Md. Code Regs. 10.28.12.04

Current through Register Vol. 51, No. 18, September 6, 2024

Section 10.28.12.04 - Standards of Quality for Therapeutically Certified Optometrists and Optometric Care

A. The therapeutically certified optometrist shall provide clinical therapeutic eye care consistent with published, universally accepted practice or clinical guidelines and standards of care.

B. The therapeutically certified optometrist shall adhere to the additional guidelines and standards of care given in §§C- T of this regulation.

C. The therapeutically certified optometrist shall ensure that:

(1) TPA records are consistent with the Subjective, Objective, Assessment, and Plan (SOAP) format;

(2) Assessment and plans are consistent with the patient's subjective and clinical findings; and

(3) TPA records are complete and legible.

D. The therapeutically certified optometrist shall document the following data, if applicable, for each TPA patient visit or communication:

(1) Date of service;

(2) Current Procedural Terminology (CPT) Code, most recent edition;

(3) International Classification of Diseases (ICD) Code, most recent edition;

(4) Medication/treatment provided; and

(5) Follow-up recommendation.

E. The therapeutically certified optometrist shall document the following data as part of the patient's permanent file:

(1) Name;

(2) Date of birth;

(3) Name of the doctor to whom the patient is referred, appointment date, and documentation that the patient or guardian preferred to schedule the referral appointment on their own;

(4) Record of tests administered and the results of the tests;

(5) Written reports of other consultations, referrals received, or both; and

(6) Documentation of the occurrence of any adverse reaction.

F. The therapeutically certified optometrist shall provide for 24-hour emergency coverage.

G. The therapeutically certified optometrist shall have a medical kit for treating anaphylactic emergencies available at each location where patients are seen.

H. The therapeutically certified optometrist shall be certified in CPR.

I. The therapeutically certified optometrist shall have a written plan for responding to emergencies, including specific plans for referral to hospital emergency rooms, emergency ambulatory centers, ophthalmologists, or other appropriate medical doctors when necessary at each location where patients are seen.

J. The therapeutically certified optometrist shall comply with:

(1) Applicable national and State standards of infection control at each office; and

(2) Principles of universal precautions as defined in COMAR 10.06.01.02B(10).

K. The therapeutically certified optometrist shall maintain a written tracking system to identify patients who are being followed or referred for emergency sight or life-threatening conditions and who fail to keep appointments.

L. The therapeutically certified optometrist shall document that a patient who fails to keep an appointment for an emergency sight or life-threatening condition was contacted by:

(1) Telephone;

(2) Electronic mail or other electronic means;

(3) Text message; or

(4) Mail.

M. The therapeutically certified optometrist shall report all adverse reactions to the Board. An adverse drug reaction may be indicated by symptoms which include, but are not limited to, painful eye, pruritus, urticarial lesions, wheals, skin rash of periorbital tissues, nausea, vomiting, fainting, confusion, cessation of respiration, wheezing, clinically significant change in heart rate, or chest pain.

N. The therapeutically certified optometrist shall prescribe and administer all therapeutic pharmaceutical agents in accordance with the applicable standards of care established under Health Occupations Article, Title 11, Annotated Code of Maryland.

O. The therapeutically certified optometrist shall remove superficial foreign bodies from the eye in accordance with the applicable standards of care established under Health Occupations Article, Title 11, Annotated Code of Maryland.

P. A therapeutically certified optometrist may not prescribe or administer a therapeutic pharmaceutical agent unless specifically authorized by law or these regulations.

Q. The therapeutically certified optometrist shall report to the Board, on the form provided by the Board, within 10 working days of the occurrence, an adverse reaction. The therapeutically certified optometrist shall include in the report, at a minimum, the following:

(1) The optometrist's name, address, and license number;

(2) Patient information including:

(a) Presenting problem,

(b) Diagnosis,

(c) Agent administered, and

(d) Method of administration;

(3) The adverse reaction; and

(4) Subsequent action taken.

R. Glaucoma Management.

(1) In accordance with Health Occupations Article, §11-404.2, Annotated Code of Maryland, a therapeutically certified optometrist shall perform the procedures and tests necessary to diagnose primary open angle glaucoma appropriately.

(2) A therapeutically certified optometrist may administer and prescribe topical pharmaceutical agents for glaucoma only as authorized by law.

S. In developing a glaucoma treatment plan that ensures the maximum effectiveness for the patient, the therapeutically certified optometrist shall consider the following:

(1) Types of agents to be administered and potential side effects;

(2) Status of the optic nerve structure, function, and its relationship to intraocular pressure;

(3) Identification of a target intraocular pressure at or below the target level in which further optic nerve damage is unlikely to occur;

(4) Maintenance of intraocular pressure at or below the target level by initiating appropriate therapeutic intervention;

(5) Monitoring of the optic nerve and resetting the target intraocular pressure if deterioration occurs;

(6) Minimization of the side effects of treatment and their impact on the patient's vision, general health, and quality of life;

(7) Education of the patient in the management of primary open angle glaucoma disease;

(8) Reference to accepted clinical guidelines for glaucoma follow-up management; and

(9) Criteria for surgical intervention.

T. Laboratory Tests. Laboratory tests shall be ordered by a therapeutically certified optometrist only as provided by law.

Md. Code Regs. 10.28.12.04

Regulations .04 adopted as an emergency provision effective May 17, 1996 (23:12 Md. R. 867); adopted permanently effective October 21, 1996 (23:21 Md. R. 1467); amended effective 48:23 Md. R. 980, eff. 11/15/2021