New Global Campaign Takes on Noisy Leisure Activities

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Worldwide, the statistics are sobering:

  • 360 million people have disabling hearing loss.
  • 43 million people between the ages of 12–35 years live with disabling hearing loss.
  • Half of all cases of hearing loss are avoidable through primary prevention.

Of course, none of this likely comes as a surprise to ASHA members, particularly audiologists, who are on the front lines of care for people with hearing loss. The good news is that we are going to hear a lot more about this serious health issue with the help of a high-profile group.

Today, on International Ear Care Day, the World Health Organization is elevating the profile of hearing loss—specifically noise-induced hearing loss—by launching a new campaign called Make Listening Safe.

The campaign educates the public about hearing dangers posed by noisy leisure activities and promotes simple prevention strategies. Young people are the focus because an increasing number are experiencing hearing loss. As the creator of the highly successful Listen to Your Buds campaign, WHO asked ASHA experts to advise on Make Listening Safe. A role the association enthusiastically embraced.

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ASHA used Listen to Your Buds to provide an early warning on potential hearing dangers from misuse of personal music players and the need for safe listening. Today, as this technology is nearly ubiquitous, the campaign is going strong on a variety of fronts.

One of ASHA’s most successful ventures is its safe listening concert series. The series educates young children about protecting their ears in a fun, interactive way by bringing innovative musicians and performances to U.S. schools. A new video showcases the most recent concert series, which took place in six Orlando-area schools in conjunction with ASHA’s 2014 convention.

Misuse of personal audio devices is also a key area of focus for Make Listening Safe. According to WHO, among teenagers and young adults aged 12 to 35 years in middle- and high-income countries, nearly 50 percent are exposed to unsafe levels of sound from the use of these devices.

This is one of the new global estimates being released with the launch of Make Listening Safe. In addition to a high-profile unveiling in Geneva, WHO is issuing a variety of materials featuring statistics on the problem’s scope, the hearing loss consequences and action steps that parents, teachers, physicians, managers of noisy venues, manufacturers and governments can take to make listening leisure activities safer.

ASHA asks members to take up the campaign. Here are just a few ideas on how you can get involved:

  • Utilize the WHO’s eye-catching public education materials—including posters, a fact sheet, and an infographic—with peers, patients, friends and loved ones.
  • Engage in grassroots public education, such as sharing statistics and prevention tips on social media or holding a free hearing screening.
  • Approach local media to pitch a story. The campaign’s launch with accompanying statistics is a great news hook. You can tie the story to your local community by highlighting an event your practice is hosting or offer tips for safe listening at local noisy venues (e.g., stadiums, concert venues/clubs). This is also an excellent consumer health story for a television station, particularly because it offers “news you can use” such as easy prevention tips.

The focus on noise-induced hearing loss in young people is not limited to March. While the WHO campaign will be ongoing, ASHA will also poll the public about safe listening practices. Our results will provide more opportunity for outreach during Better Hearing & Speech Month in May and beyond. Stay tuned!

Click here for more information. Questions may be directed to pr@asha.org.

 

Judith L. Page, PhD, CCC-SLP, is ASHA’s new president. She served as program director for Communication Sciences and Disorders at the University of Kentucky for 17 years and as chair of the Department of Rehabilitation Sciences for 10 years. 

Of Language Barriers, Culture Gaps and e-Bridges

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It certainly isn’t news that our country is becoming increasingly diverse. What may surprise us is that some of the biggest growth is happening in non-border, less-urbanized states. California, Texas and Florida continue to have the most residents who were born in another country. However, Alabama, Arkansas, Delaware, North Carolina and Tennessee all saw more than a 70% increase in foreign-born residents between 2000 and 2012.

This means that ASHA members probably find themselves with more and more English-language learners on their caseloads. These audiologists and SLPs likely also live in areas where there may not be many resources for serving ELL students. Our Code of Ethics states that we should provide culturally and linguistically appropriate services. ASHA also acknowledges that the ideal situation for ELL clients is to work with a bilingual service provider with specific language and clinical skills.

Telepractice offers an elegant solution for connecting colleagues with these competencies to our clients that need them.

The versatility of telepractice makes it useful in different settings. A school district might use several Spanish-speaking telepractitioners to manage its entire ELL caseload. A rural health clinic may create a limited agreement with a bilingual audiologist for follow-up care of a patient who communicates in a less-commonly spoken language.

Telepractice can be used for more than intervention. We can assess patients—even formally—through telepractice. Formal assessment via telepractice is getting easier because many well-known tests are now digitized. Even when a certified professional is not available through telepractice, an onsite team can use technology to connect with interpreters and cultural brokers to help provide appropriate services.

Telepractice licensing, however, remains a hurdle for taking advantage of remote services or becoming a telepractitioner. Most states don’t currently have regulations on telepractice for our professions. ASHA and local associations, however, advocate for states to formulate and adapt guidelines permitting telepractice.

In the meantime, associations advise telepractitioners to verify requirements and policies, as well as hold all appropriate credentials, both in the state where we reside and where the client receives services. This applies also to special credentialing for bilingual telepractitioners.

ASHA doesn’t certify bilingual service providers, but it provides guidelines for those who represent themselves as such. For example, we are ethically-bound to ensure that we speak or sign another language with native or near-native proficiency, and possess various clinical competencies.

To my knowledge, only Illinois and New York have a type of credential for bilingual practitioners, and these are specific to professionals working in schools. However, because policy changes frequently (and is difficult to track), SLPs and audiologists should verify any bilingual-specific requirements in states where they might practice before providing services.

Telepractice holds a lot of promise for serving clients with diverse needs. Even when there is some red tape to figure out, using technology to build bridges to communities that may not have many resources is one of my most rewarding professional experiences!

 

Nate Cornish, M.S., CCC-SLP is a bilingual (English/Spanish) SLP and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for SIG 18: Telepractice, a member of ASHA’s Multicultural Issues Board, and a past president and vice-president of the Hispanic Caucus.  Cornish provides clinical support to monolingual and bilingual telepractitioners around the country.  He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  Contact him at nate.cornish@vocovision.com.

An Audiologist’s Experiences at Convention

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I have been an audiologist since December 1982 and joined ASHA in January 1983 obtaining my CCC-A in October 1983. During those 31 plus years I’ve attended 11 ASHA national conventions and with the exception of the 2014 event my typical reason for going was to either see a city that I never saw before or to go to a city with a warm November climate.

Yes, in truth, the warmth was also why I went to Orlando! I prepared to spend many a grueling hour at Disney World and other tourist attractions. However, when I registered, I observed that every day of the convention held multiple interesting courses either directly on audiology or concerning issues related to the changing medical environment. What a blast!! Even at 60, I still believe that to learn is to live!

Keep this up ASHA and you will start to see far more audiologists attending your conferences. I truly believe that if the conventions in the past were like the 2014 convention there would never have been the American Academy of Audiology, Academy of Doctors of Audiology or Audiology Foundation of America organizations. These organizations were created because we audiologists felt disenfranchised.

At this year’s convention I didn’t feel left out and believe in giving the “devil his due.” Good job ASHA, keep it up!

 

James M. O’Day, Au.D., CCC-A, is an audiologist managing the audiology department at Androscoggin Valley Hospital in Berlin, NH. where he has worked for ten years. O’Day works directly with ENTs in both private practice and in hospital settings. He’s owned a private practice for more than 20 years. You can contact him at james.oday@avhnh.org.

#ASHA14 Audiologist in the House

blogI have been attending the national ASHA convention since 2008 in Chicago, but this year is a special first for me–MY FIRST ASHA CONVENTION AS A CERTIFIED DOCTOR OF AUDIOLOGY!!! I started attending ASHA as undergraduate while still trying to determine if I wanted to study audiology or speech-language pathology. As an undergrad, ASHA was a little overwhelming. The graduate school fair and exhibit halls, as well as the many networking events, were greatly beneficial, but as I still didn’t have a concrete plan or field, my choice in sessions was eclectic and I don’t know how much I got out of them.

The next several years I served on the NSSLHA Executive Council as a delegate for Region 8 and then as a representative for Region 3, and even though I was “at convention” I was very busy with meetings and helping run NSSLHA Day and as such, didn’t get to many sessions. The networking has always continued to be phenomenal and I loved being emcee of the NSSLHA Battle of the Regions Knowledge Bowl, but I was missing out on sessions.

Last year, as a fourth year extern who was free of meeting and other responsibilities, I was finally able to attend as a regular attendee and found some great sessions (which after three-and-a-half years of grad school, I could understand), but this year will even top that as I now have a job as an educational audiologist and can search out sessions related to what I do on a daily basis.

I always look forward to continued networking and social events as well as the exhibit hall. I’ll be sure to check out Audiology Row, the opening plenary session and closing party (Where’s my owl with a letter inviting me to Hogwarts?). As I’ve been researching audiology sessions, I selected so many sessions and posters that were of potential interest that I’ve only got two slots that don’t have conflicting sessions. I’m working on whittling the list down, but there are some sessions I feel I need to catch. Management of School‐Age Children With Hearing Loss: From the Clinic to the Classroom (#1019) is one I feel will be particulary relevant. As I’m learning the ropes at my new job (I’m the only educational audiologist in a rural four-county area of Maryland), I’m rapidly discovering that regular follow-up with dispensing/managing audiologists is not something that always happens with my students due to geographic and socio-economic issues. As such, I’m starting to develop relationships with some of the audiologists at the Children’s Hospital a couple hours away where many students were initially fit.

I’m also looking forward to some sessions and posters on APD as working in the school, it is a “hot topic.” Disentangling Central Auditory Processing (CAP) Test Findings: A Road to Greater Clarity (#1110) , Differential Diagnosis & Intervention of Central Auditory Processing Disorders (#1405), and Treatment Efficacy of the Fast ForWord-Reading Program on Language in a Child With SLI/APD (6036 poster #136).

One final session I’m also very excited about is Noise Exposure & Noise-Induced Hearing Loss Among Rural Adolescents (#1492). The area in which I live and work has agriculture and aquaculture as two significant components of the local economy in addition to many recreational opportunities for noise exposure (hunting, shooting, ATVs, boating, etc) and I feel there will be opportunities to work on implementing some hearing conservation education at the high school level for many of the students I serve.

What are some of the sessions you’re looking forward to? See you in Orlando!

Caleb McNiece, AuD, CCC-A, is a new grad and educational audiologist for the Mid-Shore Special Education Consortium which serves four county school systems on Maryland’s eastern shore. Caleb is a former NSSLHA Executive Council member and is passionate about audiology students, audiology advocacy, pediatric audiology, and private practice.

Is There a Heffalump in the Room? Learning to Be a Leader, Part 1

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In Pooh’s “Huffalump” movie, Roo asks, “’Scuse me, what’s a heffalump?” Pooh, Tigger, Rabbit, Piglet, and Eeyore sing a song about the horrible qualities that they believe heffalumps possess (three heads, fiery eyes, spiked tails, etc.).

When presented with a difficult task or situation, we often find ourselves in conflict about how to deal with it. The Chinese word for conflict or crisis consists of two symbols: danger and opportunity. When we are faced with difficult moments, we must remember we have a choice. How we manage that choice often determines the outcome of the situation. In audiology, we are often faced with conflict ranging from difficult hearing aid fitting and counseling sessions to negotiating with vendors. Sometimes we have conflicts internally in our office or conflicts regarding professional issues in our membership organizations.

Conflict often makes us think of a negative experience that did not go well. We must remember, however, that conflict is not a bad thing but an opportunity for both personal and professional growth. Think about how boring meetings and conversations would be if people did not speak up and share their thoughts and ideas. If conflict is handled right, then there are benefits that you might not expect such as:
Better understanding of the issues and the opportunity to expand your awareness to the situation.
Increased trust among your team members and colleagues. People feel safe to express themselves, allowing an opportunity for growth.
Enhanced self-awareness due to being more aware of your goals and thoughts on how to be an effective leader and team member.

Handling conflict, however, does not necessarily come easily for most. Here are some key strategies that leaders use every day to help prevent and/or defuse conflict to allow for productive opportunities or engaged conversations.

When dealing with difficult moments:
Focus on the process. It is not about the people, it is about the system or process.
Go “below the line” for a collaborative approach for conflict resolution. Imagine an iceberg. You can only see the top, which is usually only 10 percent of it. To navigate the waters, you need to know what is below the sea line, the other 90 percent, to be safe.
Listen first and then ask questions for understanding. Remember restate, rephrase, and summarize when trying to gain understanding and trust.
• Create options collaboratively. Be open to ideas.
• Negotiate what options would solve the conflict.

When dealing with conflict, it is important to consider when do you take action and who should have the conversation. To answer when—the sooner the better. Addressing unprofessional behaviors, engaging with the dissatisfied patients, and/or intervening before people forget are essential to maintaining accountability, employee satisfaction and retention, and minimizing potential liabilities. To answer who—anyone in most cases. Regardless of the title, anyone should be able to talk to us and share ideas without feeling minimized or degraded. If the leaders blink or if the culture is of the mindset “it doesn’t matter, can’t change it…,” then it is important for the leadership to step in and be a role model on how to resolve conflict or better yet create a culture where conflict is considered to be an opportunity not a negative event.

To learn more about your conflict style, the Thomas-Kilmann Conflict Mode Instrument is a widely used instrument that provides helpful information on your conflict style. The conflict styles are Competitive, Collaborative, Compromising, Accommodating, and Avoiding. Different situations call for different conflict styles, so knowing what domains you typically prefer will be helpful.

I encourage you to take Roo’s direction and instead of being scared of conflict, look for the heffalump yourself and discover that often the many traits outlined are things that are not true or can be negotiated.

So, you ask, how do I negotiate these uncharted waters? Next, Leadership Realities Part II will provide you with your compass.

Tamala Selke Bradham, PhD, CCC-A, is a quality consultant in the Department of Quality, Safety, and Risk Prevention at Vanderbilt University Medical Center. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

Changing the Clinical Question from ‘Can I?’ to ‘How Can I?’

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It’s always easy to discuss how things should be. We start sentences with:

“It’d be great if…”

“Ideally…”

“In a perfect world…”

But typically, when we discuss ideals, we quickly follow up with:

“But that’s not realistic.”

“Too bad that can’t actually happen.”

“Wish it could really be that way.”

When it comes to clinical practice, I think we default to the latter group of statements far too often. We significantly limit what we believe is actually possible, because the things we know are good in theory are just too hard to apply in the “real world.” It’s easy to sit through a graduate class or a continuing education session, but it’s another thing entirely to apply that information day-to-day in the therapy room. Think about some examples:

We learn about the importance of evidence-based practice, but “realistically,” there is not a vast amount of high-quality evidence for many of our practices in this relatively young field.

We discuss the necessity of being sensitive to culturally and linguistically diverse populations, but “realistically,” we can never learn to speak every language or understand every culture.

We understand that the Code of Ethics exists for the purpose of maintaining best practices, but “realistically,” ethical dilemmas are not always so black-and-white.

So what’s the point then? Why do we have standards that we can’t live up to in practice? Why are we taught things that we are doubtful we can ever actually apply?

That, right there, is the problem. It’s the question we’re asking. We look at a client or a situation, and we ask, “Can I do this?”

“Can I find any evidence to guide my clinical decisions with this unique and difficult case?”

“Can I effectively treat this client whose language I do not speak?

“Can I maintain my personal and professional ethical codes when a ‘sticky situation’ arises?”

The problem with these questions is that from the moment we decide to become speech-language pathologists, we have already answered all of them. In accepting the responsibilities that come with being a part of this field, we have already said a huge, resounding “Yes” to every ‘Can I?’ question. No matter how challenging the situation may be, yes, we can do it, because we must.

One of my professors recently challenged our class to change the question. When faced with difficult situations that make us uneasy, or cause us to doubt what we can handle, we have to start thinking of it differently. Instead of asking, “Can I do this?” we should ask, How will I do this?”

 How will I follow the levels-of-evidence hierarchy in order to implement EBP, even when the current existing evidence base is not extremely strong in this particular area?”

How will I be creative and use resources to effectively treat this client whose language I do not speak?”

How will I ensure that I maintain my personal and professional ethical codes and engage in best practices, even when a ‘sticky situation’ arises?”

 How will I do this?”

 Many people are familiar with the famous quote from Spider Man, “With great power comes great responsibility.” While a few ‘Cs’ behind your name may not seem like power to most of the world, as members of this field, we know differently. SLPs have the power to help others, facilitate communication, and cause change, and I would say that is great power. We have been given the power, and therefore we have accepted the responsibility. We have said, “Yes,” to every tricky situation and every obstacle, whatever it may be, no matter how challenging. We have said “Yes,” because it is our responsibility to do so, based on the power we have been given. We can, because we must.

The next time you are faced with a tough case and are tempted to ask, “Can I do this?,” remember that you have already answered yourself. Can you do this? Yes, you can, because you must.

So, start asking yourself and others something different. Start changing the question. Start asking, “How?”
Kelsey Roberts is a student in the master’s speech-language pathology program at Abilene Christian University in Abilene, Texas.

Audiologists, You Know the Science of Hearing but Do You Know the Art of Listening? 

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As audiologists, we learn about anatomy, physiology, psychoacoustics, pathologies, technologies, and interventions. We are experts in assessing hearing sensitivity, diagnosing hearing loss, and providing audiological (re)habilitation with technologies and counseling.

Here’s a question, though: Are we experts in listening? To be an effective listener, you need to focus on the meaning of what you hear and take in to gain understanding. Have you ever taking a listening test? Have you ever given your patient a listening test?

There are many types of listening styles, and there’s also depth of listening. In reviewing the literature, I identified 27 different styles of listening and six depths of listening. I believe we use different listening styles and depths of listening based on what is happening in the moment. So, I am a client, I may, during a hearing test, be a discriminative, deep listener. Or if I am the patient learning about the new hearing aids you just fitted for me, I may be a content, full listener.

These are the four most common types of listeners.

People-oriented (empathic) listeners, who:

  • Build relationships and interpersonal connections
  • Search for common areas of interest
  • Tune into the speaker’s emotions, body language and prosody of speech
  • Ask, “Tell me all about it – what happened?”

Action-oriented (evaluative) listeners, who:

  • Prefer information that is well organized, brief and error-free.
  • Will digress when a speaker goes off on a tangent.
  • Evaluate information heard and do not take things at face value.
  • Ask, “What am I supposed to do with all this information?”

Content-oriented listeners, who:

  • Enjoy listening to complex, detailed information.
  • Ask questions to test speakers (are they credible?).
  • Focus on issues and if information is credible.
  • Ask, “Is that so?”

Time-oriented listeners, who:

  • Love “to do” lists.
  • Are overbooked, so they want messages delivered quickly and briefly.
  • Enjoy the role of keeping people on task during the meetings (the time keeper).
  • Ask, “And, what’s your point?”

If you are a people-oriented listener and your patient is a time-oriented listener, then your patient may feel that you are intrusive and not respecting their time. If you are a content-oriented listener, then be careful not to “throw the baby out with the bathwater”: When taking a patient’s history, you don’t want to ignore what could be key information because you believe there’s a lack of sufficient evidence.

And those audiologists who are action-oriented listeners may need to watch that they aren’t perceived as inpatient and not caring. Knowing your listening style can help you better understand how to adapt to various listening situations. Knowing your patient’s listening style will help you with how to deliver quality care!

There are multiple tests available to assess your dominant listening style.  Here are a few that I have used:

In establishing relationships with your patients, the importance is not so much in what you say as how you listen. Knowing hearing thresholds is only part of the evaluation. Listening to what your patient shares with you will drive your overall outcomes in patient care.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

Ensuring a Warm Send-Off for Your Clients

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Those of us working in hospital settings hear about discharges all day long. And we track everything about them: monthly rates, handovers, discharge summaries, patient’s perceptions of them.

In the outpatient world, discharges are just as important. When the patient leaves your office, do they know what they need to do next?

No matter the setting, we health care providers have a responsibility to ensure safety and efficiency when discharging a patient from care.

What happens when discharge isn’t done well? Patients experience adverse events due to delayed or absent communication, inaccuracies in information exchange, or ineffective planning or coordination of care between providers, as found recently in a study by Gijs Hesselink and his colleagues. In fact, at least 20 percent of patients report adverse events following discharge, and least half of these adverse events could have been prevented.

So what is your discharge or “thank you, goodbye” practice?  Here are five take-aways to consider:

  • Write it down!  Discharge instructions should be written down for patient understanding, not for compliance and insurance companies.  Don’t worry about saving the trees, give the patient the recommendations/plan of care in writing.  And, if you have it available, the patient should be able to review them at any time on your secure, web-based patient portal that you have available.
  • Share your instructions/plan of care with the patient’s medical home, therapists, and those that need to know!  Handoffs are one of the biggest problems in patient care that leads to adverse events.
  • Check for comprehension!  Having the patient repeat back what they heard is essential.  Using techniques like “Teach Back” or motivational interviewing are great ways to check for comprehension.
  • Make the discharge follow-up phone callMultiple studies show that if a simple phone call is made within 48 hours of the patient being seen or discharged from the hospital, it is a win-win for everyone involved. For outpatients, not only will you keep that person as a patient, but you will get more referrals due to having a happy customer. For hospitals, research shows reduced readmission rates and significant cost savings.
  • Own the discharge process.  When the patient leaves your practice/hospital, everyone who directly and indirectly touched that patient needs to own the process.  Does the patient know when to return?  Does the patient know who to contact if they have problems?  Will the patient tell a friend about the great experience they had?

Are you already doing these five simple things to keep patients safe?  If not, consider one of these for your next Plan-Do-Study-Act (PDSA).

For additional information about discharge planning, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. This post was adapted from her blog leanhcare.

 

Audiologists: Are Your e-Records Putting You At Risk for an Audit?

EHR imageMedicare is encouraging the implementation and use of electronic health records, but the way some practitioners fill out these records is under scrutiny. The U.S. Department of Health and Human Services Office of Inspector General has made cloning (inappropriate use of the copy-paste feature) and over-documentation areas of high priority for 2014.

OIG has recommended that the Centers for Medicare and Medicaid Services  evaluate EHRs for fraud vulnerabilities. If fraud is suspected, practices will be subject to fines and penalties. It is essential that audiologists use EHRs effectively and not take too many shortcuts. As we transition from paper charts to EHRs, here are a few things to know.

1.) Review all entries in your note. Avoid repeating past information.
According to CMS 1995 and 1997 documentation guidelines, “A review of systems and/or a past medical, family, and social history obtained during an earlier encounter does not need to be re-recorded if there is evidence that the physician [audiologist] reviewed and updated the previous information.” In other words, in your note, refer to a previous note that has the comprehensive history. For example, you could write, “See note dated 1/1/2014 for a comprehensive history of patient X,” and update the present concerns/reason for the visit.

2.) Make sure all your diagnoses listed are relevant for that patient’s visit.
Many EHR systems allow the copying of all diagnoses listed in the problem list, even those that have been resolved or aren’t the reason for that day’s patient visit. Be sure to only list the diagnoses that are relevant for the reason the patient is seeing you. For audiologists, the first diagnoses code should be your treating diagnosis followed by the relevant medical diagnoses. Sometimes the treating and the medical diagnoses are the same and there is only one listed.

3.) Make sure your note is individualized for that patient’s encounter.
Many EHR systems also allow you to clone a previous note. Use extreme caution with this feature. Auditors are looking for patterns in documentation. If all your notes look essentially the same across time and across the patients you serve, then they will cite you for not providing individualized care. Review every item in your note to make sure they are relevant for that patient’s visit that day.

4.) All notes should be signed by the licensed professional, correctly dated for when the services were rendered, and the time associated with the visit.
Lawyers, auditors and accreditation organizations look when the notes are completed. All notes should be started on the day services were rendered and finished within 24 hours. The note should have not only the signature of the provider but the time and date on the note. If your notes are not completed in a timely manner, then be prepared to answer, “What are you trying to hide?” or, “How many patients did you see that day? How could you remember what to write if you did your note a week later?” Any notes that are placed in the medical chart greater than 24 hours after the patient was seen is subject to concern.

5.) Avoid saving the note on the wrong date—a common mistake when a professional does not complete documentation on the day of service.
Two things to know:

  • If the note is not there on the day of service, then the patient was not seen.
  • If you dropped charges on a day of services that the patient did not have an appointment and was not seen, then this is considered fraudulent billing and you could be subject to not only losing your license to practice but also significant fines. If this happens, amend the note immediately to the correct day of service! To prevent this from happening, try to incorporate your documentation during the day or at “bedside” when you are with the patient.

6.) Develop a policy on the use of cloning, the copy-paste feature, and over-documentation in EHR technology. CMS has been charged with reviewing your policy if your site is selected for audit. OIG reported that only a third of practices audited had a policy. Be prepared!

Documentation should not be considered additional work but an extension to your patient care activities. Finally, remember our ultimate goal is to provide the best possible care that is timely and based on evidence-based practices. Having timely and accurate information in your note, and nothing else, will help provide the best possible care to your patients. The consequences are too serious to do anything less.

For additional information about documentation, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

 

 

Learning to Hear: Finally, the Technology

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Hearing aids have improved by leaps and bounds over the past decade. The advanced signal processing and wireless connectivity options absolutely boggle the mind. As an audiologist, I’m constantly amazed at what today’s hearing aids are capable of doing for patients. I’m equally amazed at what my patients expect the hearing aids to be capable of doing for them; yet can we blame them? They are bombarded by newspaper advertisements and mailers boasting the incredible benefits of modern hearing aids. They don’t understand what all is (or should be) included in bundled pricing, so they figure that a $X,000 pair of hearing aids should fix their hearing problems and more. I believe these inflated expectations, coupled with a lack of comprehensive patient education during the rehabilitative process, explain why patient satisfaction and market penetration are not increasing at the same rate as the technological advancements in amplification.

So how do we address these issues? The answer always goes back to the root of our profession. As audiologic rehabilitation specialists, our job is to equip our patients with tools and strategies necessary to function successfully in the world, despite their hearing loss. Patients must understand that hearing aids are only one piece of the puzzle when it comes to successful communication. In fact, there are five essential keys to communication success:

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In previous blogs we’ve discussed listener strategies, speaker strategies, and environmental modifications as critical parts of the communication puzzle. During the aural rehabilitation process, I deliberately present those pieces before I discuss technology options. Listener strategies empower the patient to take responsibility for their hearing loss. Speaker strategies engage the communication partners to be involved. Environmental modifications make the patient and their communication partners aware of their surroundings and empower them to actively create the best possible listening situations.

When we’re finally ready to present technology options, there are two important points to keep in mind. First, we need to be sure we are presenting options. I don’t mean options in terms of different hearing aid manufacturers. I mean options in terms of ALL the technology options appropriate for the patient, based on his or her specific listening challenges. I present the options as a continuum, with inexpensive assistive listening devices and personal sound amplifiers on one end, and high end hearing aids with wireless accessories on the other end. Obviously there are many technological options in between. Second, it is critical that the technology options are presented in conjunction with the other strategies discussed. Patients must understand that technology must be combined with speaker and listener strategies and environmental modifications. The speaker, listener, environment, and technology keys are equally important when it comes to ensuring a successful communication exchange.

The fifth key to communication success is practice. Patients can learn all the communication strategies in the world, but they won’t help a bit if they don’t actually use them. The same goes for technology. Patients can buy the most advanced digital hearing aids available, but they are just a waste of money if they refuse to wear them in all of their challenging listening situations. As rehabilitation specialists, we are responsible for motivating our patients to practice and use all that they’ve learned. We must find ways to hold them accountable and create a follow-up plan that ensures long-term success.

Patients with hearing loss have many options when it comes to pursuing technology. As audiologists, it is our responsibility to make them see the “big picture” and implement a comprehensive plan that addresses all pieces of the communication puzzle. I truly believe that patient satisfaction and market penetration rates will only increase when we return to our roots and make patient education the focus of our rehabilitation efforts.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.