appropriate management plan, including the generation of well- guided referrals. In still other cases, the impact and affectivity (as well as side-effects and complications) of therapies and prescriptions can be assessed through hematologic, serologic, and chemical indices. Northeastern State University Oklahoma College of Optometry recognizes its responsibility to provide optimum primary eye care services to patients, to provide excellent educational experiences for students, and to make a conscious, concerted effort to control costs and expenses incurred. The College further assumes the responsibility for keeping patients informed of test results, for arranging appropriate recalls into the Optometry Clinic, and for pursuing appropriate medical consultation/referral services when warranted by test findings. Credentialed members of the clinical teaching staff are authorized to order radiologic and laboratory studies when deemed necessary in the differential diagnosis process, in the formation of a specific management plan for their patients, and for generating well-guided referrals. They are not to order redundant, superfluous, or otherwise unnecessary tests. They are required to evaluate test results, inform patients of significant findings, and pursue consultation/referral to medical service units when further evaluation, assessment, and/or medical treatment is indicated. Students, non-credentialed post-doctoral fellows and residents, and non-credentialed faculty members may order ancillary radiologic and laboratory tests by obtaining consultation and signatures from a credentialed member of the clinical teaching staff.

Systemic Conditions with Ocular Manifestations

Many systemic conditions have implications for the eye and vision. A provider of full- scope primary eye care services may find it advisable to order laboratory studies for conditions such as: endocrine and metabolic disease (glucose studies, thyroid profiles, etc.), cardiovascular disorders (erythrocyte sedimentation rate, lipid panels, etc.), hematologic disorders (hematocrit, white cell differential, etc.), pulmonary disorders (chest X-ray, tuberculin skin test, etc.), connective tissue disorders (rheumatoid factor, anti-nuclear antibody, etc.), skin and mucous membrane disorders (microbial cultures, HLA typing, etc.), skeletal muscle and neuromuscular disorders (anti-acetylcholine receptor antibody levels, cranial X-rays, etc.), infections and inflammatory diseases (FTA-ABS, ELISA-toxocara, etc.), and others.

Primary Ocular Disorders

Many primary ocular disorders may warrant investigative studies including radiologic and/or laboratory testing. These include, but are not limited to, corneal ulcers, congenital and juvenile cataracts, chronic or hyperacute blepharoconjunctivitis, chronic or hyperacute anterior uveitis, recurrent anterior uveitis, pediatric uveitis, granulomatous uveitis, recurrent episcleritis, scleritis, orbital trauma, ocular trauma, ischemic optic neuropathy, acquired ptosis, acquired diplopia, hemorrhagic retinopathy, occlusive retinal vasculopathy, etc.

Protocol for Ordering Radiologic/laboratory Testing:

1. 1. 1. Credentialed clinical faculty member reviews documentation of patient’s care
    2. Faculty and clinician assess the actual contribution of the diagnostic test being considered
    3. Credentialed faculty orders and signs for the test
    4. Patient is directed and/or assisted to the lab service unit
    5. Faculty sign for test and evaluate test results
    6. Obtain consult/reference if in doubt as to significance
    7. Requesting doctor assesses need for evaluation of test and/or patient by medical service unit
    8. Requesting doctor informs patient of significant findings and recommendations
    9. Requesting doctor makes any and all appropriate referrals

Building Security Policies

The primary use of the facilities of the College of Optometry are for classroom and clinical instruction. These activities take precedence over any other planned uses. Anyone wishing to use the facility for reasons other than regularly scheduled classroom and clinical instruction must obtain approval for the use and must have a sponsor who assumes responsibility for security of the facility and equipment used during the planned activity. This includes Student Project work, approved organizations, and study groups meeting in rooms which are normally locked. Students, faculty, residents, and staff are urged to respect the need for security in all clinical and educational facilities. In addition, everyone is urged to respect the privacy and confidentiality of individual faculty and staff offices.

Note: Approval for use of the facility may only be granted by a full-time faculty member or a member of the administrative staff which includes the dean, the associate dean, the assistant deans, or the coordinator of student affairs. That person is responsible for ensuring that an appropriate sponsor is available either on-site during the activity or will be present to unlock and lock doors. The sponsor may be another faculty, a full-time staff person or a resident.

Students, staff, residents, and faculty are assigned keys that access various areas of the Optometry Building. Keys are assigned to provide entry into areas appropriate to the responsibilities of the person. Any person who lends a key to another person, be they a fellow student, a family member, friend or co-worker, runs a risk of disciplinary action. Any person who illegally copies a key is subject to disciplinary action.

Faculty, residents, or staff will not lend 1-2 keys, Master Keys, or other equally sensitive keys to other faculty, residents, staff, relatives, friends, or students without first advising the Dean of Optometry, the Associate Dean, or the Assistant Dean for Administration.

Should a faculty, resident, or staff member have a compelling reason to lend a key to a member of his or her immediate family, or to another faculty, resident, or staff member, it is done so with the understanding that personal liability is not transferred with the key. Responsibility for any losses which might occur will be assigned to the person who loaned the key originally. These losses include damages to equipment or facilities, loss of supplies, or actions which may have a negative impact on the reputation of the College.

Students may not loan their keys out to anyone, including family members, under any circumstances. Each student is required to have his or her own personal key to access the student areas of the Optometry Building. Since all students have appropriate keys, there should be no reason for building keys to be transferred or loaned to another student. Also, under no circumstances should a door be left propped open to allow access to others.

Students who are issued specific keys as a result of their responsibilities within the College of Optometry (i.e., laboratory assistant or OSA officer) must obtain that key via a written request signed by the appropriate faculty or staff person. The student should submit the written documentation to the Associate Dean to receive the key, and upon completion of the responsibilities, the student must immediately surrender the key. Under no circumstances, should a student "Pass" the key on to another student, even if that student is assuming the responsibilities which require the key.

If a key is lost or stolen, the faculty, staff, or student suffering the loss will immediately report the loss to both Campus Security and the Dean’s Office.

Use of Clinics for "Special Exams" and "After Hours"

Examination and management of regularly scheduled patients receives highest priority in allocation of clinical space, rooms, equipment, facilities, and supervisory staff. Clinical research and student research projects are also a high priority, and a concerted effort should always be made to accommodate the requests of those involved, without impacting the ability to deliver care to patients.

Examination of relatives, friends, university colleagues, etc., is valuable from the standpoint of public relations, as well as for purposes of teaching and learning, but these endeavors must, of necessity, receive a lower priority.

Students may only utilize clinical space and equipment to conduct private examinations, project-related examinations and personal clinical research under the direct supervision of a member of the NSU Oklahoma College of Optometry faculty. Students must make prior arrangements for a faculty member to provide direct supervision, as well as arrange for a clinical room and electronic medical record to be made. All arrangements must be made at least four days in advance of the examination. The College cannot permit, and will not condone, the "practice of optometry without a license."

Faculty members and residents are asked to respect priorities in utilizing space and equipment for purposes other than regularly scheduled clinic assignments. Regularly scheduled clinical activities always take precedence over other activities.

Use of clinical space and equipment in the NSUOCO Pheiffer Eye Clinic at the Cherokee Nation Outpatient Health Center on weekends, evenings, and during non-routine hours, may be possible by special arrangement. Requests should be given in writing to the Associate Dean, who will then forward the request to the Clinic Administration for special consideration. Approval is much more likely if sufficient lead time is given so that all arrangements can be finalized.

Access to Academic Areas

Entry/Exit Doors

Doors into the Optometry Building pose particular problems for security. While the College desires to have easy access for those who have appropriate reasons for being in the building, we also must be mindful of issues of security. Doors which should remain permanently locked will have a notation on them.

The main doors into the Academic, Administrative and Clinic wings are unlocked at 8 a.m. and locked at 5 p.m. each weekday. These doors should never be propped open after hours.

Classroom Doors

The doors into the breakout room will be locked at 5 p.m. each day and all audio-visual equipment turned off. The Auditorium (room 104) and the classroom (room 114/115) will be left unlocked. Students wishing to use the Breakout Room as a study area after regular office hours may check out an access key which will open the Breakout Room only. Students are cautioned that they may not use the audio-visual equipment in the Auditorium or the Breakout Room after 5 p.m. or on weekends without faculty approval and supervision. The access key may be checked out from administrative personnel. Persons using these areas are responsible for seeing that all equipment is turned off, windows are closed and trash removed. Continued violations of these expectations will result in loss of access to these areas.

Student Study Areas

Students have unlimited access to the following areas for study: the Student Lounge and the Computer Lab in the basement, the foyer in Academic Wing and the alcove near Classroom 114/115; any unused classroom (between the hours of 8 a.m. and 5 p.m.) and classroom 114/115 after hours and on the weekend. The Breakout/ Conference Room is available as a study area only by checking out an access key from administrative personnel. The Breakout Room is a conference area and any activity requiring use of the room as a meeting room takes precedence over its use of the area as a study area. The students will have unlimited access to the Clinical Education Laboratory. All students have a key which accesses this area. That building should remain locked from 5 p.m. to 8 a.m. and on weekends. Doors should never be propped open during those times.

Classroom Audio-Visual Equipment

The increased emphasis on technology in teaching has introduced new expectations in many courses taught in the professional program. Assignments may include presentations in class which require outside development and practice utilizing some of the audio-visual equipment in the classrooms. However, the risk of damage or misuse must be weighed against easy access, and appropriate security must be followed. At any time during use of any equipment, technical problems must be reported immediately to the Systems Manager.

During regular office hours (8 a.m. to 5 p.m.), students may use audio-visual equipment in Room 114/115 if the room and equipment are available. However, they should report to the administrative personnel that they will be in the room and using the equipment. If the student is unfamiliar with the equipment and has any questions about its proper use, the student should seek assistance from the Systems Manager. Persons using the equipment are responsible for turning it off.

Clinic Operational Protocols

Waiting for Patients

Clinicians are asked to help minimize hallway congestion by waiting for their patients in the designated consultation areas of each clinic.
When a patient’s record is ready, the electronic medical record system will indicate the patient status. The clinician scheduled to examine the patient should review the record and prepare to call their patient for the exam.
Regardless of clinic site, patient records should be accessed by the assigned clinician, quickly scrutinized for essential data, and the patient brought in for the examination. Faculty may require, or students may elect, to discuss the case prior to calling the patient.
Clinicians should escort patients to the assigned examination room.
Students who are between patients, have a "no-show", or who are waiting for some reason should not loiter in or around the reception and/or clinic office area. Students loitering in those areas will be asked to return to the consultation area by the clinical staff person responsible for that area.

Sign-in by Patient

Each patient seen in the Optometry Clinic must check-in at the reception window.
Patients with urgent and emergent ocular conditions will be seen as priority in all clinics and may be examined prior to patients with appointments.

Patient Tardiness

Any patient who has not arrived within 15 minutes of the start of a scheduled appointment may be classified as "too late to be seen,". Depending on availability of other patients to fill the exam slot of the late patient, it should be the policy of all clinics to complete at least part of the examination of any patient who presents late. This should be the policy unless a staff doctor specifically directs that the patient has arrived too late for any productive exam to be performed and should be rescheduled.
If a late arriving patient’s slot was filled with another patient, the late arriving patient should be told that another patient was called to take their appointment when they failed to arrive. The patient should be politely offered an opportunity to reschedule their appointment. If the patient offers a plausible and unavoidable reason for being late, then the Clinic Office Manager, or the person acting as Receptionist, may offer the patient an opportunity to remain in clinic on stand-by status--an examination should not be guaranteed, however. The office staff member will then consult the supervisory faculty and determine whether a clinician is available for the patient.
A late patient given stand-by status should not be given higher priority, and all standby patients should be called in the order they presented to receive an examination.

Patient Cancellations

When a patient voluntarily cancels an appointment, the Appointments Staff Assistant should immediately fill the slot with the next available patient from the appropriate waiting list.
If a canceled appointment cannot be replaced from the waiting list due to time constraints, then a stand-by patient or patient available from the in-clinic "Quick Call List" (if available) may be appointed.

Stand-by Patient Status

During those times when Primary Care Services are being offered, the Clinic Office Manager may maintain a total "pool" of not more than 5 stand-by patients who desire to remain in the clinic in hopes of being called in the event of a no- show by a scheduled patient.
Stand-by patients (at the Pheiffer Clinic) must provide his/her chart number and will be called (should the opportunity arise) in the order that the patients requested being put on the stand-by list.
Stand-by patients should not be guaranteed any form of examination. In addition, they should be informed there is a very good chance they will not be seen that day.
"Stand-by" status should not be offered to a patient as being preferable to an appointment.
In order to remain eligible for call as a stand-by patient, individuals must remain in or near the Optometry Clinic reception area and be readily available to answer a call to receive an examination.
If a student has a patient no show, it is expected they will see a stand-by patient.
Stand-by patients should be dismissed from clinic just as soon as it becomes apparent that no further patients will be seen through the stand-by route on that day.
Stand-by priority is to be strictly a "first come, first served" protocol

Overloads in Clinic

Multiple student absences may result in excessive overloading of available student clinicians.

Attending faculty may elect to:

Assign patients to student clinicians who are available in other service units with approval of attending faculty in those service units.
Render patient care themselves.
Have patients re-appointed as necessary. This should be a last resort and the patient should be offered the option to reschedule early on if it is evident that the clinic is running extremely behind schedule.
Under circumstances where it becomes apparent that student and/or supervisory faculty absences will produce an excessive clinic overload, the Associate Dean may move to modify the day’s clinic schedule in an appropriate manner:

Hours of Clinic Operation

Clinical services are usually made available between the hours of 8:00 a.m. and 5:00 p.m. every Monday through Friday throughout the year. The University and Pheiffer Clinics will follow the published holiday schedule of the University. REP clinics will follow a holiday schedule which is modified to coincide with the Cherokee Nation Rural Health Clinic Schedule. Student doctors, faculty and staff will be given published clinical schedules at the beginning of each semester.

Patient visits are typically scheduled between 8:00 a.m. and 11:30 a.m., as well as between 1:00 p.m. and 4:30 p.m. Due to contractual agreements with other entities, NSUOCO personnel are responsible for keeping the clinics open and available to provide clinical care until 5:00 p.m. each day, except for published holidays. Therefore, closing time for all clinic locations will be 5:00 p.m. and a staff person will remain in that location until closing, or until such time as determined by the Associate Dean.

Patients presenting with potentially severe emergency-type complaints may be examined at other times, as deemed appropriate by the supervisory staff encountering the patient.

Hours of Electronic Health Record Access

Students are granted limited hours of access to RevolutionEHR in order to maintain privacy of Protected Health Information (PHI). Students are allowed to login to RevolutionEHR only during the hours of 7 a.m. to 7 p.m. Monday through Friday. They can access the non-patient training (sandbox) version of RevolutionEHR at any time. Most clinical staff members have the same limitations. Faculty members, residents, Clinic Office Managers and the NSUOCO Systems Manager have access to RevolutionEHR without time restrictions.

Documentation of Phone Consultations with Patients

Any and all specific telephone discussions held relevant to a patient should have appropriate documentation in the patient’s record. An electronic medical record entry of the Phone Encounter type can be created for this purpose. Students and staff should immediately discuss any phone calls pertaining to diagnosis and/treatment of a patient with a supervisory staff doctor to ensure appropriate documentation and disposition of the phone call.

In-Hospital Referrals

Requests for medical consultation/referral (including ophthalmology) should be made by using the current published referral policies.
Emergency requests for medical evaluation should also involve a telephone call from optometry to the medical unit involved. A note should be entered by the faculty member in the patient's record in Cerner EMR system. Students, residents or faculty may need to escort the patient to the clinic in which the patient will be seen.

In-House Referrals

Optometry Clinic professional personnel should maintain open communication and free exchange of insight, experience, and information relative to patient care, therefore, all staff should remain willing and open to sharing in the rendering of patient care and in the education of students. Referrals to such as in-house clinics as contact lens or vision therapy for example should be made within the RevolutionEHR system in the NSUOCO clinic facility. Even when in the same physical building as the service that will receive the referral, a complete referral form must be completed to ensure the patient is not lost within the system. Attending faculty should feel free to call upon one another for consultation throughout the Clinic. Patients being brought back from one Optometry service to another within the CNOHC can be brought back as a recall within the RevolutionEHR system, rather than as a referral. Requests for ophthalmological consultation should include appointment into the Disease Consult clinic. If ophthalmological care that cannot be provided either at NSUOCO or the CNOHC is needed, the patient must be referred to an ophthalmology specialist outside of the Cherokee Nation health care system through Contract Health if the patient is eligible for Contract Health Services. If the patient is not eligible for Contract Health Services, other appropriate referrals can be made.

Outside Referrals - Cherokee Nation Contract Health

All referrals for patients who are eligible for Cherokee Nation Contract Health funding must follow Cherokee Nation Contract Health policy. Cherokee Nation Contract Health is a utilization management system of providing advanced care to eligible patients based upon an approved, published list of medical priorities. To be eligible for Contract Health the patient must be a Cherokee Nation or IHS eligible patient who lives within the fourteen-county catchment area of the Cherokee Nation. As an overwhelming number of patients who receive care from NSUOCO services are Cherokee Nation or IHS eligible patients, NSU is required to conform with this utilization management system. In a further effort to ensure that Cherokee Nation Contract Health money for eyecare is spent efficiently and effectively, all contract health referrals from NSU and Pheiffer must have at a minimum verbal approval from the Associate Dean, the NSU Staff Ophthalmologist, or the Chief of Pheiffer Optometry Clinic. A referral in RevolutionEHR must be completed by the student and the supervising doctor with a notation of the source from whom verbal approval was obtained. The patient is then directed to the CNOHC Optometry Office Manager so that processing of the referral can be completed. Simply having a referral in RevolutionEHR does not indicate the commitment of Cherokee Nation to pay for the services requested and patients should be educated on this process. The referral must be approved and authorized through the Contract Health Department.

Return Visits to Clinic

All patients should have some direction for Return to Clinic documented in their RevolutionEHR record. The RTC may vary from "self appoint – 2 years", "No Recall" (used especially with no show patients of low risk) to "RTC to WI clinic 3 days". The return to clinic can be documented in various ways, but should include at a minimum the timeline for recall, the clinic the patient is returning to, and if appointment will be made by the clinic or if it is the responsibility of the patient. For the "walking healthy" patients it is highly desirable due to our lengthy waiting lists and number of patients needing eye care that the return to clinic be either 1 or 2 years and the patient will be responsible for setting up that appointment close to that time. For those patients requiring closer follow up such as glaucoma patients or diabetic patients, RTC should be specified by clinic and time frame desired (3 months, 6 weeks,etc). A recall is then added in the RevolutionEHR with that time frame to help keep the patient from being lost to follow-up. For patients needing to be reexamined in less than 1 month the patient should be taken to the clinic appointment clerk before being released to receive a specific appointment time within a specific clinical service unit. Those patients who are being released from a specific service should be advised of the need for their next routine eye exam and documentation in the exam record should reflect this advice (i.e., 1 yr. self appt. general exam).

No Show Policy

If a patient "no shows", front desk staff will document the patient's appointment in the EHR as a "no-show". The supervising faculty assigned to that patient is responsible for determining appropriate follow-up. If the patient needs to be contacted and given an appointment within the next month, the supervisory faculty should notify the front desk staff by entering the appropriate information in a RevolutionEHR "Task". The front desk staff will attempt to contact the patient and reschedule the appointment accordingly. If the appropriate time frame is at least one month away, the supervisory faculty is to create a recall in RevolutionEHR for an appropriate time frame. No show patients who the supervisory faculty feel have little to no risk of ocular/visual harm should be released from the clinic. No recall nor task needs to be entered.

Patient Accident/Patient Illness While in Clinic

In the event that a patient becomes ill or suffers an accident while in the optometry clinics, the student clinician should give primary priority to ensuring patient comfort and safety from further harm and should then move quickly to alert the attending faculty of the problem.

If the person cannot safely be left unattended, the student clinician should send word to the attending faculty through whatever means necessary to achieve the objective. Actions should be taken in quick and efficient ways, consistent with the health, well-being, and best interests of the ill or injured person. In cases of suspected respiratory arrest or cardiac arrest, a health center rapid response should be initiated by following the published health center procedures. On the NSU campus, Campus Police are to be notified by calling 2468 from a campus phone or (918) 444-2468 from any other phone. Emergency policies of the Cherokee Nation clinics will be followed when in those clinical facilities. It is advisable that most injuries and illnesses receive medical attention as quickly as possible.

Any and all significant injuries or illnesses should result in a rapid response system initiation or referral to the clinic medical department for attention. All such referrals should be initiated by means of a telephone call to the Security Office or medical department. This will enable them to send a team of medical personnel to stabilize the patient and decide if a transfer to the hospital emergency department is appropriate.

Following an incident of patient illness or injury in the Clinic, each student and supervisory staff involved should communicate the details of the event in writing via individual reports to the Associate Dean. The Associate Dean should receive a full, written account of the circumstances surrounding the illness or accident; and these should be completed and submitted as quickly as possible Also, each facility has incident forms and policies that must be completed and followed in the case of any incident.

Intoxicated, Belligerent, Harassing Patients

In the event a patient is verbally, physically, or sexually abusive toward any student clinician, attending faculty, or member of the clinical support staff, that patient should be politely dismissed from clinic. No guarantee of further service needs to be made, unless the attending faculty specifically directs that this be done. Under such circumstances, the student clinician should request to be excused from the examination room and should immediately inform the attending faculty of the situation. The attending faculty should move to dismiss the patient in a polite, but firm manner. In the event the patient refuses to leave readily and willingly, the attending faculty should immediately place a phone call to the health center, the campus, or the local security. Should such events develop, the involved students, staff, and faculty are requested to supply a detailed report to the Assistant Dean for Clinical Affairs immediately.

Insufficient Pharmaceuticals

Replacement pharmaceuticals for NSU clinics should be obtained from the Optical Equipment Technician. In the event that this individual is unavailable, the student clinician should request the attending faculty to obtain the agent for them. The Optical Equipment Technician should store a modest but sufficient inventory of frequently utilized pharmaceuticals in a designated location within the clinic. Should attending faculty determine that the pharmaceutical inventory is insufficient, they should contact the Optical Equipment Technician and request the needed agent. The Optical Equipment Technician will process or request the items through the appropriate channels.

Dispensing of Pharmaceuticals

It is against Cherokee Nation Health Services policy to dispense prescription medications to patients without processing the prescription through the Pharmacy. Pharmaceuticals found in the clinical area of Pheiffer clinic are for in office use only and are not to be dispensed to patients. Any medication dispensed to a patient seen in the emergency room must be dispensed out of the Emergency Room Omnicell which is maintained by the pharmacy. A medication order signed by an appropriately credentialed physician is required within the patient’s record every time the Pharmacy fills a prescription. A written prescription can be given to a patient for filling at a pharmacy outside the Cherokee Nation health system. Prescription pads are maintained in the Office Manager’s office and can be obtained from the clinical staff.

Any prescription provided directly to a patient in any of the University Optometry Clinics must contain a full and complete labeling of all prescriptive information including the drug, dosage, duration of therapy, refill information, and name of the optometrist prescribing the drug.

Fire Alarm While in Clinic

Each clinic will have explicit policies on safety and emergency procedures. Students should be aware of all policies and be prepared to act accordingly. Upon their first visit to a REP clinic the student should request a brief safety orientation, as each clinic has slightly different policies and procedures in this area.

Optometry Clinic, Pheiffer Clinic/Cherokee Nation Outpatient Health Center

When a fire is detected the employee will use the following steps upon discovering a fire and announcing CODE RED: Utilize the acronym R.A.C.E. as a guide in response to fire.

Rescue – Remove any patient, or visitors in immediate danger. Work as a team to accomplish the RACE steps.
Alert – Activate the Fire Pull Box and Call the Operator Emergency Ext. 4444.
Announce “CODE RED to notify staff members in the immediate area of fire situation.
Contact the Operator and give your name, department and room number where fire is located.
Notify supervisor of fire situation.
Contain – Close door(s) to the room where fire is located.
Close doors throughout the department where fire is located.
Evacuate – Evacuate if required.
Evacuations from Optometry shall be by enclosed stairwells and exit at ground level and shall continue east past the closest roadway to be accounted for.
Close doors.
Clear corridors.
Clear exits.

Health Center personnel not directly in the affected area

Close all doors regardless of location of fire.
Evacuate patients.

University Clinics, College of Optometry Building/Campus

Guide patients to the nearest outside exit.
Close examination room doors as you leave.
Attending faculty and staff should ascertain that all patients and students have exited the Clinic and then move quickly to leave the building themselves.

Take Cover Alarm While in Clinic

Optometry Clinic, Pheiffer Clinic/Cherokee Nation Outpatient Health Center

For Optometry the designated "safer waiting area" is within the Rehabilitation offices and exam rooms on Level One. The doors into the area are marked along the back hallway with "tornado area" signage.
In the event that a take-cover alarm is initiated, an overhead announcement will direct all persons to report to a designated safer area. All patients should be guided into this area of the Health Center using the enclosed stairwells and avoiding the central open staircase in the atrium.
Faculty and staff should ascertain that all students and patients are in the back "designated safer" area, and then seek cover there themselves.

Optometry Clinics, College of Optometry Building/Campus

The basement hallway of the Optometry Building is a designated a "safe" area within the building.
In the event that a take-cover alarm is sounded, all patients should be guided into this area of the building.
Faculty and staff should ascertain that all students and patients are in the area at the base of the stairwell and then seek cover there themselves.

Complaints and Directives from Health Center Staff and Administrators

NSUOCO is obligated to perform within the rules, guidelines and policies of the Cherokee Nation Health Services when providing care in Cherokee Nation facilities.

Any complaint or directive lodged by health center staff or administrators should be reported to the appropriate Service or Clinic Chief, the Assistant Dean for Clinical Care and the Associate Dean. Questions or concerns should be directed to the following for clarification and action:

Clinic or Service Chief
Assistant Dean for Clinical Affairs
Associate Dean
Dean, College of Optometry

Clinical Faculty Responsibilities

Role of Clinical Instructors

The primary purpose of clinical course work is to provide students with an opportunity to apply and relate the science and theory of optometry to real patients with real problems and concerns. The students must be taught the art of applying scientific knowledge and technique in order to provide patients with full-scope optometric care and primary health care services. It is the role of the clinical instructor to assist and encourage the students in understanding and applying the knowledge, science, skills, and techniques appropriate to the diagnosis, analysis, and management of the patient’s problems and concerns. The clinical instructor should seek to guide, counsel, motivate, and encourage each student. The role of clinical instructor is not the role of adversary.

While guidance must be firm and directed, the clinical instructors are encouraged to emphasize the positive in assisting students through the process of professional maturation. Clinical faculty are encouraged to provide opportunities, instruction, and guidance to students, and to insist on the pursuit of excellence in the delivery of full- scope optometric services. The instructors should facilitate and encourage the development of competency, self-confidence, interest, motivation, and maturity by the student. They should teach and motivate students to gain from experiences, to learn from mistakes, and to advance through intra/inter-professional relationships. They should show students mechanisms and resources which relate to the actual patient encounters. They should attempt to encourage the student to teach themselves. Successful clinical instruction can produce a clinician with a personal dedication and commitment to lifelong professional growth and advancement.

Faculty Assignments to Clinics

An instructor’s ability to teach effectively and to provide appropriate guidance to students involves the establishment of effective communication between faculty, student, and patient. An effective interpersonal relationship should be facilitated by the clinical instructor. It is desirable for the instructor to seek to improve the student’s self- confidence, while nurturing a feeling of trust in that student on the part of the patient.

An instructor should also be competent in the clinical area to which they are assigned. The instructor must be able to guide the collection of data, analyze the findings, arrive at an appropriate diagnosis, and provide students and patients with management options consistent with that diagnosis.

Faculty are assigned to clinics by the Associate Dean, upon the recommendation of the Clinic Chief in charge of the particular service. Faculty should request specific clinic assignments by applying for the duty through the appropriate Clinic Chief. Preference, interest, experience, competency, and ability will be considered in the assigning of faculty to cover specific clinics. A conscious effort will be made to avoid assignment of faculty into areas where they lack experience, motivation, or confidence.

Teaching

The instructor should be willing and able to explain and/or demonstrate those processes, tests, and techniques relevant to the case. The instructor should continuously assess the student’s skills and clinical proficiency. The instructor should allow for more independence and responsibility on the part of the student as clinical maturation develops.

Instructors may delegate responsibilities to their assigned clinicians, but ultimately the care of the patient is the responsibility of that clinical instructor. Clinical instructors have the responsibility of confirming the nature of the patient’s Chief Complaint or Reason for Presentation. They must also confirm all diagnoses and concur with any management options, treatments, or therapies prescribed or recommended. They must actively pursue appropriate consultation and/or referral, when indicated, for the best care of the patient. Clinical instructors are responsible for detection of significant ocular pathology.

Clinical instructors are expected to monitor students closely throughout the examination. This may require frequent consultation and interruption of an exam. It may also necessitate in-room monitoring of an exam. It may require that the instructor actively participate in examination of the patient. Interaction between instructor, student, and patient should permit instructors to anticipate problem cases and allow them to be readily available to provide guidance and assistance to students in difficult situations. Close observation will also give instructors the opportunity to assess the current competency and capabilities of the student. Instructors are encouraged to grant more freedom and greater responsibility to those students demonstrating reliability, clinical growth, and maturation. As the student progresses, the instructor should permit greater independence and allow for less rigid direction of the exam.

Intercession into Exam by Faculty

In an attempt to minimize patient inconvenience and to ensure clinical space and equipment for other scheduled patients and clinicians, the daily Clinic Schedule must be adhered to.

The Clinical Instructors are responsible for enforcement of the scheduled time limits. When the instructor deems necessary, he or she may intercede to complete the examination, or may interrupt the exam to arrange for rescheduling of the patient. Such return visits should make use of an appropriate "follow-up" slot within the same clinical service, and with the same student whenever possible. Referral may also be made into a specialty service clinic when the instructor deems it necessary. Students who repeatedly fail to complete routine procedures and examinations within appropriate time limits cannot be passed to the next clinical level. Goals, expectations, and requirements, including references to appropriate time limits, are included elsewhere in this document. (See section titled "Maturation of Clinical Proficiency".)

Patient Records and Charts

The patient’s clinical record and/or Cherokee Nation medical record are legal documents. They serve as the mechanism to collect all data regarding the patient, the services provided to the patient, the advice and recommendations made to the patient, materials ordered and dispensed, and fees charged and collected. When the patients are receiving services as a beneficiary of Cherokee Nation, the records are the property of Cherokee Nation. All other records are the property of NSUOCO. As such they may not be given to anyone, nor may any copies of or any part of the records be given to anyone without proper legal process. Clinical instructors should evaluate exam records to assure appropriate documentation and accuracy. It is essential that the assessment and management plan be written clearly, completely, and concisely. Any and all prescriptions should be fully and properly described. While the student clinician is responsible for filling out any examination form (paper or electronic) utilized the instructor should review and sign these records. The student should also sign all examination records. Instructors should sign all spectacle prescriptions before the student and patient proceed to the dispensary for frame selection and styling. Instructors and students should sign all exam record entries generated during the course of an examination.

Confidentiality of Patient Records

Patient files contain confidential information about the patient. Confidentiality must be maintained to assure an ethical and legal patient care system. No one shall have access to a patient file who does not have legitimate reason to see the file. Information in the file is not to be shown or discussed with anyone not involved in the care of the patient. Students who fail to maintain the confidentiality of the patient files are subject to failing or to suspension or dismissal from the professional optometry program, in accordance with NSU College of Optometry HIPAA policies.

Medical Records Release

Medicals records release at any Cherokee Nation facility must be completed according to Cherokee Nation Policy. Patients should be directed to the appropriate office within the health center to request release of their records. At the NSU campus clinic, NSU HIPAA policies will be adhered to. Information outside the area of referrals and daily care should be directed to the Privacy Information Officer prior to release of any information. At a minimum, for records to be released directly to the patient:

Written authorization for release of medical records must be signed by the patient or the responsible person (if a minor) or state-appointed guardian. The signature must be authenticated by comparing with an actual signature on the patient’s record.
The authorization should be addressed to NSUOCO.
The authorization should contain the name of the person or company to whom the information is to be given.
The authorization should be signed and dated by the person whose record is being sent. His or her request must be specific as to what information is being released.
A faxed copy of a release of information will be accepted by a medical facility when followed by the original copy for the patient’s record.
When records are released to an individual, an original authorization form must be on file before the records can be released.

Administrative Protocols

The clinical education program of the College of Optometry is comprised of numerous clinic sites. Among these are the NSU University Clinics, Pheiffer (CNOHC) Optometry Clinic, the Lesley L. Walls Vision Center on the NSU Broken Arrow campus and the Rural Eye Program Clinics. A portion of the students’ clinical education is also provided through external sites designated as part of the Externship Program. The Associate Dean oversee the administration of all clinics.

At each of the University clinics policies for third party billing are the direct responsibility of the Coordinator of Clinical Management who reports directly to the Associate Dean and the Assistant Dean for Administration. At each of the clinics which comprise the primary clinical education program of the College (University Clinics, Pheiffer Clinic and the Lesley L. Walls Vision Center), NSUOCO staffing issues, scheduling of NSUOCO staff, and personnel policies are also the direct responsibility of the Coordinator of Clinical Management. The Coordinator of Clinical Management may assign a portion of those responsibilities, particularly on routine daily issues, to the administrative staff or faculty supervisor at each site; however, all non-routine questions or matters about billing, staff scheduling or issues dealing with staff or personnel policies should be directed to the Coordinator of Clinical Management for guidance and/or interpretation.

Staff who provide clinical support in the Eye Clinics of the Cherokee Nation Rural Health Clinics and some of the staff at the Pheiffer (CNOHC) Eye Clinic are employees of the Cherokee Nation and are under the direct supervision of the NSUOCO faculty doctor assigned to that clinic. Administrative supervision is provided by the Clinic Chief of the Rural Eye Clinics. The Coordinator of Clinical Management may also be asked to provide counseling and guidance for any staffing/personnel issues brought to his/her attention by the REP Clinic Chief or the faculty person who is the on-site director of that specific clinic. Administrative supervision of the clinics is the responsibility of the REP Clinic Chief or the Pheiffer (CNOHC) Clinic Chief under the direction of the Associate Dean. The Associate Dean reports directly to the Dean. Providing input and guidance for policy and procedure definition are Clinic Chiefs and/or Service Chiefs who are faculty members with administrative responsibility for the policy and procedures of the specific sub clinics. Clinical education issues are discussed and determined at regular faculty meetings or at annual Faculty Retreats.

Associate Dean

The Associate Dean is responsible for creating the clinic and class schedules for students and faculty. This person is responsible for faculty issues involving recruitment, monitoring of leave, counseling, credentialing, insurance applications and peer review. This person attends monthly Medical Executive Committee meetings and works closely with Cherokee Nation to monitor monthly billing for services, planning for clinic equipment or facility changes. This person works closely with the REP Clinic Director on REP coverage and schedules. When significant problems, issues, or questions arise, and when they relate to clinical functions in general, or to areas clearly beyond the function of the Assistant Dean for Clinical Affairs, a specific clinical service unit or the Director of that unit, the Associate Dean should be contacted immediately. This person is responsible for pursuing all necessary avenues and options in attempting to best answer the question or solve the problem. The Associate Dean should be informed and directly involved whenever complaints are lodged against Optometry, its staff, its students, its faculty, or its representatives. These complaints could arise from patients, could arise internally, or could originate from other sources within the hospital, health centers or external clinic sites. This person will assist the Dean with reports and other functions as needed.

Assistant Dean for Clinical Affairs

The Assistant Dean for Clinical Affairs is responsible for monitoring student absences and counseling on clinic grades with Clinical Grading Coordinator. This person has primary responsibility for patient questions or complaints for issues from the NSUOCO Clinic, the Pheiffer Eye Clinic at the CNOHC and the Rural Eye Program. When issues arise which cannot be resolved at this level, they should be shared with the Associate Dean. This person will be the site coordinator and chief preceptor for the University of Houston College of Optometry Externship students. The Assistant Dean for Clinical Affairs will update the Clinic Handbook as needed and assist the Director of Optical/Spec Fab with the frame inventory. This person will monitor for inclement weather along with plans made by NSU and Cherokee Nation Health Services and help implement the NSUOCO inclement weather policy and notify students, faculty and staff. This person will assist the Dean and Associate Dean with reports and other functions as needed. This person serves as the ASCO Clinic Director SIG and IPE designee.

Listing of Principal Clinics and Service Units

Listed below are the clinic sites within the NSU College of Optometry clinical program, the services provided in various clinics at each site and the abbreviation for the services used when scheduling faculty and students into clinics.

NSU Campus Clinic

- - - Primary Care clinic (PC)
    - Contact Lenses (CL)
    - Vision Therapy (VT)
    - Specialty Care (SP)
    - Surgery Clinic (SX)
    - Optical Services (DSN)
    - Spectacle Fabrication Lab (SF)
    - Vision Rehabilitation (Low Vision) (LV)
    - Parkview School for the Blind (PV)
    - Acute Care/Walk-In (OD)
    - School Screening
    - Traumatic Brain Injury (TBI)
    - Electrodiagnosis (ED)
    - Imaging (IMG)
    - Practice Plan (faculty only)

Pheiffer Eye Clinic

- - - Primary Care Clinics (Adult "1G" and pediatric "2G")
    - Glaucoma Clinic (GLA)
    - Acute Care Clinic (WI)
    - Disease Consult Clinic (DC)
    - Retina Service (RET)
    - Diabetes Retinal Exam (DM)
    - Cataract Evaluation (CAT)
    - Optical Services (DS)

Lesley L. Walls Vision Center (Broken Arrow)

- - - Vision Rehabilitation (Low Vision)

Rural Eye Program (REP)

- - - Amo Health Center (Salina)
    - Sam Hider Health Center (Jay)
    - Redbird Smith Health Center (Sallisaw)
    - Wilma P. Mankiller Health Center (Stilwell)
    - Three Rivers Health Center (Muskogee)
    - Will Rogers Health Center (Nowata)
    - Vinita Health Center
    - Cooweescoowee Health Center (Ochelata)

Clinic Chiefs

The Clinic Chief for the NSUOCO Clinic is responsible for overall function of the student

education and delivery of patient care within that clinic. The Chief reports directly to the

Assistant Dean for Clinical Affairs. The Clinic Chief for the NSUOCO Clinic is responsible for implementing and enforcing policies and procedures as they relate to the function of the clinic. This person is responsible for NSUOCO clinical billing and organizing student clinical orientation at the beginning of each semester. When significant problems, issues, or questions arise, the Clinic Chief for the NSUOCO Clinic should be contacted immediately. This person is responsible for pursuing all necessary avenues and options in attempting to provide answers or solutions to problems. The Clinic Chief of the NSUOCO Clinic is responsible for reporting all problems and outcomes to the Assistant Dean for Clinical Affairs. The Clinic Chief for the NSUOCO Clinic should be informed and directly involved whenever complaints are lodged against any NSUOCO student, faculty, or staff at the NSUOCO Clinic.

The Clinic Chief for the Pheiffer Clinic (CNOHC) is responsible for overall function of the student education and delivery of patient care within that clinic. The Chief reports directly to the Assistant Dean for Clinical Affairs. The Clinic Chief for the Pheiffer Clinic is responsible for implementing and enforcing policies and procedures as they relate to the function of the clinic and Cherokee Nation protocol. When significant problems, issues, or questions arise, the Clinic Chief for the Pheiffer Clinic should be contacted immediately. This person is responsible for pursuing any and all necessary avenues and options in attempting to provide answers or solutions to problems. The Clinic Chief for the Pheiffer Clinic is responsible for reporting all problems and outcomes to the Assistant Dean for Clinical Affairs. The Clinic Chief for the Pheiffer Clinic should be informed and directly involved whenever complaints are lodged against any NSUOCO student, faculty, or staff at the Pheiffer Clinic.

The Clinic Chief for the Rural Eye Clinics is responsible for overall function of the student education and delivery of patient care within those clinics. Optometry clinics are located within Cherokee Nation Tribal Health Centers in Sallisaw, Stilwell, Salina, and Jay, Muskogee, Nowata, Vinita and Ochelata. The Clinic Chief for the Rural Eye Clinics reports directly to the Assistant Dean for Clinical Affairs and works with that person to determine faculty coverage at the clinics, as well as ensure that students are rotated through the various clinics when assigned to the REP by the Associate Dean. Faculty members at each REP clinic are the supervisor for the daily clinic functions and responsible for the management of that clinic. The Clinic Chief for the Rural Eye Clinics will act as the liaison between REP faculty, the College, designated staff of the Cherokee Nation and providers, staff, and administrators at the Cherokee Nation Tribal Health Centers. The Clinic Chief for the Rural Eye Clinics will be responsible for implementing and enforcing policies and procedures applicable to the function of the REP clinics. When significant problems, issues, or questions arise, and when they relate to the REP clinics, the Clinic Chief for the Rural Eye Clinics should be contacted immediately. This person is responsible for pursuing any and all necessary avenues and options in attempting to best answer the question or solve the problem and reporting those to the Assistant Dean for Clinical Affairs. The Clinic Chief for the Rural Eye Clinics should be informed and directly involved whenever complaints are lodged against Optometry clinics in the REP, its students, its faculty, or its representatives. These complaints could arise from patients, could arise internally, or could originate from other sources within the health centers.

Service Unit Chiefs

Due to the existence of several "specialty" services within the clinical program, and based upon the large patient load processed through these specialty service areas, several other faculty have been granted the authority to help establish policies which affect those service areas. The Vision Therapy Clinic, Contact Lens Clinic, Infant Vision Clinic, Low Vision Clinic, Specialty Care Clinic, Surgery Clinic, Neuro-Vision Rehabilitation Clinic and Dispensaries each have a faculty member designated as Service Chief to provide the NSU Clinic Chief, Assistant Dean for Clinical Affairs and the Associate Dean with guidelines, recommendations, and directions for operation of these clinics. This organization provides a forum for communication between separate services units and formulates the protocols and procedures used in controlling patient flow between various service units. Anyone with a question or proposal related to major aspects of clinic policy should direct their communications to the appropriate Service Chief, NSU Clinic Chief, Assistant Dean for Clinical Affairs and/or to the Associate Dean, in that order.

Listing of duties and responsibilities of Clinic Chiefs and Service Chiefs:

1. 1. Helps determine protocols for scheduling patients to receive services designated under the specific clinic
  2. Provides input into selection and performance evaluation of staff assigned to clinic
  3. Provides recommendations for faculty assignment into clinic and helps evaluate faculty performance in clinic
  4. Makes recommendations to the Assistant Dean for Clinical Affairs, Associate Dean and faculty in establishing protocol for education and delivery of service in clinic
  5. Responsible for decisions related to daily implementation of policies within the clinic
  6. Works with Clinic Office Manager to assure smooth flowing, efficient operations in clinic
  7. Clinic Chiefs have the additional responsibility of overseeing the equipment, staff, and physical plant assigned to that clinic. Service Chiefs may have specialized equipment they are responsible for, but do not have a designated physical plant responsibility.

Function of Principal Clinic Units

School Screening Service

Public and private schools may request that their students be screened by the College of Optometry. This request may be processed through the School Screening Service Chief or through the College Administration Office which will forward the call or message to the School Screening Service Chief. Students do not need to be IHS eligible to be seen as part of a school screening. These external school screenings are conducted in the Fall and Spring semester, and are staffed by First Year (I) students in the spring and Second Year (II) students in the fall under the direct supervision of the School Screening Service Chief. In the event that a child "Fails" a school screening evaluation, the teacher is advised and the parent is sent a copy of the "Parental Report Form," which describes the areas of difficulty. It is left to the parent to decide upon the course of action to be taken, and no attempt is made to steer the family to individual practitioners or toward the College of Optometry or its affiliated programs. Student clinicians conduct the tests and record the results during screening clinics, but do not attempt to make diagnostic decisions or discuss the implications of findings with either the patient, the parents or guardians, or teachers. It is the responsibility of the supervising staff doctor to evaluate the screening form and to make recommendations based on the student clinicians’ data.

Primary Care Clinic

Primary care clinics are located at Pheiffer (CNOHC) and NSU clinics. The Cherokee Nation Outpatient Health Center Eye Clinic schedules adult general eye exams and pediatric (ages 6-18 years) for Native American patients. The general exams scheduled at the NSU clinic are for indigent patients who would not otherwise be able to afford eye care and for patients from within the NSU community. Patient sources for this clinic include referral from the NSU Campus Health Center, Lion’s Club and Job Corps as well as NSU faculty, staff, students and their families. These clinics provide full-scope, comprehensive optometric examination and associated care, including therapy, treatment, counseling, and appropriate management for a vast array of ocular and visual anomalies. Students from years II, III, and IV of the clinical curriculum are eligible for assignment into the various Primary Care clinics.

Optical Services

- - Optical Dispensaries

Each of the NSUOCO optical dispensaries provide complete services for ordering, verifying, dispensing, adjusting, and repairing spectacles. There is an optical dispensary in each of the clinics at NSUOCO, NSU Broken Arrow and all of the Cherokee Nation Clinics. Students from Years II, III, and IV of the clinical curriculum are eligible for assignment into Dispensary at either NSU or the Pheiffer (CNOHC) clinic.

- - Spectacle Fabrication Laboratory

The spectacle fabrication laboratory is located within NSUOCO and provides services of manufacturing and ordering spectacles for the various clinics within the NSU clinical system. Includes student participation in repairing spectacles, tinting lenses, edging lenses and ordering from other laboratories or distributors. It is intended to expose the student to the process of an in-house spectacle laboratory. Students from Years III and IV are eligible for assignment into this service.

Contact Lens Clinic

Provides contact lens examination, fitting, evaluation, dispensing, and related patient instruction, etc., for patients desiring contact lenses for cosmesis and/or enhancement of visual function. The contact lens service provides for the primary vision care needs of its patients. Students from years III and IV of the clinical curriculum are eligible for assignment into the contact lens clinic.

Glaucoma Service

The glaucoma clinic provides management to patients with glaucoma or to patients with unusually high risk of developing glaucoma. The clinic is located within the Cherokee Nation Outpatient Health Center and sees patients who are referred to the glaucoma service for continued management. Normally all glaucoma patients cared for at the Pheiffer (CNOHC) Eye Clinic will be managed by the glaucoma service. The Glaucoma Service has developed written procedures and policies which help to ensure proper patient care. These policies include: thrice yearly exams of each patient with glaucoma, annual visual field testing, optic nerve OCT imaging and gonioscopy. Those procedures of course may be done more frequently when and if indicated. Students from year IV of the clinical curriculum are eligible for assignment into the glaucoma clinic.

Acute Care/Walk-In Service

The Acute Care Clinic provides immediate assessment, screening, evaluation, and optometric management of patients who present to clinic with acute ocular and/or visual problems and concerns. Examples: acute double vision, acute vision loss, acute red eye, ocular foreign body, broken high-power spectacles, sudden change in vision, acute ocular pain, etc. Patients are triaged upon presentation to the Optometry Clinic and will be seen based on urgency of condition, and then in order of presentation. Cases of ocular emergency will receive highest priority. This clinic also provides 1-day and 1-week cataract post-op exams.

Students from years III, and IV are eligible for assignment into the acute care service. All follow-up and progress evaluations should be by appointment, either into Acute Care/Walk-in Service, or other appropriate disease-related clinical services.

1. 1. RTC to Acute Care/Walk-in Service, when it is determined that continuity and quality of patient care is best achieved through re-assessment/follow-up.
  2. RTC to Primary Care Services, when continuity and quality of patient care and student educational experience can both be well achieved through reassessment/follow-up by the student clinician who initially encountered the patient during an assignment within the Acute Care Service.
  3. Consultation/Referrals: Ophthalmology; Disease Consultation Clinic; Contact Lens Clinic; Adult Medicine; Pediatric Medicine; Emergency Room. Appropriate referral form must be completed

Rural Eye Program Clinics

Provides full-scope, comprehensive optometric examination and associated care, including therapy, treatment, counseling, and appropriate management or referral for all patients at the health center site with eye and/or visual problems and concerns. Located within multi-disciplinary ambulatory care centers of the Cherokee Nation. During interim periods, students may request assignment into the REP clinics for clinic make-up and/or additional (elective) clinic assignments. Students from year III and IV of the clinical curriculum are eligible for assignment into the REP clinics.

Vision Therapy Clinic

Provides in-depth evaluation, analysis, and remediation of visual disorders, and/or learning/perceptual/developmental disorders. All patients seen within this service should have previously received a comprehensive optometric examination elsewhere within an NSU clinic. Vision Therapy Service is most properly considered a "secondary level" service. When possible to do so, VT clinics are conducted in the afternoon in order that patients’ time away from school may be minimized. However, the requirement to have accessible clinical space may dictate the need to have morning clinics as well. Each four- hour block of clinician’s time is divided to allow for one 90-minute examination, followed by two 45-minute sessions of therapy. The final 15 minutes of each patient visit is used to complete all appropriate re-appointing, documentation, and letters of information relevant to the patient encounters of the day. Commonly, at the conclusion of each clinic session, a grand rounds is held to review the patient encounters for that day.

Students from years III and IV of the clinical curriculum are eligible for assignment into the vision therapy clinic.

Cataract Evaluation Clinic

The cataract evaluation clinic is supervised by an Optometrist affiliated with an ophthalmologist providing cataract surgery locally. This clinic is located within the Cherokee Nation Outpatient Health Center and provides cataract evaluations to patients who have been referred from our various Cherokee Nation Clinics who have met the tribe’s visual qualifications for cataract surgery coverage. They verify qualification and appropriateness of cataract surgery, acquire preoperative measurements, obtain patient surgical informed consent and provide pre and post-operative prescriptions and instructions. Students from Years III and IV are eligible for assignment into this service.

Diabetes Service

The diabetes clinic provides eye care to our patients with diabetes. This clinic is located within the Cherokee Nation Outpatient Health Center and provides full eye examinations to patients with diabetes. We attempt to see all our Native American patients who have diabetes for a dilated fundus exam at least yearly, or more often as appropriate for their level of ocular involvement. OCT retinal imaging and retinal photography are frequently performed as indicated. Communication with the Cherokee Nation diabetes management team and the patient’s primary care provider are integral parts of these exams. Referral to retinal subspecialists or other subspecialties is a frequent aspect of this clinic. Students in year IV of their clinical education are available for assignment into this clinic.

Disease Consultation Service

The disease consult clinic provides ocular or neuro-ocular disease consultation and management for patients referred for further evaluation and management. This clinic is staffed by the NSU staff ophthalmologist and/or a faculty member with a disease emphasis. It is located within the Cherokee Nation Outpatient Health Center and receives referrals from all clinics within the NSU clinical system as well as other IHS and tribal clinics within the region. This clinic often utilizes ancillary ocular and neurological imaging and laboratory testing to accurately diagnose and manage the disease presentations. Patients are often referred or comanaged with ophthalmology subspecialties outside this facility. Students in year IV of their clinical education are available for assignment into this clinic.

Retina Service

The retina clinic provides retinal disease consultation and management for patients referred for further evaluation. This clinic is staffed by NSU faculty members with retinal disease emphasis. It is located within the Cherokee Nation Outpatient Health Center and receives referrals from all clinics within the NSU clinical system. This clinic often utilizes ancillary ocular imaging and other testing to accurately diagnose and manage the retinal disease presentations. Patients are often referred or comanaged with ophthalmology subspecialties outside this facility. Students in year IV of their clinical education are available for assignment into this clinic.

Electrodiagnostics Service

Patients evaluated in this service are referred from other clinics including Pheiffer, Rural Eye, and private practices. Special tests performed include EOG, VEP, and ERG (flash, pattern and multifocal). Once evaluated a thorough written report of findings is sent by the attending faculty back to the referring doctor for continued care. Students from year IV of the clinical curriculum are eligible for assignment into the Electrodiagnostics clinic.

Infant Vision Service

Provides full-scope, comprehensive optometric examination and associated care, including therapy, treatment, counseling, and appropriate management for pediatric patients (ages 1 day to approximately age 6) with eye and/ or visual system problems and concerns. Students from year IV of the clinical curriculum are eligible for assignment into the infant vision clinic.

Vision Rehabilitation/Low-Vision Service

Provides in-depth assessment of sub-normal visual function, and evaluation of magnifiers, lenses, and other optical aids potentially useful in the maximization of visual potential; provides aids techniques, and counseling directed toward visual rehabilitation and enhancement. This is a second-tier clinical service, and sees patients primarily upon referral from other services. The Low-Vision Service, however, provides for the primary level needs of its patients, including ocular health checks at appropriate intervals. This clinic also has two sub clinics which are provided at the Oklahoma School for the Blind in Muskogee, also known as the Parkview School and at the Lesley L. Walls Vision Center on the NSU Broken Arrow campus. Students from year IV of the clinical curriculum are eligible for assignment into these clinics.

Neuro-Vision Rehabilitation

Neuro-Vision Rehabilitation Clinic is a specialized rehabilitative clinic whose emphasis is in the area of stroke rehabilitation, closed head injuries, and developmental disabilities, including multisensory therapy. Patient referrals are accepted from any health, psychological, educational, or developmental resources or agencies. Students from year IV of the clinical curriculum are eligible for assignment into the TBI clinic.

Specialty Care Clinic

Provides specialized eye care for patients by referral, who have already received primary eye care elsewhere and been identified as a candidate for surgical intervention. Includes pre-operative, surgical, and postoperative care for laser surgical procedures and minor surgical procedures. Cataract pre-operative and postoperative evaluations are also performed in Specialty Care Clinic. Punctual plug evaluation, insertion, and follow-up are performed in Specialty Care Clinic. The Specialty Care Clinic provides for the secondary eye care needs of the patients referred from other doctors or clinics. Following conclusion of the secondary care, the patients are returned to the referring doctor or clinic for continued eye care. Students from year IV of the clinical curriculum are eligible for assignment into specialty care clinic.

Surgery Clinic

Provides exposure to advanced surgical procedures for students and residents. Includes pre-operative and postoperative care. Students and Residents assist in and observe advanced surgical procedures performed by the NSU staff ophthalmologist. Commonly this clinic runs concurrently with specialty care clinic. Students from year IV of the clinical curriculum are eligible for assignment into surgery clinic.

Practice Plan Service

The faculty of the College of Optometry is composed of professionals in a wide variety of specialties in ocular health care. The Professional Practice Plan policy applies to those faculty who hold fulltime appointments in the College. Full-time members of the College of Optometry accept all rights, privileges and obligations of other University faculty as set forth in University policies. Accordingly, the primary goal of full-time faculty members of the College is the education of students as professionals. Faculty are encouraged to engage, within the limits of the time available to them, in such income- producing activities as consulting work, sponsored research, professional optometric practice and other activities which are closely related to their University work. A reasonable degree of active involvement by the faculty in direct eye health care delivery is vital to the maintenance of their professional skills. Active participation in professional activities requires of the faculty a significant commitment in terms of energy, emotional dedication, time and the assumption of personal liabilities in addition to those assumed in carrying out academic programs. The decision to engage in such professional activities by faculty members will be made with the knowledge and understanding that it must be done in accordance with the provisions of the Professional Practice Plan policy.

Doctor of Optometry

Doctor of Optometry

Clinic Handbook

NSUOCO Mission Statement

Mission Statement of NSUOCO Clinics

Goals of the Clinical Program

Educational

Service to Patient

Patient’s Bill of Rights

Patient’s Bill of Responsibilities

Process for Patient to File Complaint

Notice of Privacy Practices

Our Notice of Privacy Practices

Attendance in Clinics

Clinic Swaps

Clinic Absences

Make-Up Clinics

Punctuality and Professionalism

Absences During 4th Year Externship

Student Swap Request Process

Student Absence Request Policy

Extenuating Circumstances

Start of the Semester Absences

Inclement Weather

Additional (Elective) Clinical Attendance

Student Permission for Professional Travel Policy

Examination Room Protocols

Duties in Clinic

Student Clinic Assignments

First Year

Second Year

Third Year

Fourth Year

External Rotations

Goal

Objectives

Evaluation and Grading of Student Clinicians

Counseling and Advisement of Student Clinicians

Grading of Clinical Performance

Daily Grading - The Closing Interview

Periodic Clinical Progress Review

Disciplinary Dismissal of Students from Clinic

Procedure for Student to File Grievance

Procedure for Faculty to File Grievances

Maturation of Clinical Proficiency

First Professional Year

By completion of the spring semester, first year:

Technical Skills

Organizational Ability

Analysis and Diagnosis

Formulation of Management Plan

Communication

Second Professional Year

By completion of the fall semester, second year:

Organizational Ability

Analysis and Diagnosis

Formulation of Management Plan

Communications

By completion of the spring semester, second year: Technical Skills

Organizational Ability

Analysis and Diagnosis

Formulation of Management Plan

Communication

Clinical Skills Competency Evaluation

Third Professional Year

By completion of the summer semester, third year:

Organizational Ability

Analysis and Diagnosis

Formulation of Management Plan

Communications

By completion of the fall semester, third year: Technical Skills

Organizational Ability

Analysis and Diagnosis

Formulation of Management Plan

Communications

By completion of the spring semester, third year:

Organizational Abilities

Analysis and Diagnosis

Formulation of Management Plan

Communication

Absences During 4^th Year Externship