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A very warm welcome to everyone. Thank  you for joining this educational webinar.   We're very lucky and very fortunate  to have so many of you join us today  

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from very many different parts of  the world. We thank you for that.  Just a quick introduction my name is Vik Dudhia  I'm the senior clinical international trainer  

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here at Neolight and I'm going to be hosting  today's webinar. Today's webinar is brought  

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to you by Neolight and the Clinical Education  team and our C.A.R.E.S. program which supports  

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the effective use of our products through  educational support and shared best practice.  Now C.A.R.E.S. stands for continuing advancements  and resources and education support. Lots of our  

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products as well as the relevant therapy  areas the information can be found on our   website and if you go to the education part at  theneolight.com you'll be able to find all that  

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information on there now we're always updating  the resources and the information that you'll  

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see on there so please check back regularly. Now today's webinar I'm very excited to be  

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talking about this is the topic of nurse led ROP  retinopathy of prematurity screening and we've  

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got an amazing panel of experts who are going  to be sharing their insights with you today.

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Before we get started, a little bit of  housekeeping, we're going to keep the   cameras and the microphones on mute, cameras  are turned off just to avoid any unnecessary  

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distractions. Feel free to submit any questions  during the presentations in the chat section and  

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what we'll do is we'll address those questions  at the end of the webinar so that we're not  

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disturbing anyone during their presentations. We plan to get through as many of those questions  

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at the end as we can but if we don't we will  then answer those questions directly so we'll  

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provide those contact details for you at  the end of the webinar so you can contact   the clinical Education team at Neolight and we'll  do our best to answer those questions directly.

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Now before I do the introductions, I'm very  excited to do that is what we're going to   do is we're going to turn off the cameras and  then we'll just focus on the slides which are  

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being presented and the information that's  being shared with you today. Before we do  

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that let me do a quick introduction of Candice  White. Candice is a senior clinical specialist  

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that's Candice over there. With over 20 years  of experience in Ophthalmology and advocating  

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healthcare education. Candice's passion has always  been education exploring opportunities in the NICU  

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and Ophthalmic communities to broaden access to  clear digestible learning material and content.  

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I know that Candice really is kind of an expert  of promoting that collaboration between several  

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specialties which I know that you know leads  to kind of better advancements of patient care.

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With that in mind I'm very pleased  to hand it over to Candice.  Thank you so much Vik I'm super excited to present  information. I'm going to share my screen and  

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we'll get started with the presentation. As  Vik mentioned my background is very heavily  

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Ophthalmology I come from lots of eyes and when I  started I really wanted to find a way to say how  

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do we teach a group of people that may not have a  lot of information about the eye how do we teach  

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them to be the best imagers that they can be. I'm so excited to talk about the ICON today  

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about how we can image the best practices what  are we looking at in the back of the eye and  

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what do we say when we think an image is good or  quality what kind of pictures are we looking at.  

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Today's presentation's really going to be driven  towards Retinopathy of Prematurity. There's lots  

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of different things that we can image for and  that we do image for with these camera systems   but today I really want to stay focused on nurse  led imaging in the NICU and why do we look for  

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retinopathy of prematurity and what we're trying  to do is we're trying to look at photographic  

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documentation to say is there presence or absence  of disease and how far does that disease extend  

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May it affect long-term Vision are we looking at  something that's very able or something that we   need to just watch over time so we look at how the  retina is vascularized and you can see a little  

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bit of vascularization you know big fancy words  where we've got a lot of blood vessels growing   in places that they shouldn't be is it bad enough  that we want to intervene or do we just want to  

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watch these vessels and see if they start to react  the way that they should be reacting so moving on  

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we're going to look at just pretty basics of what  the eye is what are the parts of the eye and what  

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do we see in images so when I say Basics I know  there's a lot of things that are up here but I   really want to say how do we make this digestible  for those people who don't necessarily know what  

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the vitreous is what the cornea is so the cornea  is the very front window to the eye it actually  

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has a power so it refracts light and so does the  lens inside the eye so the both of these subjects  

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refract light in different areas and that's kind  of what gives us our vision to a certain extent  

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what's really important especially with contact  Imaging for neonates and Pediatrics is we float  

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the camera on the top of this surface on top of  the cornea understandably though for infants that  

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are born early a lot of these parts of the eye  aren't done growing yet that's really why we're  

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looking inside the eye because we have premature  birth things aren't progressing the way that they  

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should be so we want to document what that looks  like that being said the corn is not done growing  

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yet so we have to understand when we're looking  through these parts of the eye what are going  

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to affect what I'm seeing whether I'm standing  at the bedside or whether I'm taking a picture   with a camera we float that camera in gel and we  go through the pupil the pupil is the center of  

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the hole that's inside the iris the colored part  of our eye it's not anything tangible it's not a  

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you know anatomically something that I can touch  or take out it's really just an absence inside  

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the iris that colored part of the eye and when  we use dilating drops what we do is we contract  

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the iris it's a muscle and we Flex it that way it  can't react to light so I get it really in a mode  

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where it's flexed and when I look inside the eye  it's not going to move it's not going to actually  

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get bigger or smaller it's going to stay in one  fixed position and that allows me to push light  

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through that cornea through the pupil through the  lens all the way back through this vitreous jelly  

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which is just the substance in the middle of  the eye so that I can see the retina the retina  

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I have always described like film in a camera I  know we are so far past anyone actually having  

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film in a camera but I still like to think about  it in that way in that it develops pictures I'm  

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taking a picture that's truly what my eyes are  doing and then I send that picture through the   optic nerve and the optic nerve develops my photo  for me so if the retina is damaged if the film in  

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my camera is damaged then you can imagine the  picture that the optic nerve will will take is  

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also going to be damaged and that's why we keep a  really close eye on the retina the macula really  

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isn't something that we always see in pictures but  I always like to point it out that's where so much  

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of our central vision comes from our really good  Vision comes from just this small area which is  

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why it's so important that's why we watch really  this specific area the other term that we hear  

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sometimes in terms of ROP Imaging is the ora  serrata and again this is a pretty fancy word  

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for where the back of the eye where the retina  starts to meet the structures at the front of   the eye this is where the retina's done growing  and the reason we talk about that sometimes is we  

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want to say how far are we getting vascularized in  to the retina so let's look at a real picture you  

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know this is just a cut of what the eye looks  like so what am I really going to see when I'm   taking pictures and we actually don't see a lot of  those structures it's important to understand how  

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they work and how they affect us when we image  but this is what we see when we take pictures  

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we see the optic nerve it may always be a little  bit of a different color everyone's got a little  

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bit of a different shape but typically it's the  circular shape it's a white or lighter color and  

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you can see all the vessels plug into this optic  nerve as I mentioned earlier the Maia is a little  

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bit difficult to pinpoint point just in perfect  pinpoint but it's usually in the same spot from  

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the optic nerve sometimes a little bit darker  in color because we think it has a lot of cells  

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a lot of rods and cones if we remember learning  about that in school all of those are condensed  

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in this one small area another item that's really  important to look at is what I call the arcades  

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sometimes we refer to them as the temporal arcades  and the reason this is important for Imaging is  

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it tells us where in the eye we're looking so the  optic nerve and the way that these vessels extend  

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from the optic nerve tell me this is actually  a left eye you'll notice that the vessels on  

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the other side of the optic nerve are a little  bit straighter they don't Arc like an arcade so  

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that's how I tell okay I'm looking centrally I'm  looking straight up and down into the eye and if  

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I were to move this optic nerve if I pointed my  camera and it moved a little bit toward towards   the bottom of this photo that's what helps  us understand how we're Imaging in different

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quadrants so in this animation what we're  really talking about is how do I tilt the  

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camera in different positions to image different  parts of the retina we're really just pointing  

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light into different areas and we're capturing  what that looks like and here's an example of  

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what we say when we talk about quadrants these  are real life examples I really wanted to bring  

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to the table images that are taken on infants  and neonates because that's really important  

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so this is what's called posterior pull fancy  for Center we're just looking straight up and  

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down I see my optic nerve here to the right  and then I see those arcades extending off as  

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I mentioned earlier if I pull that optic nerve  where I tilt the camera so that my optic nerve  

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is at the bottom what I'm actually doing is  looking up superiorly and you can kind of  

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see when we tilt the camera light is going up  towards the forehead opposite from that if I  

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tilt the camera and my optic nerve is now in  the top of my photo what I'm really doing is   I'm tilting and looking down towards the cheek  so I have an inferior view of the retina then  

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by tilting the camera in different directions I  can also look temporally towards the ear and then  

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nasally towards the nose and this is how we build  an exam looking for ROP in different areas of the

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retina so I do want to take a moment I know we  don't have a lot of time and I could probably  

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speak on this for days on end but I want to talk  a lot about quality what do we mean when we say  

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an image is quality and the exact definition  of quality is the standard of something as it  

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measures against other things of similar kind  sometimes what we're driven to do is compare  

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Imaging and neonates and adults to Imaging I'm  sorry we compare Imaging neonates to Imaging  

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adults and what I disagree with is that's not  a standard that I can compare something because  

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it's similar Imaging on adults is not similar to  Imaging on neonates in any way and these examples  

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kind of show that we have this wonderful young  lady sitting at a tabletop she's listening to   instructions we are guiding her verbally and we  can comfort her verbally but I can't do those  

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things in an infant or a baby in this system here  we see a patient actually pressing up against a  

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camera so we're really using the ability to move  them and guide them both verbally and physically  

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to capture images in ways that we can't capture  images and infants who are born too early infants  

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who are small neither one of these adults have  a CPAP they don't have any issues dilating we  

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don't have to put lid speculums in these patients  again because we have the ability to so many do  

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so many things both verbally and physically that  we can't do with small children and infants so we  

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have to rethink quality we have to think I have  to shift from this mindset and not compare it to  

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this mindset of Imaging where I'm actually making  contact with the eye and the reason that we have  

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to make contact is because we can't verbally guide  patients I can't tell them to look up look down   I have to do that for them so let's look at some  images or actually let's look at how the eye grows  

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because that makes a big difference too in image  quality we know that when infants are born the  

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eye is obviously smaller than it will be in adults  so we think back to this Imaging elderly patients  

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Imaging even teenagers the eye is going to be the  same size every time we image so my image quality  

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is very reproducible I'm always Imaging the same  kind of eye the same type of eye over and over  

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and over again but with small ones we have babies  that are born premature before term and then we  

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start doing serial exams so we start our first  exam around 30 to 31 weeks and then we continue  

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those exams weekly and the eye is actually  growing during those exams so we will see our   image quality change over time as the eye really  finishes out the process that it should have done  

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to begin with but we had to Halt that process so  I don't want to compare that quality image of the  

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same eye the same size the same quality over time  to an eye of a neonate or an infant that I know is

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changing and this is an example of real life  images on neonates real life images of Pediatrics  

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so I know compared to those adult images they're a  little bit hazier sometimes well the reason is not  

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because we are bad imagers or it's a bad system  it's because the eye itself wasn't done growing  

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we talked earlier about the cornea the cornea is  the first window to the eye like a windshield and  

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if you can imagine your windshield's not clean  or if you bought a windshield before it had gone   through all of its processes to be smooth and  sanded down then you would have a little bit of  

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haze over exam times we see that haze improving  because the eye itself is growing and improving  

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we also may have areas of Darkness to the side  and that's because neonates notably don't dilate  

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great sometimes we have to put more than one set  of dilating drops in infants and babies than we   would ever have to put in adults because they're  processing those drops differently and we need  

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the people to be as large as possible we have  wonderful instances like this picture where we  

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get really good Clarity we have really good  dilation and a and a Cooperative patient but  

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this image next to it we look at it and think  that it's not quality but this is actually a   wonderful image it tells us so much about what's  going on in the eye if you remember we're looking  

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for presence or absence of disease and I can see  the blood vessels I know what they're doing and  

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I know whether they're starting to raise the  alarm for me or whether they're looking okay  

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and I can make choices for the next steps same  thing in this image of an infant that didn't  

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dilate very well but I can still capture so much  good information that tells me that these vessels  

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are looking smooth nothing super alarming right  now and I feel confident in saying I would love  

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to see this patient in a week so it's just  redefining that thought process of what is

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quality and understanding the basics of Imaging  so we talked a little bit about the eye itself  

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how we put light into the eye how it comes back  to the camera sensor but there are a few things  

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that we can do to improve our image quality one of  those things is focus so we can take a picture and  

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we definitely want to have our blood vessels in  Focus as much as possible remember the cornea may  

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be working against us and this is not different  in whether we're taking pictures with a camera or  

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we're looking with our own eye remember our eye  is a camera itself so if the cornea is foggy if  

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I were looking in with my own eye I would have  the same fog that I would have if I'm looking   with a camera system so we want to make sure  that we can get things as focused as possible  

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a really another helpful thing is being able to  change your intensities and your gain on the ICON  

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system is almost like Black Light correction  we can illuminate a photo without having to  

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put any more light in the eye so I can keep my  intensity the same but I can brighten this up  

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by changing the gain it's so important to know  that no two eyes are the exact same so we'll see  

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an intensity here of 49 and gain of eight and I  really think this is a beautiful image we have  

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really good Focus Clarity and saturation but  if I look at another photo here my intensity  

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is actually 24 it's lowered quite a bit but I  still have a lot of reflectivity in this eye  

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sometimes that's just because of the way the  eye is in these small babies and small infants

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I still think this is a lovely image because  I can see the vasculature we have really good  

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Focus I can see the vessels and whether or not  they're starting to get tortuous or curvy I  

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can see that everything is looking smooth and I  know that I can make good decisions on presence   or absence of disease in this point looking at  another example here are the gain we bumped up  

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to 10 and we can see this image getting a little  bit brighter and the intensity is at 26 I love  

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having the ability to see these numbers and this  is where Vik and I are so happy to help because  

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when I see these numbers if someone sends me  this image and says what can I do better we  

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can guide them to say let's try and drop this  gain down to six these are usable images very  

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good images but we could improve them a little  by using some of the tools available to us like   focus and gain and intensity and here's one more  example and now we had the gain at eight so it  

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was actually lowered but our intensity went up  so we still have some of that reflectivity but  

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again when we're working on patients where our  cooperation is in milliseconds these are still  

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very good and very usable images there's rarely  a time when capturing an image has no value

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whatsoever here's another example of real life  situations where we're looking at different parts  

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of the eye and we say well what does it look like  to have disease and what does it look like to not   have disease of course an ophthalmologist or a  medical doctor is going to make that decision  

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but just based on my knowledge I can tell you  when we see these vessels that look straight  

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right we've got good branches nothing is getting  really curvy like a dam has been blocked up we're  

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typically saying that we have good growth we're  not going to take them off of our regimen to   watch for ROP but we know that there's nothing  super alarming happening yet we may still have  

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some blood vessels that grow as the eye itself  continues to grow but everything looks like   it's doing well at this time in this eye we can  see a very distinct line called the demarcation  

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Line This is avascular retina versus vascular  retina this is a very clear black and white on  

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where vessels started and where they stopped and  then at some point the body panicked and said oh  

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my gosh I forgot to grow retina vessels  I'm just going to grow as many as I can  

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and they're not good they're not good vessels  so they start to grow up into different parts  

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of the eye we'll see that they could leak  processes here leak fluid and now we start  

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to see that curviness right we start to see all  these vessels growing in places they shouldn't be growing we talk about Imaging different pathology  so this is just a quick example of what we look  

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like if we're moving from an ROP thought process  into an abusive head trauma process and what I  

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really want to bring to the table just in this  slide is showing that same thought process in   quality right we're trying to document presence or  absence of disease we're looking at the quality of  

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these images and the quality of patient that  I have and saying the information that I'm  

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getting from these photos is so valuable and  so important as Vik mentioned as I close my  

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portion of this presentation I want to recap  Vik's discuss discussion on our cares kit we  

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really want to ensure that everyone has access  to information that is at the level that they  

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need information so we have things that are basic  we have things that are more in-depth and we're  

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constantly wanting to improve that so always  feel free to reach out to us we want to make  

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sure that you have the in information that you  need available to you and we are always happy  

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to put together educational material that helps  our fellow imagers there in the market worldwide  

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so I will close my presentation with that slide great thank you so much Candice that was very  

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captivating very informative I appreciate your  time I just want to remind everyone that please  

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continue to submit your questions on the chat  and then we'll get through as many of those as  

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we can at the end of this webinar so now it's my  very great pleasure to introduce our next speaker  

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then we introduce you to Edyta. Edyta received  her BSN from Arizona State University and began  

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her career in the NICU she was a bedside RN for  12 years and then moved into a leadership role  

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as ROP clinical manager and coordinator now as  this was a brand new ROP worked closely with her  

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senior nursing and Ophthalmology colleagues to  develop the protocols for nurse Le P screening  

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and this was the first of its kind in the  unit where she worked she then went on to   train a team of 14 RN screening Specialists  and the program successfully screened over  

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500 patients which is just incredible I know that  Edyta has a tremendous passion for helping nurses  

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to learn how to be successful at retinal Imaging  as well as assisting peers in creating effective  

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ROP screening programs to meet their specific  facility needs so without fur further Ado Adisa  

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I'm G to pass over to you thank you so much  excellent thank you Vik for that warm and kind  

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introduction I'm going to go ahead and share my  screen here and turn my camera off so that's not

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distracting excellent okay so as Vik mentioned I  had a very active role in setting up a very large  

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Ro screening program it was the first of its kind  in the United States we covered four very large  

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volume NICU and we it was very typical for us  to screen over 500 patients annually so I love  

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helping others set up a program that's successful  and we're going to kind of talk a little bit about   the benefits of a nurse led ROP screening program  as well as kind of tools to help you get started  

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and how to set up your program so let's dive in  so as I discussed here are object objectives that  

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we're going to go over we're going to talk  a little bit about the benefits we're going   to look at the nursing perspective the patient  perspective and the unit perspective how to create  

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a new program what supplies you need how to create  your team how to roll out your program and then  

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how do you evaluate if you're being successful  so why choose a nurse-led r training program I  

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have such a passion about this and as many of you  can see you throughout the world there's just a  

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shortage of ophthalmologists that are qualified  and that are able and willing to screen babies  

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for ROP and that being said there's more and  more babies that are being born earlier and   earlier we able to through the use of wonderful  technology we're able to help them survive and so  

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we're having more and more babies that do need ROP  screening so let's chat about that a little bit so  

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as there's a shortage of those ophthalmologists  you nurses are available in all these units and   so why not Implement these programs where the  nurses are the feet on the ground and they're  

25:56

able to provide screening for these patients and  send it virtually to screening ophthalmologist and  

26:05

that way they can cover many more babies and help  to provide R screening in very remote areas so  

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there's several benefits to using a nurse led ROP  screening program and we're going to kind of break   this down into the nursing perspective the patient  perspective and the unit perspective and you'll  

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kind of see that they do overlap actually quite  a bit and that's on purpose so let's get into  

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that so from the nursing perspective it does give  nurses autonomy to perform these screenings when  

26:38

they're available it's another reason for them to  get involved in the unit and it really helps them  

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to take pride in what they're performing in these  screening exams it helps them to gain a new skill  

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set and it with that it provides an opportunity  for growth sometimes people in different units are  

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looking for what they can put on their resumés or  what they can bring to their manager of why their  

27:03

their qualifications continue to build and why  they should be maybe considered for a promotion or  

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a raise or things like that so it's another thing  for them to have on their resume also nurses are  

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so experienced with you know their NICU babies  and they're very protective of their NICU babies   and so doing these exams they really have a lot of  control of the patient experience they can provide  

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those comfort measures and really understand the  patient cues that occur during these exams and so  

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they can tailor those exams to really meet the  needs of each individual patient depending on  

27:39

what their their situation is with their family  involvement maybe their family can only come one  

27:45

time during the day and so that's not when we're  going to do the exam right we're going to do it on  

27:52

a time where it's not interrupting any of our  family time if the patient on is on different  

27:57

ventilator support they can work around that  and use their resources to really help them in  

28:03

able to continue to image the patient no matter  what the patient circumstance might be and also  

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because you're building this team of nurses that  can screen these babies there is a consistency   of care it's always the same team of imagers that  are coming to the bedside to screen the baby and  

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again they're becoming more and more familiar  with that patient individually and it provides   another opportunity to work as a team and not only  to involve the nurses but you're really creating  

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those wonderful communication lines between not  only the neonatology staff but Ophthalmology staff  

28:39

and any other disciplines that are involved with  that patient's care from the patient perspective  

28:45

let's look at the benefits from that perspective  so again there's a consistency of the same ROP  

28:53

screeners coming to the bedside to perform these  exams so you do have a wonderful opportunity to  

28:59

build those bonds and those relationships with  those families because it's the same group coming   week after week to screen their babies again  they're from the patient perspective we're able  

29:10

to be flexible to meet the patient care needs if  the patient has a procedure off the unit we can do  

29:16

it prior to the procedure or after the procedure  or as I mentioned If the parents are only able   to come at one time and they wish not to watch  the exam we can offer them uninterrupted family  

29:28

time and come back and do the screening later it  also decreases their disruption of care so that  

29:34

patients can sleep and we all know how important  sleep is for these babies so that they continue   to grow and improve promotes family centered  care as I mentioned we're not interrupting  

29:43

that precious family time we the nurses are  able to utilize their skills and resources  

29:49

to really minimize that patient discomfort and  provide them with swaddling or medication that  

29:56

they might need prior to because we're working so  closely with the family we're really increasing  

30:02

the parent understanding of what's going on with  their specific baby now in the NICU there are so  

30:08

many things going on with each patient and so if  a patient does have ROP it's wonderful to be able  

30:14

to show them the images on the device and show  them this is what your baby looked like last week   and this is what your baby looks like today and  this is why we're continuing to Monitor and it's  

30:24

wonderful especially when the disease is pro  is progressing to get them involved get them  

30:29

understand to understand what's going on and  it really helps as their discharge to increase  

30:35

that compliance post discharge and then help  them to continue to get to those Ophthalmology   appointments after they're no longer in the  hospital and another patient benefit is that  

30:47

because the nurses can provide ROP screening in  more rural settings the patients can stay where  

30:54

they were delivered and it decreases the patient  transfer and therefore we're not separating  

30:59

families from the facility that they chose to  deliver in and there are of course benefits from  

31:06

the unit perspective as well so units love to be  known for their family centered care model and so  

31:15

this is another way that we can support that model  and really provide a secure environment and a  

31:21

comfortable environment for those families to feel  like they're involved in their patient care which  

31:27

only leads to better scores and just better word  of mouth referrals even for delivery centers if  

31:34

they had a great experience there we're going to  decrease the my patients because the nurses that   are there at on the site are making sure that the  patients fit into the screening schedule when it's  

31:45

appropriate for them and if the patient happens  to be transferred or moved to a different unit  

31:53

the nurses are aware of that and make sure that  they're being followed by technology as needed  

31:58

also it helps to keep revenue within that patient  or within the hospital itself because we're not  

32:04

transferring patients out so they can keep that  Revenue that they're getting from those admissions   the ophthalmologist doesn't need to physically  access the unit as frequently they're able to  

32:13

remotely view the images for their ROP patients  and then able to spend more time seeing their own  

32:20

patients within the clinic so that's wonderful  and it also provides and this is a huge thing  

32:25

in the United States it might not be pertinent in  other areas but in the United States it provides  

32:31

the autonomy for the unit to continue to provide  the ROP care again so that it prevents transfers  

32:37

of patients and that helps them to maintain their  level three NICU accreditation also from a unit  

32:44

perspective when you're having this nurse Led  ROP program it really does increase communication  

32:49

within the care team because you have someone  that's very involved and invested in making sure  

32:54

that the baby is getting the care that they need  from an eye perspective and so it just helps unite   everyone from the neonatology standpoint from  the Ophthalmology standpoint nursing and then  

33:05

any additional therapies that might be involved  with the baby and it helps to provide a seamless  

33:10

discharge that all those outpatient appointments  are being created in a timely manner and an   appropriate manner okay so your unit has decided  you're going to go to towards this ROP the nurse  

33:23

led ROP screening program which is so fantastic  so but might be feeling a little bit lost and a  

33:28

little bit nervous and where in the world do you  start so let's talk about the what those next  

33:34

steps might be so in my particular circumstance I  was identified as the ROP coordinator so I was the  

33:42

lead of the program and I do feel like that is a  very important role to identify very early on in  

33:49

your program creation so that this person can be  involved in all the steps but also it just creates  

33:54

more of a passion and more of an involvement and  of an awareness of what the needs are and that  

34:01

way you can really tailor your program to your  unit and your facility needs so after you've  

34:07

identified your ROP coordinator you're going to  want to select your ROP team and then after that   you're going to want to establish protocols and  workflows that are going to be appropriate for  

34:16

your unit you're going to establish how you're  going to train your staff and how education will  

34:22

be provided not only for the staff but for parents  and then you're also going to roll out your new   program so again we're going to want to select  the best team possible your first person that  

34:35

you're going to select is your ROP coordinator  then your screeners you're also going to want   to identify your reading ophthalmologist as  well as your treating ophthalmologist or how  

34:45

infants that are identified that do have Ro or  ROP that's progressing towards treatment need  

34:51

to be treated so that is a workflow that you'll  definitely want to identify and then of course   how your neonatologists and your practitioners are  going to be aware and notified of what's going on  

35:02

in the eye with these patients so here's some  characteristics that you should be looking for  

35:07

when you're creating your team you want someone  that's comfortable with the eye so the eye and  

35:14

eye exams are not everyone's cup of tea and so  you want to make sure that it's someone that is  

35:19

comfortable with eye exams you want to make sure  that your team has excellent communication skills  

35:26

that they're motivated that they're willing to  learn it is a new skill that they're going to  

35:31

need to learn and so you're going to want them to  be willing to put in the time put in the effort  

35:37

and be excited for it right you also want to find  people that are very cognizant of all the details  

35:46

surrounding the patient that they have great  attention to detail that they're comfortable   with technology because they are of course going  to be using a retinal camera that they're reliable  

35:56

that they show up for their shifts that they're  engaged and that they're that they that they'll  

36:02

be there when they need to for these screenings  you also want someone that's highly organized that   is excited for the change and that works well in a  team and is ready to get started in all of this so  

36:14

as I mentioned before you're going to your Ro  coordinator should be selected first and that  

36:20

should be either a nurse or a nurse practitioner  and that's the person that's really going to be   involved in overseeing the schedule and when  patients are seen and making sure that they're  

36:32

seen in a timely and an appropriate manner so how  many screeners do you think you need well this  

36:38

is a kind of a challenging question to answer so  it might it's really based on your facility need  

36:43

as Vik mentioned my team ended up having 14 ROP  screeners but that was spaced over four different  

36:50

facilities so I always recommend that you start  with a minimum of two to cover your vacation and  

36:55

sick days so if your unit is screening more babies  you can absolutely add to it but I wouldn't start  

37:04

out training to too many nurses because you want  it to be a skill that they can really hone in on  

37:11

that they can practice and that they can be really  skilled at while still providing your unit and the  

37:16

patients the coverage that they need so when  you're selecting your screeners you do want to   make sure that it is someone who is experienced in  the unit that you're in so if you're in the NICU  

37:27

you want someone that has been there for at least  a couple of years that is familiar with how the  

37:32

unit runs how the processes flow in the unit and  that they're comfortable taking care of patients  

37:38

because when they do go to screen the patients  there are going to be a variety of circumstances   that the patient might be experiencing that  they need to be comfortable approaching and  

37:48

Performing the screening okay so you've selected  your team so the other thing to think about is  

37:56

where you go from here as far as your protocols  and workflows so in the United States we use the  

38:02

American Academy of Pediatrics ROP screening  recommendations as a baseline for all of our  

38:08

protocols so when I started my position as ROP  program manager we had nothing in place so we were  

38:17

going from a program in which the ophthalmologist  would come weekly and do bedside exams with a  

38:25

binocular indirect ophthalmoscope and he would do  them in person and so we were shifting from that  

38:32

type of program to a nurse-led ROP program and we  didn't have anything in place for protocols and   workflows so we really had to use from scratch or  start from scratch we started with the Academy of  

38:42

Pediatrics ROP screening recommendations and kind  of use that as a framework and built around that   for our protocols but I also recommend if you're  in a facility where locally where wherever you  

38:53

are globally if there are other Ro screening  program you may want to reach out to them and  

38:58

see kind of how they work their programs and what  they recommend so whether that's local to you or  

39:04

in other nearby countries what's fantastic about  Neolight which I wish I had when I was starting my  

39:10

program was that they have this wonderful cares  kit that Vik and Candice talked about which is  

39:16

so incredible because it provides a framework  for so many things but especially for workflows  

39:23

and protocols and procedures so you're not having  to start from scratch you can take it and you can  

39:29

adapt it and you can tweak it however you need to  fit your facility and your country standards but  

39:35

you're not having to start from scratch which  is so incredible the other thing you're going   to want to identify is on what day does your  ophthalmologist want to read these exams so  

39:46

that's going to dictate when you're going to do  the exams right so you want to identify does the  

39:52

Ophthalmologist want to read them first thing in  the morning so do they need to be done on night   shift or is your ophthalmologist going to read  them after clinic hours or during their break  

40:01

midday so that will definitely dictate when you're  going to be performing your exams and then you're  

40:08

also going to want to in work well closely with  your it Department because you're going to want to   identify how those images will be transferred to a  situation where your Ophthalmologist can read them

40:19

remotely okay so what are the supplies that you  need so of course you're going to need a retinal  

40:27

camera so this is a picture of the ICON you're  going to want to use a coupling gel the gel is  

40:33

going to create a nice Bridge from your lens of  your camera to the image that you're taking of  

40:40

the retina and it's going to provide a better  way for you to see out into the periphery it  

40:46

is a nice viscous coupling gel this is one that  we recommend but you can definitely reach out to  

40:52

Candice or Vik or and find what ointments or gel  is available in your area you're going to want to  

41:02

have speculums of various sizes and we're going to  go over that in just here in a little bit and then   comfort measures for your babies so not every  baby is able to have sucrose or pacifier but  

41:12

if they are those are wonderful tools to have on  hand you'll also want to have some gauze and some  

41:17

sterile water for cleanup and then of course a  comfort measures they're so important when you're  

41:22

doing these exams I always recommend a second pair  of hands never recommend screening on your own for  

41:28

neonates because they are wiggly and so you want  a second pair of hands for containment honestly  

41:34

sometimes even a third or fourth pair of hands  depending on what the patient circumstance is   and how squirmy the patient is you could also  want to consider any swaddling or containment  

41:44

devices that you might have on the unit okay  so let's consider speculum so these are some  

41:50

of the speculums that I used during my program  but depending on where you're located and what  

41:57

where you're getting your supplies from they might  be different but this is kind of what they look   like they range in sizes so you're going to want  to have various sizes so I always recommend at  

42:06

least two sizes but if you can have three that's  wonderful some are a little bit larger some are  

42:13

like a medium size and some are smaller so you  want to make sure that you have the right size  

42:18

for your baby because if you don't what's going to  happen is if the speculum is too large it's going  

42:24

to prevent contact of the lens of the camera and  the actual lens of the eye same thing if it's too  

42:33

small you're not going to get your speculum to  open the lid enough and you're not going to be   able to get those images of the back of the eye  because you're going to have issues with contact  

42:41

so those are really important tools to have on  hand and a variety as I mentioned another thing  

42:48

to consider is perhaps using a scleral depressor  this is the Flyn lens Loop depressor which I used  

42:54

and I liked but that's of course up to you guys  of how you're what you feel comfortable with and  

43:00

also what your ophthalmologist is comfortable  with you using to move the eye so when you're  

43:05

setting up your program you want to train your  nurses and practice makes perfect the more you   can get your hands on that device and practice  your body mechanics and how it might be oriented  

43:15

for different patient situations in different  bedsides at your facility it really makes a   world of difference most devices come with  a false head and a false eye so that you can  

43:27

practice measuring that way or practice I'm sorry  Imaging that way and I always recommend getting  

43:33

as many practice sessions in as possible before  you transfer to live patients I always recommend  

43:39

starting to image with two people well I always  recommend Imaging with two people regardless but   especially when you're starting out making sure  that you have two people available is wonderful  

43:49

and then you're going to want to set up a process  for how you're going to competency validate your   nurses and the cares kit again is an amazing tool  that actually has some examples of what you can  

44:00

use for competency validation for your nurses  whether that's yearly or by annually and then  

44:07

what's another great tool that you should utilize  is the Train the trainer approach so you're going  

44:12

to train one person perhaps your ROP coordinator  to be the the expert right and then as if nurses  

44:21

leave or they come and go or your program is doing  well and you need to expand because you're Imaging  

44:26

more and more babies they can pass on those  skills to new incoming imagers okay so you've  

44:34

got your program in place you're ready to roll it  out I think the most important part about rolling  

44:39

out a new program is communication so you want to  communicate with your staff that's there so that  

44:46

they're aware of this change and process that's  occurring and then you also want to educate those  

44:51

parents so you're going to have parents that are  there that perhaps had babies there when you still   had your old program in place or whatever that  workflow looked like so you're going to want to  

45:00

make them aware that the change is occurring and  what they can expect and how it's going to impact  

45:07

the care of their baby and all that good stuff so  you might want to create one for create a parent  

45:12

handout that's what we did that we provided to  patients and that were already in the hospital   and we provided them with a handout that they  knew what to expect as well as another handout  

45:23

for future admissions that was included with our  admission p so that going forward when patients  

45:28

were admitted they understood what ROP was and  what the process was of following for that and  

45:34

then as your program is rolled out you're going  to modify and make adjustments it's never going   to be perfect on the first try but you just need  to be flexible and kind of roll with the punches  

45:43

and then again ensure that your whole care team  is on board and that they understand what's going   to go on in the changer process so you're up  and running what are you going to do to make  

45:53

sure you're successful well you're going to want  to make sure you're really diligent in observing   and evaluating if there are any Miss to patients  that's key you want to make sure that whatever  

46:04

changes you're doing to your program that no  patients fall through those cracks and that   they're being screened in a timely and appropriate  manner you're also want to talk about the quality  

46:15

of your Imaging so as I mentioned before practice  makes perfect the more you can get your hands on  

46:20

the device and practice on a false eye the better  you're going to be when it comes to getting on  

46:26

actual patients and then it's wonderful to be  able to ask for and obtain support and feedback  

46:33

from your reading Ophthalmologist so that your you  gain confidence and your images can only improve  

46:38

from there also another key thing to continue the  success of your program is to provide continue  

46:45

education for RN screeners it'll keep them  motivated keep them happy keep them understanding  

46:51

of how they can become better imagers and this  is just something that's wonderful to provide and  

46:58

then any adjustments in workflow you'll want  to make sure that those are being addressed   and implemented and then of course outpatient  follow-up once the babies are discharged from  

47:07

your unit you want to make sure that there is an  outpatient follow-up program in place and that   they're not being lost to follow-up I know this  can seem daunting especially when you're changing  

47:19

from a more hands-off approach to a very much so  nurse directed nurse-led ROP screening program I  

47:27

know it can be a little bit scary but they're they  have been so successful worldwide I know you can  

47:32

do it there's so much support out there I really  encourage you to use those resources and Neolight  

47:39

is so wonderful their clinical Education team is  really great at providing you those resources and  

47:45

the support that you need especially when  you're first starting out but the whole   time while you're doing your program so thank  you for listening and that is my presentation

47:58

that's wonderful thank you so much Edyta I just  wanted to raise a point that you mentioned at  

48:04

the start of your presentation was really the  challenges that you know that the nurses face with  

48:11

the availability of pediatric ophthalmologists  and that's a global issue we know that that's   a global issue and so your encouragement your  feedback and your kind of I guess sharing your  

48:26

experiences is really valuable to those people  who are listening into our presentation today so  

48:32

thank you to Edyta and Candice both of you for  your valuable contribution today thank you so  

48:37

much thank you thank you be now it's my very great  pleasure to introduce our last guest speaker Julie  

48:48

Flanigan unfortunately Judy could not be with us  due to her clinical responsibilities but she was  

48:55

very gracious enough to record an interview  with me just last week so let me introduce  

49:03

Julie to you so Julie Flanigan is a registered  nurse she's a registered Midwife and independent   nurse prescriber and she currently works as a  senior sister and ROP screening coordinator at  

49:14

the newborn Intensive Care Unit at St Barry's  Hospital in Manchester UK Julie comes with over  

49:21

20 years of clinical experience and she started  her clinical sorry has screening Journey just  

49:27

over 10 years ago she was a Pioneer in fact in  being one of the first to step forward as a nurse  

49:33

screener and then has since gone on to develop an  amazing service with the help and support of the  

49:40

Pediatric ophthalmologist there Professor biswas  now Judy went on to develop a retinal Imaging  

49:46

course consisting of Competency Based Education  and Training and which has been accepted by the  

49:51

Manchester Foundation trust Nest portfolio nest  I think I believe stands for neonatal education  

49:57

training and Julie is also a member of the UK ROP  guideline Development Group which is responsible  

50:04

for R screening treatment updates so I'm going to  hand over to Julie I really had to sort of develop  

50:13

it myself and in actual fact the initial sort of  education program I took from ay education program  

50:25

so it was nothing to do with Ophthalmology so  incredible Yeah so basically it was a competency  

50:33

based document that I did in the first instance  just following through the whole screen how we  

50:39

would screen where we would start you know  what's you know you know using the speculum  

50:45

all those simple the whole screening process I  just looked at the whole screening process and   then broke it down into parts and then that's  how I develop the competency document alongside  

50:58

I mean Mr bisw would have been quite happy for me  to just see one do one but I wasn't happy because  

51:04

it was such a different skill set of course and I  did find it challenging because as a nurse you're  

51:09

obviously doing a different your role is different  and then to actually look at baby's eyes and have  

51:18

absolutely focus on that baby's eyes it can be  quite difficult to to take that transition and  

51:26

that's took a while to develop because you are  the nurse so but then you know all about Comfort  

51:32

Care measures you know about all about pain and  signs of pain so that's why we went down the  

51:37

nursing route and obviously we I was here as well  all the time so I could look at the babies where  

51:45

the pathways what they were on when it was the  right time to be able to screen them where often  

51:51

it would a baby on a Thursday which is when we do  the clinics that baby might not be well so that  

51:58

baby would miss the screen and it's a very timely  a timely condition that we have to get right so we  

52:05

found it very valuable to be able to have a degree  of flexibility within the service to screen the  

52:11

babies when it's right for them and not I mean  you have to take into account the guidelines the  

52:17

ROP guidelines you can't just do a baby 3 weeks  before because you think in 3 weeks it's going to   you know it's something else is going to happen  but you might know that the babies going down to  

52:27

scan for a for an image or something like that  so you don't want to be doing an ROP on those  

52:32

babies then you might fit that in the next day and  things like that so it it's been a valuable tool  

52:40

an absolutely valuable tool and allows the service  a degree of flexibility yeah to be able to fit in  

52:50

with the baby's pathway so it's very rare that we  well we don't miss babies we haven't Miss babies  

52:56

the only reason we might not be able to undertake  a screen is because the babies are too clinically   unwell right yeah and you said something very  important there and I know that people will  

53:06

have picked up on it but it's the statement that  you mentioned about the fact is that you're there  

53:14

you know your patients and you understand your  patience you understand you know what they need  

53:20

and when is the best time to screen them because  sometimes they might not be ready for screening  

53:25

when the ophthalmologist is ready to scream them  so you know that that's a that's something that I  

53:30

know will resonate with a lot of the people that  are hopping on to this webinar but generally also   people who are thinking about setting up a system  as well so from your experience you know from 10  

53:41

years ago right up to today now you've I know  that you've trained you and I've spoken before  

53:47

and I know that you've trained other nurses how do  you how did that come about and how do you kind of  

53:54

go about select people that are the right kind  of candidates for you know becoming nurse images  

54:04

so the I don't think you can just sort of grab  somebody off the unit and say right you're going  

54:09

to be a nurse imager there has to be passion  about and there has to be an interest in what  

54:15

they're doing because that's the way you get the  best performance that's the way you get the right  

54:21

sort of people so we've recruited onto the team  obviously you have to look at forward planning  

54:27

as well you know people leave and then you've  got to you've got to then train other people to  

54:33

become Imaging nurses and it's usually the people  that have an interest in ROP have shown motivation  

54:41

and have shown that interest in that area of  practice that we tend to recruit to because  

54:47

they're the people that are we're going to retain  they're the people that are going to get the most   out of the course and they're the people that are  going to enjoy the taking the images and educating  

54:59

the staff and educating the doctors because it's  been invaluable for being able to educate the new  

55:06

staff coming in and the new doctors coming in  and also for the parents to be able to engage  

55:11

with the parents more and get them to understand  the involvement that they need to that they need  

55:18

to participate in their baby's care and understand  what it involves about doing the Imaging and what  

55:26

you know why we're seeing babies weekly why we're  seeing babies other babies too weekly and what  

55:32

are the concerns so and it's having that passion  having the Champions to promote the ROP because  

55:39

unfortunately ROP screening has got a degree of  negativity because of the associated possible  

55:46

side effects it's not a it's not a procedure  to be taking light live it you know what I mean  

55:51

it we are finding that we have less detrimental  effect with imaging because you're not using the  

55:57

indenter we do use the speculum so you still need  the dilation drops but you're you know because of  

56:06

the field of view that you are achieving you're  not having to use the indenter and you're learning  

56:11

trick ticks and tri trick trips ticks you know  tricks and tips on how to optimize that view  

56:22

there's lots of studies that has been saying that  Imaging is less invasive than is more sensitive to  

56:29

the baby's needs than maybe an ophthalmologist  coming along using indenter where they might   cause some corneal bruising because they're that  they're that enthusiastic trying to get the you  

56:40

know trying to get the area that they want to  see and often we've had babies coming over and  

56:46

the diagram that the ophthalmologist has done is  nothing like the what you're actually seeing with  

56:52

the Imaging device because there it's like  a jigsaw they're trying to draw everything   together where the Imaging device is live do you  know what I mean you're actually seeing that ROP  

57:04

and the fact that you can do a comparison is  just so amazing that you can see how that the  

57:11

pathology is changing week by week yes so I'm  very passionate about it and I want people who  

57:22

are also passionate to do it because that leads  to a better success of completing the course yeah  

57:29

definitely yeah and you know I've spoken to you  a few times and I can definitely see that passion  

57:35

and I always kind of leave our conversations  feeling really enthusiastic about learning more  

57:41

about ROP and screening and for some somebody  that's at the start of their Journey then Julie  

57:47

someone that's thinking about you know becoming  an imager what's the one piece of advice that  

57:53

you'd give them that wish that you'd been given  I think to be patient and don't put too much on  

58:01

yourself it's a completely different skill set  it's a completely different area of practice  

58:09

and I think you just need to be patient to be able  to you know you need to have a lot of information  

58:16

about the pathology Etc and it's a learning curve  and it's a steep learning curve but at the end  

58:24

of it it's a fantastic experience to be able to  undertake these images and to be able to manage  

58:33

this condition in such a timely manner and work  as a team with the ophthalmologist and work as  

58:39

a team with the parents and engage in that in  that to be able to manage ROP effectively and  

58:46

when you get a baby who comes back in who's had  treatment and comes back in and the parents are  

58:53

just value so much the input that you've given  and it it educates them as well it's just such  

59:00

a fantastic thing to do at the end of it it's  deep learning curve but when you get to the end  

59:05

of it it's an absolutely valuable skill to have  yeah absolutely okay so for somebody that's maybe  

59:13

thinking of setting up a system what a screening  program I should say What's you know what are the  

59:21

key must haves would you say well you have to  have investment from the management from the  

59:26

higher management U see and an investment from the  Ophthalmology team yeah because ultimately without  

59:34

them they are the graders and they ultimately  manage the disease we do the nurse-led screening  

59:43

and I might be able to say to Mr bizos this baby  needs treatment But ultimately it is his decision  

59:48

as to whether that baby requires treatment or  not obviously it's to have experience with ROP  

59:57

having a bit of knowledge about ROP to be able to  have the equipment that you is required which is  

1:00:04

like the isets being aware of the effects of the  drops and the type of drugs that you need I mean  

1:00:13

Imaging is fantastic but without a dilated pupil  Vik you're not going to get adequate images so  

1:00:21

you need to have an awareness about the positives  about Imaging but the also the restrictions with  

1:00:30

any method of screening you know the bio has got  some negativities as well as some positivity’s and  

1:00:37

being aware of that really and when I mean we do  a mixed a mixed strategy for babies so we do the  

1:00:44

majority of their screening is done with imaging  but the final review because of the criteria for  

1:00:50

discharging on ROP screen in is to get out to Zone  3 and even though we may be able to get out to  

1:00:59

peripheral Zone 2 and maybe into an anterior Zone  3 there's no way we can get into peripheral Zone 3  

1:01:05

so we the final review is a binocular indirect top  that CER so you have to have the team engagement  

1:01:13

with that to be able to do a successful strategy  but I know that some units solely London solely  

1:01:20

does Imaging and discharges on Imaging and I  think that the way forward that is the way that  

1:01:26

we will go once people have more confidence with  imaging and the capabilities of of the Imaging and  

1:01:33

the technology that's moving on all the time yeah  yeah so it's just having the right equipment the  

1:01:42

dedication of the workforce the technology to be  able to store that data and share that data with  

1:01:52

the right people having somebody who you know  having the same team that are as passionate as  

1:02:02

yourself really to be able to do it absolutely  yeah what does what are the key criteria’s would  

1:02:08

you say for training you know obviously that that  enthusiasm and the passion is really important you  

1:02:14

know to be engaged in the whole process but what  from the training program that you you've been  

1:02:20

rolling out what are the key things that people  maybe need to be mindful of if they're in the   same position of thinking about doing something  similar it's quite a commitment yeah because  

1:02:32

our cost is actually four to six months but we're  hoping to shorten that that's because we do weekly  

1:02:40

exposure but if somebody was going to be doing  it all day then obviously that would condense  

1:02:45

the course having said that it can be quite  challenging you know taxing on the brain to take  

1:02:51

that amount of information in all in one go but  it has been done you know we know that that has  

1:02:57

been done so we have an education platform so that  they get a background and a foundation knowledge  

1:03:05

about ROP they might have had some experience of  the pathways maybe helping a doctor to do an to  

1:03:11

do a you know a binocular indirect ophthalmoscope  review but they don't really understand all about  

1:03:18

ROP and awareness of the classification Etc so  that sets up the that they need to understand  

1:03:24

because when you're taking an image you'll be like  what's that I don't know what that is I don't know   you know having a basic awareness of the eye about  the optic nerve about the macula about what are  

1:03:36

retinal vessels and the layers of the retina and  things like that so all those help to improve your  

1:03:43

the process of Imaging and then the effects of  the actual screening process on the Infant not  

1:03:50

just about Comfort Care measures about pay pain  you know pain relief or pain scores how the baby's  

1:04:00

handling the screen when you can screen and when's  the right time you know about feeding and how much  

1:04:07

that can impact on the on the baby actually having  the screen and then the technology an awareness  

1:04:13

of what's what the machine does and that is quite  imperative really because because of how much Tech  

1:04:20

you know we do a lot of teaching on the technology  your familiarization with the device certain  

1:04:28

functions that the device has I mean at the moment  we still do still images but obviously you can do  

1:04:35

if the baby's really getting agitated you can  actually go on to doing a video because that  

1:04:40

takes less time but you can still slice into those  images and take that information from there so but  

1:04:48

you need to establish your skills before you could  move on to doing videoing but that is something  

1:04:54

that we're considering and looking at and things  like that so and involvement of the parents and  

1:05:00

the decision-making process the involvement  of the multi-disciplinary team in the decision   making process because they have to look after  the babies after the screen which may the baby  

1:05:12

may have some side affects you know bradycardia  the fact that the they can get feed bradycardia  

1:05:19

from the drops because of the slowing of the gut  so all those things you need take to account as  

1:05:25

well as patient identification Vik ensuring that  you've got the right patient how will you how  

1:05:32

will you store these images how will you protect  that patient data yes we found a lot of that as  

1:05:41

time's gone on how will you how will you contact  the if the ophthalmologist is remote how to plan  

1:05:49

the clinic you know what type of babies will you  screen are some babies better being left for the  

1:05:57

ophthalmologist because of the fact that it's a  discharge review or and so that baby could be done  

1:06:03

in another day but then you have to look at what  the pathways the baby's already on so that's how  

1:06:09

we've that's how we've done it really and then at  the end we do a competency assessment so you might   have an interim assessment a month or two into it  when you're starting to do some images we use a we  

1:06:20

use a simulation doll to get people used to just  handling the camera and how by just keeping the  

1:06:28

camera on the eye you just tilt you only have to  tilt you don't have to move the camera to get you  

1:06:34

know to get the images and not to worry about the  medical terminology like temporal and nasal just  

1:06:41

think where's the optic nerve the location of the  optic nerve tells you if it's a I use a clock face  

1:06:49

I don't know whether I mean I'm sure my colleagues  in other countries will do it differently but I  

1:06:54

use a clock face s 12:00 3:00 6:00 9:00 those are  the images that you need to get and then obviously  

1:07:02

the central image of the optic disc and then you  want to make sure that the baby's dilated so you  

1:07:08

would you would take a picture of the front of  the eye or the anterior segment to make sure the  

1:07:13

baby's dilated so fantastic going into all that  as well so there's a lot of information but all  

1:07:21

that information makes you a better imager yeah  absolutely and I think when we spoke before as  

1:07:28

well you said that kind of the assessment or  the or the criteria to make sure that your  

1:07:36

up to speed is done on an annual basis on your  unit is that right yes it's a stealth assessment  

1:07:42

yeah so all the people that are working on the  unit and anybody that we've Tau because we've   Tau some external candidates as well we're always  open to them saying I'm struggling a bit I've not  

1:07:54

seen I've not looked after babies who are very  dark do you know I haven't done any images on   a on a very dark baby can you give me some tips  and tricks where you can do a teams meeting or  

1:08:05

they can come over to the unit and provided they  have a obviously provided they have a some sort  

1:08:11

of contract they can come over to your unit and  become exposed to those type of things talking  

1:08:19

about the capabilities of the of the of the device  what you have to do to be able to optimize that  

1:08:26

view yeah so that's the type of thing that we tend  to do but they do a self-assessment and that's  

1:08:35

worked on a competency based document and we also  have a guideline so that looks at your scope of  

1:08:41

practice what babies you can screen these people  work that the people that work here work on the  

1:08:47

neonatal unit if a baby needs to be screened on  a pediatric unit they shouldn't be going down to  

1:08:54

the Pediatric unit to screen that baby because  of the information government's framework that   they're working on so they can go down and assist  the ophthalmologists but the scope of practice is  

1:09:06

the recognition of the scope of practice is  crucial because if anything happens to that   baby down on pediatric unit then yeah you're the  accountable person yeah of course yeah that makes  

1:09:18

sense we we've lost your video feed but we'll just  carry on you mentioned if you've got patients with  

1:09:27

dark fundi what are your kind of hints and tips  on Imaging Darkly pigmented infants so from an  

1:09:36

intensity perspective you may have to go slightly  up I mean I know you can preset on the particular  

1:09:43

device that we have you can do preset but we don't  do that because people are training and we want  

1:09:49

them to see and be exposed to the difference that  using the intensity and gain to complement each  

1:09:56

other to be able to get better images and clear  images so we tend to go up on the gain rather  

1:10:06

than on the intensity you might go up by one or  two points with a with a baby who's got dark eye  

1:10:14

rids you know dark eyes but not significantly we  certainly wouldn't go because that white light  

1:10:20

intensity can be really uncomfortable for the baby  and then you'll obviously get a non-compliant baby  

1:10:26

that can cause quite a bit of discomfort so you  would use the game but you know that if you go   too high on the gain then it can the images  can become very grainy so we tend to go up  

1:10:38

maybe onto a level of about 20 on the game maybe  not much more than that but you do a test you're  

1:10:45

testing that all the time while you're doing the  images and maybe the intensity I would only go   up to maybe 10 yeah on the dark babies and go  up on your gain a little bit for the front of  

1:10:57

the eye when you're looking at a condition called  Tunica vasculosus lentis where which is where you   see Iris vessel engorgement you may go up a little  bit more on the on the gain just to pick up those  

1:11:09

fronts of vessels but then you would come back on  the game to actually take pictures of the fundus  

1:11:15

itself yeah so and we found that works for us Vik  that that does work for us so that's excellent and  

1:11:22

really it sounds like it's more of as you're as  you're developing and honing your skills you kind  

1:11:28

of learn then in terms of how to manage the device  and the settings depending on what the patient  

1:11:34

requires at the time or previous images you look  at previous images look at look at how clear those  

1:11:40

images are and take those settings to the next to  the next screening session as well yeah absolutely  

1:11:47

yeah so you're kind of building on your experience  as you go along yeah perfect excellent great well  

1:11:54

I want to extend my gratitude to Julie for sharing  so much of her valuable time what we're going to  

1:12:01

do now is we're going to open up to questions  that you've been submitting so thank you for that  

1:12:07

please continue to submit those questions on the  chat I don't know if my colleagues are ready to  

1:12:13

answer some of these questions perfect so one of  the first questions that we've had and I'll throw  

1:12:22

this open to both Edyta and Candice is it neonatal  nurse practitioners who have to perform Imaging or  

1:12:31

can registered nurses use the camera as well yeah  registered nurses can absolutely do the Imaging it  

1:12:40

needs to be someone who is at least a registered  nurse so some programs do all registered nurses  

1:12:47

I've seen do a mixture of registered nurses and  nurse practitioners so it really just depends but  

1:12:54

it wouldn't be someone you wouldn't use like a  CNA or like a nursing assistant it would need to  

1:13:02

be someone who's licensed sure perfect thank you  Edyta the next question that we've had through so  

1:13:10

thank you so much for this one is what's the best  way what's the best way to make sure nurses stay  

1:13:16

educated in terms of their goals documents skills  checklists Etc Candice would you be happy take  

1:13:23

this one absolutely and I know Edyta really helped  with a lot of the documents that we made when we  

1:13:31

built our cares kit just watching the program that  she built it kind of guided us to make documents  

1:13:38

in terms of goals documents to say I want to be  able to read these guidelines that are specific to  

1:13:43

my territory I want to be able to say regardless  of whether we have infants for Imaging within the   unit I want to get this camera out every single  week so that I'm building on that muscle memory  

1:13:54

and of course those documents then go into helping  with the skills checklist and really making sure   that we're staying fresh on those skills and then  growing the skills that need to be grown perfect  

1:14:06

thank you Candis AB another question that's just  coming thank you so much for that one what are the  

1:14:13

tips for Imaging micro prems things like speculum  size that's a great question thank you that is  

1:14:20

a great question so very important tool to have  is the correct speculum size is you wouldn't use  

1:14:28

you want to make sure you have a small speculum  that's appropriate for micro preemies because if  

1:14:34

you use a speculum that's appropriate for just  your standard newborn you're really going to  

1:14:39

have a difficult time getting your getting good  contact because the speculum is actually going  

1:14:45

to open the eye in such a way that it's going to  prevent your camera actually from getting into  

1:14:51

the eye so you want to make sure you have the  appropriate size speculum and then of course as  

1:14:56

I mentioned containment and comfort measures  during the exams are very important as well  

1:15:06

great thank you tier another question yeah this  is a good one are there are there support groups  

1:15:13

for new programs like user advisory boards and  that may change depending on where our listeners  

1:15:21

are coming from are you know people attending  our webinar so I don't know if you guys want  

1:15:26

to just comment on your personal experiences of  that yeah I think within Neolight we really try  

1:15:32

to support user advisory boards in fact we anytime  we're seeing a strong imager like Julie and like  

1:15:40

Adida we really try to grow those relationships  because from my standpoint I have a really great  

1:15:46

background in Ophthalmology but we really need  some of that nursing side to partner with our  

1:15:52

educ efforts so we're constantly building out user  advisory boards medical advisory boards and we try  

1:16:00

to support those in different areas as well as we  see different territories on boarding groups to  

1:16:06

make sure that we have those anchors those people  that we can recommend and anyone can reach out to   when they're building their new programs great  thanks we we've got so many questions I'm not  

1:16:18

sure that we're going to have time to address them  all but we will be sharing our contact details at   the end of the web now so please do not hesitate  to contact us directly we'll be more than happy  

1:16:28

to answer your questions let's just do a couple  more so all great questions again what type of  

1:16:35

parent education should be provided I think it's  important to have some kind of document that you  

1:16:43

can provide your parents so that they know kind  of what to expect that their baby qualifies for  

1:16:48

an ROP exam when that ROP exam might be you know  such as what date it might be on and then maybe  

1:16:57

the time just so that they can decide if they  want to be there or not and then some type of  

1:17:02

education providing the results right and kind  of explaining what ROP is kind of selecting  

1:17:08

what their baby has and what the follow-up that's  recommended is it's always great too if you feel  

1:17:18

once you feel comfortable looking at the images  and showing them just showing them from you know  

1:17:24

pulling up that baby when the parents are there  at the bedside and showing them from week to week  

1:17:30

what the exams look like it really helps them to  understand what's happening with their baby yeah  

1:17:36

that that's a that's a great it's a great question  and a great response to and I know that from my  

1:17:43

experience having that par having the parents  involved right from the onset is so valuable  

1:17:50

in terms of that Journey not only for the patient  but for the imager and getting the parents engaged  

1:17:56

early on is really vital so 100% AG Greek we we're  hopping back on to the education side so what type  

1:18:05

of frequency of continuing education or competency  validation should be considered that's a great

1:18:12

question and you want me to do that one or you  oh yeah you can do that one I mean Adida knows  

1:18:20

from the nursing side like that that we typic  see these probably done either by- yearly or  

1:18:25

yearly and then I think I had mentioned earlier  just from A continuing education standpoint when  

1:18:32

you're building a new program you want to  get that camera out as often as possible   and you want to practice like you play we're  always telling the new nurses actually stick  

1:18:40

the little baby head the test eye put that in a  radiant warmer in an incubator in a crib whatever  

1:18:46

your Imaging environment is and really get used  to those small details where do I put the system  

1:18:51

where do I stand where with my partner stand on  that's Imaging with me because when you get those   details down it makes those Imaging sessions so  much easier but I'll let Adida kind of speak to  

1:19:03

how often we would see those competencies re  revamped and re-checked yeah so competencies  

1:19:10

usually are done as Candice mentioned annually  or biannually I guess it depends on your facility  

1:19:17

but I would say at least annually and that way  too from an accreditation standpoint if anyone  

1:19:23

has any questions of when the nurses were last  checked off on their skills they can pull that  

1:19:29

up and it's an a document that can be easily  referenced there is there are some examples  

1:19:35

of that also in the Neolight C.A.R.E.S. kit  some skills checklists that you can use and  

1:19:42

kind of walks you through using the system and  that way whoever's overseeing those nurses can   initial off that that yes they can appropriately  use and safely use the device advice on Imaging  

1:19:53

patients yeah absolutely thank you both and we  heard in in Julie's video that on her unit it's  

1:20:03

done on an annual basis as a self-assessment and  that's I think for me from what from my experience  

1:20:09

that's what I've seen more often than not there  are a few places that do like a like a biannual  

1:20:16

assessment but it's really down to kind of you  know your hospital protocols and the criteria  

1:20:23

that your your education requirements are so yeah  thank you both for that for beginning images so I  

1:20:34

think the question is for images at the beginning  of their Journey what's the best tool to have on  

1:20:40

hand that's a great question thank you for that  I think I will say the same thing that Julie said  

1:20:47

patience and Grace you can have all the tools  available to you but to have patience and Grace  

1:20:55

especially when I think of comparing myself to  an ophthalmologist who spent many years training  

1:21:00

in school and I'm coming into the new process  patience and Grace is what we need 100% agree  

1:21:10

anything for you from you Edyta yeah I would agree  definitely if you're looking for like a physical  

1:21:16

tool I we say multiple size speculums would be  huge like you have to have a good coupling gel  

1:21:25

or you're just not going to get those good images  so those were the two physical tools that I would   say and if you could you know a second pair of  hands is always recommended yourself patience  

1:21:38

understand that it takes practice it's a new  skill and you know every time you do it you're  

1:21:45

going to get a little bit better at it and just be  patient and hang in there and you can get it you  

1:21:50

know it is something that has been as I mentioned  in my presentation it's successful worldwide many  

1:21:57

nurses Do It so it definitely can be done it just  takes some time and some practice absolutely yeah  

1:22:05

I think I think you're both you're absolutely both  right you know embrace the fear when you first  

1:22:11

start I think you just have to be brave and know  that you know there's colleagues around the world   are already doing it and practice makes perfect  and they they've become expert images so draw on  

1:22:23

that and patience absolutely right and I've spent  quite a bit of time with Julie U working with  

1:22:29

her and and it really comes across you know she  she's a real advocate of just don't be too hard  

1:22:36

on yourself and I know Candice mentioned that in  her presentation but that really does come across  

1:22:43

that you know just don't be too hard on yourself  it's you know you will get there and practice   makes good so we we're going to finish off with  one more question thank you so so much everyone  

1:22:55

for all the questions we won't have time to get  through all of them but this is a good one to end  

1:23:00

on I think what's the one piece of advice you'd  give to someone who's Imaging for the very first

1:23:06

time oh gosh I would say take a deep breath  and maybe wear some shoes that you can take  

1:23:19

off because you might have some trouble using the  foot pedal and so if you have some shoes you can  

1:23:27

take off that's helpful sometimes put a booty on  a surgical booty perfect thank you excellent so I  

1:23:36

think unless my esteemed panel and colleagues  have anything else to add we're going to draw  

1:23:43

this webinar to a close so I want to thank Edyta  and Candice and and Julie for their valuable time  

1:23:52

and input and also my colleagues who help put the  webinar together and of course for all of you for  

1:24:02

attending we're very honored and grateful that you  spent the time with us and of course if you have  

1:24:09

any questions our contact details will be shared  at the end of the webinar thank you so much thank

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