General Dermatology Exam Protocol

A checklist of general steps for dermatology exam procedures from the National Health and Nutrition Examination Survey.

Pre-Examination Procedures
1
-If possible, prepare the room for the examination before the patient enters the room
2
-Replace the cover to the anthropometry scale
3
-Move the anthropometry table to the designated location beside the camera stand
4
-Lower the background screen completely to the floor
5
-Cut strips of masking tape used to tape the patient’s gown
6
-Confirm that all equipment and supplies needed for the exam are available and accessible:
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Scissors; stick-on rulers; Co-flex tape; masking tape; eye covers; and jewelry container
8
-When the patient enters the room, introduce yourself and close the exam room curtain
9
-Walk the patient into the ISIS system and open the dermatology exam
10
-Ask the patient to remove all jewelry and place it in the designated container
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-If the patient refuses or is unable to take off a piece of jewelry, leave it as is
12
-Briefly explain the purpose of the exam and the number and type of images to be taken
13
-Refer to the demonstration images displayed on the wall and tell the patient that these images are examples of the four images that will be taken
14
-Inform the patient that his or her face will not appear in the images and the identification bracelet will be covered
15
-If the patient has not yet completed the vision component, he or she must wear an eye cover during the taking of images
16
-Give the patient the eye cover to try on. Make sure the fit is tight enough so that the patient cannot see any light around the edges.
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-Ask the SP to lift the eye cover onto the forehead until you are ready to take the first image.
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-Cover the patient’s name band with Co-flex tape
Examination Procedures
1
-Always tell the patient what you are going to do before you do it
2
Instruction for First Image
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1. After showing the demo image, instruct the patient to face the background screen
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2. Ask the patient to place the right foot on foot outline #1 and the left foot on foot outline #2
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3. Open the back of the gown and roll it to the sides to fully expose the patient’s back
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4. If hair extends below the shoulders, ask the patient to pin it up and provide hair clips if necessary
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5. Place a stick-on ruler on the patient’s upper right scapula
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6. Ask the patient to turn both palms toward the screen
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7. Instruct the patient to bring the shoulders back, bend the arms slightly, and rotate them out to square up the elbows
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8. Fully expose the forearms by bringing them outward and tucking in the sides of the gown, as necessary
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9. (If applicable) Lower the eye cover over the patient’s eyes
12
10. Tell the patient that you are now going behind the camera and to hold the pose
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11. Move behind the camera and lower the arm so that the viewable image is as follows:
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- Top of image is patient’s neck (no head)
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- Camera focus indicator is on patient’s spine
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- Patient is centered in the viewable frame
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12. Tell the patient to close his or her eyes
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13. Snap the image
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14. Tell the patient to relax and open their eyes
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15. (If applicable) Ask the patient to lift the eye cover onto the forehead
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16. Push the camera arm forward and approach the patient
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17. Remove the stick-on ruler, close the back of the gown, and ask the patient to turn around to face you
Instruction for Gown Preparation for Remaining Three Images
1
-Tell the patient that you are going to cut the gown to expose the left arm and lower legs
2
-Cut the left sleeve of the gown to the arm seam, and fold the gown to expose the upper inner arm
3
-Ask the patient to tuck the upper part of the gown into the waistband so that it is as tight against the body as possible
4
-Cut the front of both pant legs from the bottom to the mid-thigh
5
-Pull the pant leg back to expose the legs, slightly twist the pant leg, and ask the patient to tuck it into the waist
6
-Push the socks down to the ankles
Instruction for Second Image
1
1. Ask the patient to place the left foot on foot outline #1 and the right foot on foot outline #3
2
2. Point to the demo image and demonstrate how the patient should stand
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3. Ask the patient to extend the left arm with palm up and turn the head up and to the right
4
4. (If applicable) Lower the eye cover over the patient’s eyes
5
5. Tell the patient that you are going behind the camera and to hold the pose
6
6. Move behind the camera and frame the image in the viewer as follows:
7
- Top of image is patient’s neck (no head)
8
- Camera focus indicator is on the left edge of the patient’s gown
9
7. Tell the patient to close his or her eyes
10
8. Snap the image
11
9. Tell the patient to relax and open their eyes
12
10. (If applicable) Ask the patient to lift the eye cover onto the forehead
13
11. Push the camera arm forward and approach the patient
Instruction for Third Image
1
1. Ask the patient to place the left foot on foot outline #1 and the right foot on foot outline #2
2
2. Show the patient the demo picture and demonstrate how to place his or her hands
3
3. Provide the following guidelines, as necessary:
4
- “Point your thumbs together on your beltline."
5
- "Point your fingers downward and spread them apart"
6
- "Now move your thumbs about an inch apart."
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- "Keep your wrists and hands flat to the camera, instead of wrapped against the body, like this (demonstrate).”
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4. If needed, assist the patien in positioning the hands correctly
9
5. (If applicable) Lower the eye cover over the patient’s eyes. Tell the patient that you are going behind the camera and to hold the pose
10
6. Move behind the camera and lower the arm so that the viewable image is as follows:
11
- Frame includes wrists and hands to top of the booties
12
- Camera focus indicator is centered on the patient
13
- Patient is centered in the frame
14
7. Tell the patient to close his or her eyes
15
8. Snap the image
16
9. Tell the patient to relax and open the eyes
17
10. (If applicable) Ask the patient to lift the eye cover onto the forehead
18
11. Push the camera arm forward and approach the patient
Instruction for Image 4
1
1. Point to the demo image and demonstrate how the patient should pose for the last image
2
2. Instruct the patient to turn and face the screen and place the left foot on foot outline #2 and the right foot on foot outline #1
3
3. Ask the patient to place his or her hands behind the back on the lower hips; the palms should be flat to the camera with the fingers spread and pointing down
4
4. If needed, assist the patient in positioning the hands correctly
5
5. (If applicable) Lower the eye cover over the patient’s eyes
6
6. Tell the patient that you are going behind the camera and to hold the pose
7
7. Move behind the camera and frame the image in the viewer as follows:
8
- Frame includes wrists and hands to top of the booties
9
- Camera focus indicator is centered on the patient
10
- Patient is centered in the frame
11
8. Tell the patient to close his or her eyes
12
9. Snap the image
13
10. Tell the patient to relax and open the eyes
14
11. (If applicable) Ask the patient to lift the eye cover onto the forehead
15
12. Push the camera arm forward
Image Retake and Exam Completion
1
-If any image is unacceptable, retake that image
2
-Tell the patient which image is inadequate and retake the image following the same procedures
3
-Do not retake any image more than twice
4
-When all four images are correctly accounted for, advance to the Exam Status screen
5
-Confirm that the exam is Complete, Partial, or Not Done, and specify a reason if the status is Partial or Not Done
6
-Advance the screen to end the exam
7
-Tell the patient that the exam is finished and thank him or her for participating
8
-Wait for a message from the coordinator indicating where to direct the patient
9
-Use this time to remove the cover to the anthropometry scale, raise the background screen, and move the white table against the wall with the mirror
10
-Escort the patient to the next exam room or to the coordinator
Created by Smith62. This checklist is public.
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