Clinical Practice

Making a good impression… before the impression begins

Take your “impressions” to the next level by cultivating a special clinic space that is relaxing and encourages open communication.

I solemnly swear to not make any ‘impression’ puns during the course of this article, as it’s safe to say that’s been done before. While the process of taking an ear impression and the associated punnery is well documented, the importance of taking a good impression cannot be overstated. However, many people overlook one of the most important aspects in the impression process: your patient! Their role in this process is an important one, as it is their ears in which you will be working and if the process goes less than smoothly there could be consequences later on. Let’s take a look at how small changes to your ear impression protocols in the clinic can make a world of difference in your practice.

The space

In an ideal world, every clinic has a separate space dedicated to cerumen management, Lyric insertion/removal, and ear impressions. This space should have a full-sized patient chair that can be raised and lowered easily, a comfortable stool that can also be raised and lowered, a conveniently placed table or cart where sterilized tools are within easy reach, and a high-powered microscope or loupe system that is appropriately adjusted. Not only that, but this room should be the most comfortable room in the entire office. Softer lighting, a muted color scheme, and even soothing sounds playing, like a small bubbling fountain or soft, relaxing music. This room should make the patient feel like they can relax, because in this room you will be working in one of the most delicate parts of the body… the depths of the ear canal.

The tools

If there was one piece of advice I could give to audiologists wanting to optimize their ear impressions process it’s this: sterilize. A quick wipe with an alcohol pad is not enough. CDC guidelines suggest that any tool that comes into contact with bodily fluids (including blood) through use or misuse must be sterilized. That’s right, this means the tools you use to take impressions: your otoscope tips, your penlight tips, the tip of your syringe, and any tools utilized for cerumen management. Though it might seem like overkill, especially if you haven’t had a patient bleed before, this protects our most vulnerable patients from harm: those who are immunocompromised and are especially susceptible to infection.

In the arena of infection control in the audiology clinic, our profession is lucky to have A.U. Bankitis, who has created dozens of presentations and eLearnings on this very topic. You can find a list of her infection control presentations on AudiologyOnline here. Given the ongoing threat of COVID-19, there are an abundance of online resources dedicated to helping you establish a winning clinical sterilization protocol.

The process

Anytime you work deeply in the ear canal, your patient should have a solid understanding of what you are doing and why you are doing it, unless they say otherwise. While the patient is seated in the chair, ask them: “Would you like for me to explain what I’m doing?” Some will say no… they may be more comfortable not knowing, while others will want to know. Consider this an easy way to show your patient that you value their input and will tailor your care to fit their needs. An easy win! When explaining, give a brief introduction telling them what you will be doing and how you will be doing it This interaction looks something like this:

Clinician: Alright Mrs. X, today we will be taking a cast of your ear so that we can have a new earmold built for you!

The patient is shown where to sit and the chair is adjusted appropriately.

Clinician: Alright! Now before I begin, would you like me to walk you through what I’m doing as I go along? Some people like to be aware of what’s happening and some don’t, so I like to ask everyone first.

That’s it! If the patient wants narration, then simply tell them what step in the process you are completing just before you start it. If they don’t want to know, then feel free to engage the patient in conversation or simply let them relax as you work. That wasn’t so hard, was it?

Cultivating a relaxing space in your practice will go a long way to help patients feel at ease as you work in their ear canal. With the release of over-the-counter hearing aids on the horizon, differentiating yourself from everyone else on the market is more important than ever. Tailoring your communication to each patient’s needs will not only further relax them, but will also strengthen the patient-provider bond and ensure you are their ‘go-to’ for hearing care well into the future.

 

If you would like to read another blog article by Chase Smith, we invite you to read “A winning strategy for lost hearing aids”.

 

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