Safety precautions - Home Page - Optometry Scotland



INTRODUCTIONThese FAQs will help you to interpret the recent guidelines released in Scotland and at the UK level during the COVID-19 pandemic.This document will be updated frequently as guidelines change during this unprecedented era for the health service and optometry.Contents TOC \o "1-3" \h \z \u Safety precautions PAGEREF _Toc35806104 \h 1GOS claims PAGEREF _Toc35806105 \h 5Dispensing PAGEREF _Toc35806106 \h 6Pre-registration optometrists PAGEREF _Toc35806107 \h 7Other PAGEREF _Toc35806108 \h 7Safety precautionsWhat type of patients should I be seeing?You must triage all patients by telephone to avoid the patient presenting at the practice unnecessarily and minimise any contact with patients with respiratory symptoms.You should limit your provision to patients:who DO NOT have any signs which may indicate COVID-19; ANDwho you suspect have a significant eye condition.If you do not consider that the patient has a significant eye condition then you should instruct them to wait until normal GOS resumes and can advise them on interim measures such as using lubricating drops or other treatments which make sense from their symptoms. As always, you should record this and ask the patient to contact you if there is a change in their symptoms.What are the definitions of emergency and essential eye care?You should triage every patient and only see those who have a problem which cannot wait – i.e. an eye condition which requires prompt treatment to prevent permanent damage. Emergency (as per College of Optometrists guidelines)There is no legal definition of an emergency. It may include but is not limited to:?red eyerecent loss of visionrecent onset of ocular painsymptoms which strongly suggest a recent retinal tear or detachment, orgiant cell (temporal) arteritis (GCA).EssentialEssential care is to be interpreted as meaning appointments for patients who would not normally be considered to be emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing. It does not include watery eyes, conjunctivitis, trouble reading etc.Do I have to do a full examination if I have not seen the patient before?No, this is not a requirement. During the current pandemic, your examination should address the patient’s presenting signs and symptoms and only contain procedures directly related to this. It is important to keep examination time down to a minimum to safeguard yourself and the patient.If a patient contacts the practice with headaches, what should I do?Complete a detailed history over the phone to determine onset, severity, medical history and any other symptoms they may have. You should decide whether this could be handled with appropriate telephone advice or if it is something significant that requires attention. If a diabetic patient contacts the practice and is having problems with their vision, what should I do?You should take a detailed history over the phone and decide whether this could be a significant problem. If the symptoms do not sound like a significant problem you should ask the patient to return when normal GOS resumes and to contact you if there is a change in their symptoms. Where you have concerns you should arrange for the patient to be seen.What do I do if I see a patient for an essential appointment but it then requires a routine referral?Refer to local arrangements. The Hospital Eye Service has ceased all non-urgent outpatient appointments. You should advise the patient that you will notify them when normal service resumes.What do I do if a patient phones up asking if they can be referred for cataract surgery?You should explain that all cataract surgery has been suspended due to COVID-19 and you will refer them when normal service resumes. You should advise the patient that you will notify them when the referral has been made. General advice regarding strategies to support a patient with reduced vision would be beneficial.What do I do if a patient has a supplementary recall? Contact the patient and advise that they will be seen when normal service resumes. If I have been monitoring a patient for suspect POAG glaucoma, does this count as an essential appointment?No, this patient would not be classed as essential and could wait for an appointment. Phone the patient to advise an appointment will be made for them at a later date.A patient had cataract surgery 4-6 weeks ago and is due a post cataract surgery review. Does this count as an essential appointment?This will depend on the individual patient. It is recommended that the patient is only seen under an essential appointment if the patient has significant visual impact/distress from the vision they have obtained after surgery. You should explain to the patient that a post cataract surgery review at this time carries a risk of COVID-19 exposure and is therefore only needed if absolutely necessary. If there is other significant symptoms (e.g. suspect CMO), the patient should be seen as an emergency.I was due to see a child back for a cycloplegic refraction. Should I still go ahead and see them?No, this should wait until normal service resumes.Can I still provide private examinations?No, that would not be appropriate. Can I provide contact lens aftercares?No, this would not be appropriate. The GOC have produced helpful advice which relaxes the usual rules on supply. You should provide a supply of contact lenses and arrange to see them when normal service resumes.Should I wear a mask when examining patients who display no symptoms of COVID-19?We understand that optometrists are concerned because of their close contact with patients. The Scottish Government and NHS Scotland are currently reviewing the requirements for Personal Protective Equipment (PPE) for optometrists and further information on this will be published in due course. If you need to wear PPE, it is important that you use the correct type and are trained in how to use it.We advise that you do not see anyone with cold or flu-like symptoms and ask them to rebook when they are better.?The main advice when seeing patients is to use:Scrupulous hand hygiene;Respiratory etiquette; andGood disinfection practice including cleaning hard surfaces.NHS Education for Scotland have released detailed guidance on infection control which can be found on TURAS.Sensible precautions Do as much as you can on the phone with the patientIf you decide to see them, keep your distance as much as possibleIf you are required to examine the internal eye consider whether fundus imaging is more appropriate than SL-BIO. Avoid touching patients. If you need to lift the lids to examine the cornea you may wish to use a cotton bud to do this to avoid touching the patient. If you need to touch the patient, ensure you practise appropriate hand hygiene before and after contact.Consider using a cough guard on your slit lamp if possible. The Royal College of Ophthalmologists has advice on how you can make a temporary cough guard here and the AOP have a DIY video here.Sensible precautions Do as much as you can on the phone with the patientIf you decide to see them, keep your distance as much as possibleIf you are required to examine the internal eye consider whether fundus imaging is more appropriate than SL-BIO. Avoid touching patients. If you need to lift the lids to examine the cornea you may wish to use a cotton bud to do this to avoid touching the patient. If you need to touch the patient, ensure you practise appropriate hand hygiene before and after contact.Consider using a cough guard on your slit lamp if possible. The Royal College of Ophthalmologists has advice on how you can make a temporary cough guard here and the AOP have a DIY video here.What should I do if a patient identifies as being at risk of having COVID-19 in the practice?If the advice above is followed, patients should not attend the practice if they show signs of COVID-19 infection. However, if COVID-19 is considered possible when an appointment is already in progress, assess a suitable and safe point to bring the consultation to a close, withdraw from the room, close the door and wash your hands thoroughly with soap and water. You should always regularly check the following advice from Health Protection Scotland to ensure you are referring to the latest advice: claimsIf I have to close my practice, e.g. due to having to self-isolate, will I still be paid the average monthly GOS fee payment?Yes, this monthly payment will continue for the period where “normal GOS” is not provided. However, there must be no amendments to the information held on the relevant NHS Board’s Ophthalmic List during the financial support period - except where there is a change to the practice’s opening hours or where the practice is closing permanently. Refer to PCA(O)2020(4) and PCA(O)2020(5) for further information.Do patients have to sign for the GOS exam?Patients should not be signing any forms at the moment. You should simply write COVID where the patient signature would usually be. Refer to PCA(O)2020(4) for further information. I understand I can submit a payment claim for a telephone consultation, but not for a normal telephone triage call. What is the difference between the two?If an optometrist/ophthalmic medical practitioner (OMP) feels that it is appropriate, and in the patient’s best interest, to have a telephone consultation rather than attend in person at the practice then a GOS(S)1 claim can be submitted via eOphthalmic for the telephone consultation under a supplementary eye examination (SEE) reason code 2.8 (non-IP optometrist / OMP) or 4.8 (IP optometrist).The difference between a telephone triage (for which a claim cannot be submitted) and a telephone consultation (for which a claim can be submitted) is as follows:Telephone triage: A patient phones the practice with concerns about their vision or eye health and a practice staff member (usually an optical assistant, dispensing optician or optometrist) asks a series of questions to explore the concerns more fully and make a decision whether the patient has an emergency or essential eye problem and requires a telephone consultation with an optometrist.Telephone consultation: A telephone consultation is undertaken by an optometrist and will involve all the elements of a normal eye examination, except that tests and procedures which require the physical presence of the patient cannot be performed. The patient’s history and presenting signs and symptoms will be recorded, and a diagnosis and subsequent management or treatment plan will be made. Any advice and recommendations should be issued and clearly recorded.I am an IP optometrist. What code do I use when seeing a patient who requires emergency or essential eye care?If you are providing emergency and essential eye care under arrangements agreed with your local NHS Board, an IP optometrist must submit a GOS(S)1 claim via eOphthalmic using supplementary eye examination (SEE) reason code 4.8 - irrespective of whether or not the patient’s pupils are dilated. If I see a patient with a condition which could be managed by an IP optometrist, can I refer the patient to them?This depends on local arrangements. If this is in place, you can contact an IP optometrist and discuss the patient with them. If appropriate they can prescribe or see them and then prescribe. If, after having undertaken an examination or consultation, you refer a patient to an IP optometrist in a different practice, you would submit a GOS(S)1 claim via eOphthalmic using SEE reason code 2.8 and the IP optometrist would submit a GOS(S)1 claim using SEE reason code 4.8. If you refer a patient to another IP optometrist in the same practice, only one GOS(S)1 claim can be submitted using SEE reason code 4.8.Can an IP optometrist prescribe without seeing a patient?Yes, you should attempt to minimise contact with patients at all costs. This may mean that you will prescribe according to a patient’s symptoms and history or following an examination with another optometrist. As always you should make notes of your decision making process and ensure that you are happy with the decision and that it is safe and reasonable.DispensingIf a child has a high prescription and breaks or loses their glasses, can we do a repair voucher? Do we need to see them?If necessary, you should repair the glasses and claim a GOS4 as usual. You would not need to see the patient but should ensure an explanation is clear in the patient records.Do these measures extend to collections and dispensing?Yes, you should minimise contact with patients as much as possible and therefore should avoid contact with patients in this scenario. You can post glasses or deliver glasses to a patient.Can I post glasses to a patient if they are:Child or protected group?1st time varifocal wearer?Yes, the GOC have produced helpful advice which covers this – the usual rules have been suspended.Can patients still purchase glasses?Routine dispensing of glasses is not appropriate at this time. What should I do if someone breaks their glasses and requires for work or driving? You should have minimal contact with the patient. It may be possible to duplicate an order or take extreme precautions to provide them with something appropriate.What should I do if someone bought glasses and is having problems with them?You should triage this patient over the phone to try and determine what the problem is. If you feel it is not an emergency or essential, you should reassure them that you will further investigate this problem when normal service resumes.Pre-registration optometristsWhat is going to happen to pre-reg optometrists? I am worried I won’t complete my number of tests.All assessments and visits have been cancelled. The College have released advice covering these scenarios. They are liaising with the GOC to extend the time allowed in which to complete all of the requirements to avoid this being a problem.I am due to start my pre-reg placement in July, what does this mean for me?The College is working with education providers and the GOC to find solutions for this. See here for more information.OtherI have a CL contract with the hospital, should I continue with this? You should only see patients with significant problems following all of the advice above. All routine appointments should be ceased. However, you may still provide such patients with replacement contact lenses during the COVID-19 period.Will I receive a payment for the DRS work I usually do?No, all diabetic screening has been suspended.I have children. Are optometrists defined as a key worker and what category?Optometrists are recognised as Category 2 key workers. Further guidance for key workers can be found online at: . ................
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