1Jun-17

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Welcome to CASLPO E-Forum

2Jun-17

College of Audiologists and Speech Language Pathologists of Ontario

CASLPO e-Forum: New Standards for Hearing Aid Services: Overcoming the confusion of ADP, prescriptions, multiple audiologists and more

June 7th, 2017

3Jun-17CASLPO e-Forum: Circle of Care

Carol Bock

Deputy Registrar

Samidha JoglekarAudiology Advisor & Manager of Mentorship

4Jun-17

5Jun-17

6Jun-17

7Jun-17

Agenda

• Review New Standards for Hearing Aid Services by Audiologists

• Scenarios illustrating key points

• Questions

CASLPO e-Forum: Circle of Care

8Jun-17

Practice Standards for the Provision of Hearing Aid Services by Audiologists

• Previously was a Preferred Practice Guideline (PPG)

• Four documents combined into one

• Introduces new standards that apply to all aspects of hearing aid services

9Jun-17

Where is it?

10Jun-17

THE PURPOSE OF STANDARDS

• To identify the minimum requirements of practice for audiologists when providing hearing aid services to people of all ages and abilities

• To articulate expectations with regard to the knowledge, skill and judgement that a member must possess and the practices to which they must adhere

• Standards are identified through a process of consensus within the profession

11Jun-17

Practice Standards for the Provision of Hearing Aid Services by Audiologists

Table of Contents

A) PreambleB) Definition of ServiceC) Scope of PracticeD) Resource RequirementsE) Collaboration RequirementsF) Health and Safety PrecautionsG) Principles Guiding Service Delivery – Includes Consent & Risk ManagementH) Intervention : Competencies and ProceduresJ) DocumentationN) FAQs

12Jun-17

Our Focus Today

H) Intervention: Competencies and Procedures

• Determination of Hearing Aid Candidacy

• Hearing Aid Prescribing-Definition of prescribing & prescription-Standards

• Dispensing and Fitting -Definitions & Standards

• Verification and Validation-Definitions & Standards

13Jun-17

Scenario 1

14Jun-17

• Experienced clinician who works in a hospital setting

• Nancy is assessing Max, a 6-year-old with a syndrome affecting hearing

• Max has physical as well as cognitive impairments associated with his syndrome

Nancy, Audiologist

15Jun-17

• Nancy is unable to obtain a complete audiogram for Max because it’s challenging for him to respond reliably

• She has threshold ABR data for Max at 500Hz, 2KHz, and 4KHz.

• The audio and ABR thresholds indicate that Max has a moderate to severe sensorineural hearing loss

Nancy, Audiologist

16Jun-17

• Polling Question: Given the limited information that Nancy has about hearing status, is Max a good candidate for hearing aids?

Yes No Maybe

Nancy, Audiologist

17Jun-17

CASLPO STANDARDS: Determination of Hearing Aid Candidacy (P.17)

• Nancy will determine Max’s hearing aid candidacy based on many additional factors:

• Competencies & Procedures for determining hearing aid candidacy (p. 17-18)

18Jun-17

Competencies & Procedures: Hearing Aid Candidacy (P. 17-18)

• Nancy will consider all areas above in Max’s case

Example in Max’s case

Example in Max’s case

19Jun-17

Competencies & Procedures: Hearing Aid Candidacy (P. 17-18)

• Nancy will consider all areas above in Max’s case

Example in Max’s Case

20Jun-17

Scenario 2

21Jun-17

• Max’s parents tell Nancy that he wears his glasses all day at school and he doesn’t remove them

• Max’s teachers have received training on how to change hearing aid batteries and carry out basic hearing aid trouble shooting in the classroom

• The school is willing to support further hearing aid training for Max’s teachers if necessary

Nancy, Audiologist Max and His Parents

22Jun-17

Nancy, Audiologist Max and His Parents

• Poll Question: Despite gaps in audiometric data, given all the information that Nancy has about Max, can she proceed with generating a hearing aid prescription?

Yes No Maybe

23Jun-17

CASLPO STANDARDS & DEFINITIONS : Hearing Aid Prescription (P. 20)

• The prescription is a document Nancy will produce based on the act of prescribing

24Jun-17

CASLPO STANDARDS : Hearing Aid Prescription (P. 20-21)

• Patient name and DOB• Date of issue• Ears to be fitted

• Make, model, type• Hearing aid performance specifications that align with the fitting formula

• Audiometric data/or any other data (e.g., electrophysiological measures) along with any necessary patient-specific information from the assessment that would be required for dispensing and fitting (e.g., unreliable respondent, auditory neuropathy spectrum disorder)

Necessary information that must be included in a hearing aid prescription

25Jun-17

CASLPO STANDARDS : Hearing Aid Prescription (P. 20-21)

Other elements considered necessary to the prescription must be specified such as:

• Features including but not limited to directional microphones, telecoil, direct audio input, volume control, tamper proofing etc

• Earmould style, material and specifications for modifications (e.g.. Venting and tubing)• Special applications for earhooks (pediatric ear hooks)• Special applications such as BAHA or BICROS systems

• Colour (if important to prescription)• Accessories (if important to prescription)

Necessary information that must be included in a hearing aid prescription

26Jun-17

CASLPO STANDARDS : Hearing Aid Prescription (P. 20-21)

If another audiologist will dispense the hearing aids then the prescription must contain all the previously mentioned information in a consolidated & accessible format (Standard H.6, p.21)

along with:

• Member’s name• Member’s contact information• Member’s CASLPO registration number• Member’s signature

27Jun-17

Scenario 3

28Jun-17

• Nancy generates a hearing aid prescription for Max

• The hospital does not have a hearing aid dispensary

• Patients purchase hearing aids at a dispenser of their choice and can return to Nancy for follow-up if they so choose

Nancy, Audiologist Max and His Parents

29Jun-17

• Max’s parents inform Nancy that they live far away from the hospital and they likely will not return to her for follow-up

• They will visit a hearing clinic closer to home

• Nancy provides them with a copy of Max’s hearing aid prescription

Nancy, Audiologist Max and His Parents

30Jun-17

• Nancy is worried about the family not returning to her, as Max’s case is complex.

• Poll Question: Is Nancy’s responsibility to Max and his parents finished once she hands them the prescription and they go on their way?

Yes No Maybe

31Jun-17

CASLPO STANDARDS: Verification (P. 25-26)

32Jun-17

CASLPO STANDARDS: Validation (P.27-28)

• Knowing that Max and his parents may not return to her Nancy will inform Max’s parents of the importance of verification and validation and document that this information was provided

33Jun-17

Scenario 4

34Jun-17

• Max’s parents go to a hearing clinic in their local town to have the hearing aids dispensed

• They meet Sean, an audiologist at the private clinic

• They give Sean the prescription that Nancy generated

Max and His Parents Sean, Audiologist

35Jun-17

• Sean notices that there are gaps in Max’s audiometric data

• Polling Question: Can Sean proceed with dispensing and fitting hearing aids for Max without re-assessing Max himself?

Yes No Maybe

Max and His Parents Sean, Audiologist

36Jun-17

CASLPO Definitions: Hearing Aid Dispensing & Fitting (P. 22-23)

Sean will dispense and fit the hearing aids according to Nancy’s prescription:

The prescription was provided by an audiologist. Despite gaps in the audiometric data Sean does not have to re-assess Max.

37Jun-17

CASLPO Standards: Hearing Aid Dispensing & Fitting (P. 24)

As the audiologist who will be dispensing Sean will meet the standards for dispensing and fitting:

38Jun-17

CASLPO Standards: Hearing Aid Dispensing & Fitting (P. 24)

• Sean will fit Max’s hearing aids according to the fitting formula specified in the prescription

• If Sean decides to change the prescription he must follow CASLPO’s Position Statement on Changing Hearing Aid Prescriptions

As the audiologist who will be dispensing Sean will meet the standards for dispensing and fitting:

39Jun-17

CASLPO Standards: Hearing Aid Dispensing & Fitting (P. 24)

• Insertion/removal of hearing aids• Battery use• Manipulation of accessories (e.g., remote controls)• Telephone use• Maintenance of hearing aids• Acclimatization to hearing aids

As the audiologist who will be dispensing Sean will meet the standards for dispensing and fitting:

40Jun-17

Scenario 5

41Jun-17

• Has been practicing in Alberta for over 10 years

• Recently moved to Toronto

• Has her general certificate from CASLPO to practice as an audiologist in Ontario

Jane, Audiologist

42Jun-17

• A patient comes in for a hearing assessment and after a comprehensive evaluation Jane determines that the patient is a good candidate for hearing aids

• The patient hands Jane an ADP form with the “prescriber” section already signed by the family physician

Jane, Audiologist

43Jun-17

Jane and Ravi, Audiologists

• Jane is confused because she thought she would be prescribing as the audiologist

• She talks to Ravi, an audiologist she works with, and he explains that, in this case, Jane would be the ADP “authorizer”

44Jun-17

Jane, Audiologist

Poll Question: If Jane is not signing as the prescriber on the ADP form, does she still need to meet CASLPO standards for prescribing and the prescription?

Yes No Unsure

45Jun-17

ADP V.S. CASLPO

• ADP does not set practice standards for any profession, that is the College’s role

• ADP is a funding program and the rules are an attempt to appropriately allocate funds and prevent the misuse of funds

From ADP Manual on Authorizer Roles & Responsibilities

46Jun-17

CASLPO STANDARDS & DEFINITIONS : Hearing Aid Prescribing (P.18-19)

47Jun-17

Prescription of a Hearing Aid by an Audiologist

ADP Authorizer

Jane will be carrying out the act of prescribing as an ADP authorizer

CASLPO standards must be met

• Prescribing is a process Jane will carry out with her knowledge, skills, and judgement

48Jun-17

Jane, Audiologist

Poll Question: If the ADP form was not signed by the family physician could Jane proceed with prescribing a hearing aid for her patient?

Yes No Maybe

49Jun-17

ADP V.S CASLPO: Hearing Aid Prescription

• Jane is prescribing hearing aids as an audiologist (RHPA, 1991)

• Accessing ADP funding is a separate issue

• Jane needs to meet ADP requirements to access funding for her eligible patients

• ADP requirements are distinct from CASLPO’s requirements and standards for prescribing and prescription

50Jun-17

Jane and Ravi, Audiologists

Poll Question: Can Jane ask Ravi to sign as the prescriber and she sign as the authorizer on the ADP form?

Yes No Maybe

51Jun-17

Jane and Ravi, Audiologists

Jane and Ravi work for the same private practice

From ADP Authorizer Roles & Responsibilities Manual:

52Jun-17

Jane, Audiologist

Poll Question: If Jane keeps a copy of the ADP form in the patient file unmodified as is, does it meet CASLPO standards for a hearing aid prescription?

Yes No Unsure

53Jun-17

CASLPO STANDARDS & DEFINITIONS : Hearing Aid Prescribing (P. 20)

• The ADP form on it’s own does not include all the information required in a hearing aid prescription

54Jun-17

CASLPO STANDARDS : Hearing Aid Prescription (P. 20-21)

• Necessary information that must be included in a hearing aid prescription

• Patient name and DOB• Date of issue• Ears to be fitted

Included on ADP form

CASLPO requires more information

55Jun-17

Make it a Learning Goal in your Self-Assessment Tool (SAT)

Obtain some CLACs! Continuous Learning Activity Credits

Thank you for your attention and participation!

56Jun-17

Questions?