Optometric Management - December 8, 2004

Newsletter

Glaucoma Flow Sheets

December 8, 2004

Here’s a practical aid to help you manage your glaucoma patients: a paper form that organizes all glaucoma related procedures and findings in the patient’s record. If you aren’t already using a glaucoma flow sheet, you’ll like the overview of office visits, test results and drug prescriptions, which allows you to monitor all the various data and risk factors as you decide on the best treatment regimen.

Without a glaucoma flow sheet, comparing previous test results, like IOP readings and cup/disc ratios, involves flipping through many pages in a patient record and trying to remember the findings. Tests like visual fields and nerve fiber analysis, which should be performed at regular time intervals, can sometimes be overlooked and get off schedule. Tests that are usually performed once, like corneal pachymetry, may be hard to locate when you need the information later, because you don’t know where it is in the chart, and the charts are usually pretty thick. All these problems are solved with a glaucoma flow sheet, so it definitely saves time and prevents errors in management.

I should mention that grouping and organizing data is one of the advantages of electronic medical record software programs, so doctors who use those systems generally already have access to sorted data. The majority of offices still use paper records, however, so this form is a great help. In my practice, a clinical technician records all the entries on the glauacoma flow sheet, and it’s kept on top of all other forms so I can’t miss it.

It’s easy to make up a master glaucoma flow sheet for photocopying yourself, or to take to a printer for reproduction. I’ll share the format we use in my practice, so you can revise and improve it as you see fit. The form is actually like a grid, with boxes for each test result or a check mark. You can use a word processor to design the form, or simply type the names of column headings across the top of the paper and use a ruler to draw vertical and horizontal lines. My staff photocopies our forms onto different colors of paper to help us find the correct sheets at a glance in the chart or in a storage closet. Our glaucoma sheet is light green. To provide the maximum number of entries and to give the most space, I orient the 8.5 x 11 inch form in the “landscape” format, so the 11 inch side becomes the “top”.

The top of the form has a section reserved for patient identification and a very brief history that’s pertinent to glaucoma management. I also include test data that is usually only done once. Several entries can go on one line to keep the form concise.

Patient name and date of birth
Ocular diagnosis including type of glaucoma
Medications and diseases
Allergies
Race and family history of glaucoma
Blood pressure and pulse
Pachymetry
Gonioscopy and chamber angle grade

The remainder of the form is dedicated to dates of visits and test results. The headings of columns are as follows, and the width of a column can vary, depending if you are entering a number, a check mark or written comments. I still use my regular exam forms for all office visits, so the glaucoma flow sheet is actually a second entry for the data. I keep more details and notes on the regular exam forms, so the flow sheet does not need to have a lot of writing.

Date	VA	IOP	C/D	Fields	NerveFiber	Photo	Comments	DrugRx	F/U

A date is entered in the date column for each patient visit and an entry is made under each test that is done on that date. Some boxes will be blank on some dates, but you can easily see how long it’s been since the last field test, for example, and you can easily see a progression of IOPs. VA, IOP and C/D has an entry for each eye recorded as R/L. Fields, nerve fiber analysis and photos can have a check mark if performed, or can have an abbreviated descriptive notation. The drug Rx column indicates the therapy that was prescribed on the date shown, and the number of refills should be included. The follow-up column indicates the date the patient should return to the office.