Split into the following sections:
After patient has left/end of day
Please bear in mind these protocols are all likely to change and adapt as we move further out of lockdown.
Changing of opening times:
Alva and Alloa: Monday-Friday 9:00-5:30pm (No half days – closed 1pm-2pm for lunch) – optometrist on Mondays and Wednesdays-Fridays
Selkirk and Stenhousemuir: Monday 9:00-5:00 pm, Tuesday 9:00-5:30pm (closed 1pm-2pm for lunch), Thursday 9:00-1:00pm Optometrist on Tuesdays
We are going to operate two teams of staff – Alloa/Stenhousemuir and Alva/Selkirk. The two sets of teams will be kept separate so that if one team has to isolate the other can continue to operate.
All staff carry out hand hygiene once they arrive in work.
Diary is split into discrete sections. 9am-9:30 practice admin. 9:30-12:30, 45 minute spots for seeing patients face to face. 12:30-1pm practice admin/phoning patients. 1pm-2pm lunch. 2pm-5pm, 45 minute spots for seeing patients and disinfecting practices. 5pm-5:30 time for optoms to phone patients and arrange appointments for the following day (this may be for a different practice) or general admin and cleaning. Collections of glasses organised to fit in with other appointments.
A list should be kept of all individuals who enter the practice on each day to assist track and trace if required.
Since 10th July appointments can be booked on a “needs-led” basis in addition to Emergency and Essential eye-care. This means that if a patient wishes to book an appointment to get a new pair of glasses they can. We are still not allowed to see routine appointments (“I always get an eye test in July but I’m not having any problems and dont want new glasses”) or send out reminders. It is still the case the only patients with appointments who have passed the COVID questions will be admitted to the practice. Patients who wish to make an appointment should do so by phone.
Receptionists can now book patients directly into appointment slots without the optician needing to speak with them first if they fall into the following categories:
Emergency care would include urgent clinical advice or intervention e.g. for red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc.
OR
Essential eye care would include 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. (i.e. a patient feeling that they are not seeing as well as they would expect)
OR
The patients feels they need new glasses or contact lenses
If in doubt whether someone fits into these categories, run it past the optometrist.
If they fit into one of these categories then ask the patient:
COVID Questions:
Have you or anyone in your household had a fever in the past few days?
Do you or anyone in your household have a new continuous cough or a shortness of breath in the last few days?
Do you or anyone in your household feel they have a change or loss in their sense of smell or taste?
If the patient passes the questionnaire then either book them into a clinic for a SUPPLEMENTARY examination (we are still not allowed to see people for primary exams) or, if the patient simply wants some advice, take a phone number and pass their information along for the optometrist to call them.
If patient fails the covid questionnaire we follow the local NHS red zone protocol – we do not see these patients in practice.
The receptionist can also deal with other issues such as contact lens orders, organising simple repairs etc. If in doubt, run it past the optometrist.
The front door is to be locked and only opened for patients with appointments and those that have passed the COVID questionaire.
Patients advised to wait in car until practice is ready to see them – minimise their time in practice wherever possible, limit the number of people in the waiting area to one patient (and possibly their escort).
Patients advised they must wear a face covering to enter the practice. We can give them a NHS facemask if they don’t have one under special circumstances.
Patients advised to attend alone if possible.
Patients undergo hand hygiene upon entering practice.
Optometrists to don PPE equipment prior to patient attending. As long as receptionists are more than 2m away from patient or behind reception desk screen they do not need to wear PPE. If, for any reason the receptionist needs to go closer than 2m to the patient then they need to wear facemask.
A video on how to don and doff PPE can be found here https://vimeo.com/393951705
Minimum of tests performed during eye exam to satisfy symptoms.
Non-contact tonometry allowed if using a visor and mask
While dispensing optometrist provides frames for patient to try on. These frames are disinfected when patient leaves the practice.
Consider fitting frames to patient then, collecting payment and posting out when ready.
Consider payment over the phone and delivering or posting out specs/contacts.
Until further notice, only the following supplementary eye examinations
(SEEs) can be undertaken:
Standard Supplementary Eye Examination
2.1 – Paediatric Review (without dilation/cycloplegia that does not follow a
primary eye examination)
This code is to be used to review a child within 12 months of a primary eye
examination, as judged clinically necessary, and dilation/cycloplegia is not required.
2.2 – Follow-Up / Repeat Procedures (without dilation and not associated with
glaucoma)
This code is to be used for additional or repeat procedures not requiring dilation of
the patient’s pupils and which are required to refine a diagnosis or clinical outcome
in order to determine whether the patient needs referral or can be retained for
ongoing care in the community. This code can be used for a refraction, on a
separate day, that could not be undertaken at the primary eye examination.
2.3 – Suspect Glaucoma (without dilation)
This code is to be used specifically for suspect glaucoma review, in keeping with
SIGN 144 guidance for diagnosis and referral for glaucoma, and which does not
require dilation of the patient’s pupils. This includes ocular hypertension.
2.5 – Anterior Eye Condition (without dilation)
This code is to be used for a supplementary eye examination of a patient with a
suspect or diagnosed anterior eye condition within the normal interval between
primary eye examinations, and which does not require dilation of the patient’s
pupils.
2.7 – Post-Operative Cataract Examination (without dilation)
This code is to be used for a post-operative cataract examination of a patient, which
includes refraction, an ocular examination and (if required) a feedback report, but
does not require dilation of the patient’s pupils.
2.8 – Unscheduled Appointment (without dilation)
This code is to be used for a supplementary eye examination for a patient who
presents with symptoms for an unscheduled visit within the normal interval between
primary eye examinations, and which does not require dilation of the patient’s
pupils.
2.9 – Cataract Referral Advice and Counselling
This code is to be used when providing advice and counselling to a patient following
an eye examination which has resulted in the patient being considered for referral.
This may include providing prognosis or counselling and preparation for consent
for cataract surgery, including risk factors.
Enhanced Supplementary Eye Examination
4.1 – Paediatric Review (with dilation/cycloplegia that does not follow a
primary eye examination)
This code is to be used to review a child within 12 months of a primary eye
examination, as judged clinically necessary, and dilation/cycloplegia is required.
4.2 – Follow-Up / Repeat Procedures (with dilation and not associated with
glaucoma)
This code is to be used for additional or repeat procedures requiring dilation of the
patient’s pupils and which are required to refine a diagnosis or clinical outcome in
order to determine whether the patient needs referral or can be retained for ongoing
care in the community.
4.3 – Suspect Glaucoma (with dilation)
This code is to be used specifically for a suspect glaucoma review, in keeping with
SIGN 144 guidance for diagnosis and referral for glaucoma, and which requires
dilation of the patient’s pupils. This includes ocular hypertension.
4.5 – Anterior Eye Condition (with dilation)
This code is to be used for a supplementary eye examination of a patient with a
suspect or diagnosed anterior eye condition within the normal interval between
primary eye examinations, and which requires dilation of the patient’s pupils.
4.6 – Cycloplegic refraction of a child referred from the hospital eye service
To facilitate the cycloplegic refraction of a child aged under 16 referred from the
hospital eye service. The supplementary eye examination must include an internal
and external examination of the eye.
4.7 – Post-Operative Cataract Examination (with dilation)
This code is to be used for a post-operative cataract examination of a patient, which
includes refraction, an ocular examination and (if required) a feedback report, and
also requires dilation of the patient’s pupils.
4.8 – Unscheduled Appointment (with dilation)
This code is to be used for a supplementary eye examination for a patient who
presents with symptoms for an unscheduled visit within the normal interval between
primary eye examinations, and which requires dilation of the patient’s pupils.
The following SEEs must not be undertaken, because they are dependent on a
recent PEE having been undertaken:
Standard Supplementary Eye Examination
2.0 – Cycloplegic Refraction Following Routine Primary Eye Examination On
A Child
2.4 – Patients Aged Under 60 Requiring Dilation Following Primary Eye
Examination
3.0 – Additional Appointment To Complete Primary Eye Examination For A
Patient With Complex Needs
After patient has left/end of day
Disinfect test room. Wipe down surfaces that may have been exposed with alcohol wipe.
Disinfect frames with alcoholic wipe (Ultra violet sterilisers have been ordered but won’t arrive until mid-July)
The key pad of the card machine needs disinfected after each person has used it. Consider putting on gloves to enter the payment information before asking patient to enter their pin. Then dispose of gloves and carry out hand hygiene.
Any used PPE should be binned and double bagged and stored for 72 hours. After this time, it can be put into the normal rubbish.
We still need to enter claims for GOS via ePayments as normal. This is for phone Consultations and for face to face appointments.
Posters: On door: Locked door/How to make appointment, Hand hygiene poster, DO NOT ENTER COVID poster
On desk: hand hygiene poster, staying covid-19 secure in 2020 poster. Infection control certificate
Frames to be placed in box of rubbing alcohol for disinfection prior to repairs or adjustments. Consider the use of gloves or a zip-lock bag to reduce contact with frames until disinfection has taken place.