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LAW; u r getting there. Flashcards

1
Q

what are the types of eye protectors?

A
  • spectacles with or without side shields
  • moulded eye shields
  • box type googles
  • cup type googles
  • welding helmets
  • face shields
  • hand held welding shields
  • face masks
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2
Q

what are the characteristics of safety spectacles?

A
  • not suitable for dust, gases, molten metal, hot solids, liquid droplets or splashes (BS EN 166)
  • can be made to fit well
  • available in plastic frames-safer than metal
  • available in metal frames:
  • –more damage when impacting on face
  • –pads cause injury to the nose
  • –screws work loose
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3
Q

characteristics of safety spectacles with side shields?

A
  • must be transparent and not discolour
  • injection moulded are best, as they do not wrap to leave gaps
  • polycarbonate material ideal
  • may be perforated for ventilation
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4
Q

characteristics of moulded eye shields (afocal one-piece, wrap around)?

A
  • moulded from single piece of polycarbonate
  • great for emmetropes
  • usually only one size
  • often supplied by employer-but lack of fitting.
  • employees’ typical complaints:
  • –restricted field of view
  • –slight magnification effect
  • –reflections
  • –peripheral displacement effect
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5
Q

characteristics of googles-cup type?

A
  • housing made from PVC and tight fit
  • good for flying particles such as metal,dust, etc
  • suitable for welders
  • adjustable nasal fitting
  • screw rim to allow for glazing
  • large bridge aprons to protect the nose are available
  • disadvantages:
  • –cannot be worn over spectacles
  • –poor ventilation
  • –uncomfortable
  • –poor peripheral vision
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6
Q

characteristics of box-type googles?

A
  • normally made of PVC, good fit
  • one piece lens: polycarb/cellulose acetate or possible toughened glass
  • can be worn over spectacles
  • well ventilated, lightweight
  • wide field of view

disadvantages:

  • –nasal fitting not adjustable
  • –replacing one-piece lens
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7
Q

characteristics of face shields?

A
  • good for protection against splashes and flying particles
  • headband-supported vision that cover the face and neck
  • easily worn over specatacles
  • excellent FOV
  • polycarbonate/ cellulose acetate
  • can be handles for welding screens
  • motorbike helmet, security guards etc!
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8
Q

characteristics of helmets,

A
  • mostly for welding
  • protection against intense heat and splatter
  • contains filter for radiation protection
  • most have a cell which darkens to welding density as soon as the arc is struck
  • sometimes have own air supply as gases from welding rods are toxic
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9
Q

what are the lens materials for eye protectors?

A
  1. Glass
    - heat-thoughened
    - chemically-thoughened
    - laminated
  2. Plastic
    - PMMA (perspex)
    - CR39
    - Polycarbonate
    - Trivex
    - Cellulose Acetate
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10
Q

What are the characteristics of heat-toughened glass?

A
  • crown lens placed in furnace at 637’c for 50-300s
  • lens cooled rapidly (cold air)
  • sudden cooling creates compression at surface and tension within lens mass- ‘compression envelope’
  • quick and cheap process

DISADVANTAGES:

  • high plus powers require prolonged heating
  • lenses will be thicker
  • scratches reduce impact resistance
  • photochromic lenses do not work well if toughened
  • strain tester pattern (maltese cross)
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11
Q

characteristics of chemically toughened glass?

A
  • more popular in US
  • compression coat formed by chemical process
  • preheat lens and immerse in KNO3 at 470’c for 16hours
  • large K+ ions exchanged for smaller Na+ ions in glass- 100microm compression coat applied
  • thinner than heat-toughened but greater impact resistance
  • all lenses take the same time to toughen
  • no warping
  • expensive process
  • hard to tell when material has been toughened
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12
Q

What are the results in breakage of toughened glass?

A
  • radial fracture pattern
  • sometimes concentric cracks
  • only a few splinters formed
  • fragments tend to stay in the frame
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13
Q

what are the characteristics of laminated glass?

A
  • two layers of crown glass with inner layer of plastic material
  • impact resistance only slightly higher than crown glass
  • supposed to stick to plastic if it shatters-not always
  • silvers from back may come off into eye
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14
Q

characteristics of plastic materials?

A
  • greater impact resistance
  • fragments tend to be large and blunt
  • 50% weight cf glass
  • some powers will be thinner in glass, as no need to thicken for impact resistance
  • withstands molten metal and hot sparks better, as metal does not fuse with surface
  • less condensation (lower thermal conductivity)
  • greater Uv protection than glass

disadvantages:

  • easily scratched
  • hardcoat reduces impact resistance
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15
Q

why do we need eye protectors?

A

to defend against:

  • molten metals and hot solids
  • gases
  • dust
  • impact of different severities
  • optical radiations
  • droplets and splashes
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16
Q

characteristics of PMMA & CR39?

A
  • PMMA = ICI perspex and now largely replaced by CR39
  • CR39 greater impact resistance, but sharper fragments.
  • both suitable for eye protectors
  • CR39 can be tinted unlike PMMA
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17
Q

characteristics of polycarbonate?

A
  • high impact resistance
  • very soft
  • quartz coating often used but can reduce impact resistance from 224ms to 152ms
  • good for children’s spex
  • cracks on impact
  • no warping or chipping
  • very lightweight
  • refractive index: 1.586
  • absorbs UV
  • accompanied by colour fringes in periphery
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18
Q

what are the characteristics of trivex?

A
  • highest impact resistance (low energy impact grade)
  • unaffected by most common chemicals and solvents
  • lightweight and thin
  • V value: 45 (reduced chromatic aberration)
  • refractive index: 1.53
  • high tensil strength make it resistance to cracking
  • 100% protection against UV
  • good for children’s spex
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19
Q

what are the characteristics of cellulose acetate?

A
  • only used for basic eye protectors due to relatively poor impact resistance
  • good resistance to chemicals
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20
Q

How to test the resistance?

A
  1. impact resistance
    - influenced by
    - ->scratches on lens
    - ->size and speed of missile
    - ->lens thickness
    - ->lens material
    * CR39 more impact resistance than glass
    * heat more impact resistance than chemically toughened glass
    * impact resistance improves with lens thickness and curvature
  2. surface hardness
    - a thinly coated (5microm) polycarbonate lens is superior to an uncoated CR39 lens
  3. chemical resistance
    - glass lens resistant to most chemicals
    - plastics can craze but CR39 has relatively good resistance
  4. thermostability
    - polycarb & PMMA are prone to distort more radily than glass
  5. resistance to hot particles
    - glass easily pitted as hot particles fuse with glass material
    - plastics do not pit easily due to elasticity of surface when heated.
  6. radiosensitivity:
    - if particles penetrate the eye it is helpful if they are visisble on x-ray
    - glass can be seen if > 0.5mm
    - plastics very hard to fine
  7. flammability
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21
Q

STANDARDS AND REGULATIONS:

A
  1. CE mark
    - most PPE must be certified with 3. things: independent insoection, basic safety requirements, CE marked
    - illegal for suppliers to sell PPE without the CE mark - includes all spectacle frames
  2. British Standard (BS)
    - health and safety executive (HSE) publish guidance on PPE regulations
    - these refer to BS and european standards
    - most relevant to optometrist is BSE EN166 personal e ye protection-specifications
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22
Q

what are the two things that an optometrist must do after get qualified?

A
  1. Get professional indemnity insurance

2. Register with GOC (General Optical Council)

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23
Q

what is professional indemnity insurance?

A
  1. One must hold professional indemnity insurance cover valid for UK purposes in order to register with GOC
  2. one must not carry out any professional work outside the terms of the insurance policy
  3. The cover must be in place before the GOC accept the application for registration
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24
Q

How to get professional indemnity insurance?

A
  1. join a professional body that provides it
    - Association of Optometrist (AOP)
    - Federation of Opticians (FODO)
  2. check if covered by employer
    - note well that if take this insurance, one wont be covered for any other professional activity elsewhere (locum)
    - most optometrist have their own AOP or FODO cover
  3. Buy a policy on the open market
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25
Q

what are the core functions of the GOC?

A

SAMI

S- Setting standards for Education and Training, Performance and Conduct
A- approving qualifications for registrations
M- maintaining and publishing the registers
I- Investigating allegations that registrants’ fitness is impaired

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26
Q

What is General Ophthalmic Service (GOS)?

A

*with GPs, dentists and pharmacists,these are the non-NHS businesses that contract with the NHS to provide services to NHS patients, as well as offering services to private patients.

  • the majority of optometrists and dispensing opticians work in local optical practices
  • NHS optical services are called General Ophthalmic Service

—–> in wales, one can perform sight test under GOS only if on the Ophthalmic List or Supllementary Ophthalmic List of a health board in wales. (if want to work in england (must be listed in ophthalmic performer list of NHS england) and in wales, one must be listed seperately in both)

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27
Q

How to get and stay listed with the NHS?

A
  • undergo ‘Disclosure and Barring’ check
  • declare and keep NHS updated on fitness to practise- health, convictions, disciplinary matters (same as for GOC registration)
  • provide evidence- qualifications, indemnity insurance, identification, professional experience, refrences, communication skills.
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28
Q

what are the functions of the AOP?

A

serves its members by…

1) promoting, protecting, representing, and supporting them
2) providing them with relevant services
3) enhancing their professional and business effectiveness
4) expanding the role of optometry

5) ‘like a trade union for optometrists’
- insurance
- defence
- advice
- education
- members’ interest

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29
Q

“if you want to work in primary care, you should get listed by the NHS and if you want to keep the letters MCOptom after your name, you should join the College of Optometrist”

explain.

A

College of Optometrist (COptom):
for the public benefit
-improvement and conservation of vision
-advancement of study and research and promotion of science and practice of optometry
-maintenance of highest standards of professional competence and conduct

  • shows your high standards of clinical practice- MCOptom
  • -advice
  • -education (including the scheme for registration)
  • -code of ethics
  • -professional conduct
  • -public interest
30
Q

LAW 2; APPOINTMENTS: how do contracts/ appointments works?

A
  1. requires three essential ingredients
    - an offer: the offerer promises the offeree something in exchange for the offeree’s promise to do or not to do something
    - –> the practice promises the patient a sight test in exchange for the patient’s promise to pay (or to enable the parctice to be paid)
  • an acceptance: the offeree gives the offeror whatever was requested, such as to do or not to do something
  • –> the patient gives the practice a promise to pay (or to enable the practice to be paid)
  • a consideration: whatever each party brings to the table in the bargained-for exchange
  • –> the practice provides the sight test and the patient pays (or signs the NHS paperwork)
  1. an intention to create legal relations
    - –> you make an agreement to meet a friend at the pub- may have moral duty to honour that agreement but not a legal duty to do so because this was not made in a commercial context
  2. capacity or competence
    - -> incapable due to intoxication, health, age
  3. consent
    - -> free will, voluntarily entered in to, no coercion
31
Q

LAW 2; APPOINTMENTS: how can the contracts can be discharge?

A

a contract become discharged trough performance where both parties have fully performed their contractual obligations
-practitioner test the patient’s sight and the patient pays the practitioner

32
Q

LAW 2; APPOINTMENTS: How UK law is classified?

A
  1. civil law: covers such areas as contracts, negligence, family matters, emplyoment, probate, and land law
    - relationship between individuals and/or private organisation
  2. criminal law: defines the boundaries of acceptable conduct
    - relationship between and individual and society as a whole
33
Q

LAW 2; APPOINTMENTS: How Civil Law is enforced in England and Wales?

A
  1. a person who believes that another individual or organisation has committed a civil wrong, eg. breach of contract, can complete a claim form and send it to the appropriate court, usually the COUNTRY COURT.
  2. the person who starts a civil case is called a CLAIMANT, and he or she has the burden of proving that, more probably than not, the other party (the DEFENDANT) committed a civil wrong.
  3. if the CLAIMANT is successful, the usual remedy is DAMAGES: a sum of money paid by the DEFENDANT to the CLAIMANT.
  4. Either party to a civil case may appeal to a higher court against the decision.
34
Q

LAW 2; APPOINTMENTS: how to examine patient who presents as an emergency appointment?

A

There is no legal definition of an emergency: (it might include Giant Cell Artritis, red eye, recent loss of vision, recent onset of ocular pain, symptoms which strongly suggest a recent RD)

NHS only cover full eye exam.

Practitioner must assess and decide on the best course of action

1) if decide to conduct an emergency examination of a patient who presents with and acute condition,
- make it clear to the patient that it is not a statutory sight test or full eye exam
- adressing only the presenting symptom
- make it clear before examine the patient whether or not there will be a charge
- the patient should return to their usual optometrist for a routine eye exam when it is due
- refer the patient to an appropriate healthcare professional if applicable
- record all findings and advice given to the px
- practitioner may charge an appropriate fee for the emergency examinations unless he/she participate in an NHS-funded scheme ( but NHS only cover full eye test?)

  1. if decide not to conduct an emergency eye exam; or if the patient does not wish to pay for a private emergency examination when there is no NHS service,
    - the practitioner must ensure that the patient is directed to an appropriate healthcare professional with indication of the urgency.
35
Q

LAW 2; APPOINTMENTS: Who can get a GOS sight test (google the detailed version)?

A
  • certain age groups
  • certain income groups
  • certain groups with clinical need (home visits if entitled as above and unable to leave home unaccompanied because of illness or disability)
  • must be clinically necessary.
36
Q

LAW 2; APPOINTMENTS: what is post-payment verification (PPV)?

A

1) also knows as NHS audit
2) the NHS will check that payments made on their behalf to primary care contractors, including opticsl practices, are accurate and valid
3) practitioner should check patients’ entitlement before providing GOS or enhanced services (services other than GOS e.g. wales eye care services)

37
Q

LAW 2; APPOINTMENTS: what is point of service check?

A

1) a simple check performed at the time a patient signs a declaration that the patient is entitled to a free sight test
2) every patient claiming help is asked to show evidence to support their claim
3) services are not withheld if evidence isn’t show

38
Q

LAW 3; RECORD KEEPING: what are the aims of the data protection act 1998?

A

the data protection act 1998 aims to balance the needs of ORGANISATIONS to use and collect the personal data for business or other purposes with the INDIVIDUAL’S right to have privacy on personal details.

39
Q

what are the requirements of eye protectors?

A
  • durable
  • protect from the hazard
  • non-flammable
  • not likely to cause irritation or undue discomfort
  • lightweight
  • easily maintained and cleared
  • not likely to trap condensation, fog-up, or restrict movements.
  • readily replaced and inexpensive
  • not impair vision
  • good optical quality
  • cosmetically acceptable
  • compatible with other safety equipment
40
Q

LAW 3; RECORD KEEPING: What does an optical practice have to do?

A
  1. NOTIFY the INFORMATION COMMISSIONER that it is processing personal data and pay a fee. (information commissioner holds public register and failure to notify is a criminal offence)
  2. PROCESSED personal data FAIRLY and lawfully, and IN LINE with the conditions of the act.
  3. RESPOND to an individual’s subject access request.
41
Q

LAW 3; RECORD KEEPING: What is an individual’s “subject access request?”

A
  1. respond within 40 calendar days
  2. fee
  3. understand abbreviations
  4. SAR require you to tell an individual whether you are processing their personal data and if so, to provide them with a copy
    - in most cases you must respond to a valid subject access request within 40 calendar days of receiving it
    - however you do not have to grant subject access in respect of personal data to which an exemption applies eg.nfor data relating to an individual’s mental health
  5. you may charge a fee of between £10 and £50 for complying with a SAR relating to health records
    - up to £10 for records held electronically
    - up to £50 records held wholly or partly in non-electronic form
  6. in addition to providing copies of the data, you must also be able to explain the content of the abbreviations
    - so make sure you can read your own handwriting
    - and don’t write anything inappropriate in the notes

*remember to notify your insurer immediately if there is a potential claim against you.

42
Q

LAW 3; RECORD KEEPING: Copies of the prescription?

A
  • if your patient asks you for a copy of his or her prescription, you should comply with the patient’s request
  • if another supplier asks you for a copy of a prescription, you should:
  • –give a copy to the patient to pass to the supplier
  • –send the copy to the supplier after first obtaining the patient’s permission in writing or verbally
43
Q

LAW 3; RECORD KEEPING: What are the 8 data protection principles?

A
  1. Personal data shall be PROCESSED FAIRLY AND LAWFULLY and, in line with the at least one of the conditions of the Act:
    - consent
    - contracts
    - legal obligations
    - vital interest
    - administering justice or public function
    - legitimate interest
  2. personal data shall be OBTAINED FOR ONE OR MORE SPECIFIED AND LAWFUL PURPOSES, and shall not be further processed in any manner incompatible with that purpose or those purposes.
  3. personal data shall be ADEQUATE,RELEVANT, AND NOT EXCESSIVE in relation to the purpose or purposes for which they are processed.
  4. personal data shall be ACCURATE, and where necessary KEPT UP TO DATE
  5. personal data processed for any purpose or purposes shall NOT BE KEPT FOR LONGER THAN IS NECESSARY for that purpose or those purposes
  6. personal data should be PROCESSED IN ACCORDANCE WITH THE RIGHTS OF DATA SUBJECTS UNDER THE ACT
  7. appropriate technical and organisational measures shall be taken AGAINST UNAUTHORISED OR UNLAWFUL PROCESSING of personal data and AGAINST ACCIDENTAL LOSS OR DESTRUCTION OF, OR DAMAGE TO, PERSONAL DATA.
  8. personal data SHALL NOT BE TRANSFERRED TO A COUNTRY OR TERRITORY OUTSIDE THE EUROPEAN ECONOMIC AREA unless that country or territory ensures an adequate level of protection for the rights and freedoms of data subjects in relation to the processing of personal data.
44
Q

LAW3: What are the requirements of requests from third parties?

A

before disclosing records to any third party you must be satisfied that they have the appropriate authority

  • a child patient’s parents
  • someone authorised in writing by the px
  • a person appointed by the court to manage the affairs of patients incapable of doing so

-ask the request in writing and keep it with the patient’s record

45
Q

LAW 3; RECORD KEEPING: What are the steps needed to verify a prescription?

A

•Comparing the data on the patient’s original prescription with the details provided by the patient’s prospective supplier of glasses
•Does not need the patient’s express consent
–as it is reasonable to deem consent by virtue of the fact that the patient has passed the prescription to the supplier
•Enter the request in the patient’s record
•Check the details given to you by the supplier are correct
•Reply with a ‘yes’ or a ‘no’
–either the prescription they have is correct or not
–any details not in the supplier’s possession should not be offered without the patient’s explicit consent

46
Q

LAW 3; RECORD KEEPING: What are the records in optical practice?

A
  • Clinical (written and electronic)
  • Sales & purchases
  • Business administration & accounts
  • Employment, payroll and staff training
  • Health & safety
47
Q

LAW 3; RECORD KEEPING: What is a good clinical records?

A 
•A good record involves writing down
–what the patient said
–what you said to the patient
–what you did
–what you found and what you did not find
–your conclusions
–your advice
48
Q

LAW 3: Why do we keep the clinical records so long?

A
  • Claims in negligence, e.g. for personal injury, may be brought up to three years from the time that the injured party became aware of the injury giving rise to the claim
  • Claims may also be brought in respect of personal injuries done to children for three years after they reach their majority
49
Q

LAW 3: Who owns clinical records?

A

•The optical practice
–The Data Protection Act 1998 allows patients to have access to their records – to have copies or to view the records – it does not confer ownership on the patient
–The optometrist does not own the records and is not entitled to take copies of the records for his or her own purposes

50
Q

LAW 3; RECORD KEEPING: How patients access their records?

A
  1. Asking you for a COPY of the PRESCRIPTION
  2. Asking ANOTHER optometrist or dispensing optician to ask you for a COPY of the PRESCRIPTION
  3. Asking for a complete COPY of their RECORDS
  4. Asking SOMEONE ELSE to ask you for a complete COPY of their RECORDS.
51
Q

LAW 3: How can a practitioners access to records that they have made?

A

•If you require access to the records you have made to defend a claim alleging negligence against you, you must seek permission from the records’ owner either
–through your contractual arrangement as an employee or locum or
–under section 35 of the Data Protection Act
•disclosure exemption for legal proceedings

•On the sale of a practice the seller should include in the contract of sale a clause allowing the seller, or his or her representatives & former employees to have access to the patients’ records to defend any claims

52
Q

LAW 3: What is the freedom of Information Act?

A

•“Public authorities” are obliged to publish certain information about their activities
•Members of the public are entitled to request information from public authorities
•Optical practices in receipt of GOS payments are deemed to be public authorities
–with regard to their public function

FOI PUBLICATION SCHEMEs:
•Every public authority must have a publication scheme setting out its commitment to:
–publishing information
–making it possible for information to be easily identified and accessed
–reviewing and updating information regularly

53
Q

LAW3; RECORD KEEPING: How long should clinical records be kept?

A

•No absolute period can be stated with regard to retaining patient records, however
–Data Protection Act states records shall not be kept for longer than is necessary for the purpose for which they are kept
•Why are we keeping them?
–GOS Terms of Service (Wales) & GOS Contract (England) require minimum seven years
–AOP has issued minimum guidelines

AOP minimum guidelines on keeping records
•Based on recommendations of the Department of Health in respect of negligence claims, i.e. current standards of best practice in respect of keeping patient records
•adults’ records
–keep for 10 years after the conclusion of treatment or the patient’s permanent departure from the country
•children and young people’s records
–keep until the 25th birthday, 26th if the entry was made when the patient was 17
•deceased patients’ records
–keep for 10 years after the death of the patient

57
Q

LAW 5; GIVING ADVICE: according to the opticians act 1989 & sight testing no2 regulations 1989, what are the duties to be performed on sight testing?

A

1) eye examination
2) immediately following the eye test to give a written statement that consist:
- that you have carried out the examination
- that you are or (as the case may be) are not referring the patient to a doctor
- if you referring the patient to a doctor, setting out the reason for the referral
- give out either a signed,nwritten prescription for an optical appliance or a signed, written statement that he or she does not need to use or wear an optical appliance

however, there are exceptions to the duty to issue written statement or prescription which include:

  • when the practitioner refer the patient to his doctor for further investigation or treatment
  • when the sight test was carried out as part of a general medical examination
  • the patient was resident in a hospital or a clinic, for the purpose of treatment,mwhen his sight was tested.
58
Q

LAW 5; GIVING ADVICE: what are the particulars that are need to be included in aprescription or statement?

A

1) the DATE of the testing sight
2) the NAME and ADDRESS of the patient and if he or she UNDER THE AGE of 16, his or her DOB
3) NAME and practice ADDRESS of the practitioner who carried out the testing sight
4) ADDRESS where the practitioner practice (address at which the testing of sight was carried out)
5) PARTICULARS of any sphere power, cylindrical power (including axis), prism (including base direction), near addition (if any) and such other particulars as may be necessary to enable each lens to be replicated
6) a statement to the effect that NO CHANGE IN THE PATIENT’S EXISTING APPLIANCE is necessary where this is the opinion of the optometrist.
7) a statement wether patient DOES NOT NEED TO WEAR OR USE OPTICAL APPLIANCES (including names,dates, adresses for prescription above)

59
Q

LAW 5; GIVING ADVICE: What are the GOS regulations on testing of sight in England?

A

1) where the sight test
- shows on examination signs of injury, disease or abnormality in the eye or elsewhere which may require medical treatment OR is not likely to attain a satisfactory standard of vision notwhitstanding the application of corrective lenses

the contractor shall, if appropriate, and with the consent of the patient

  • refer the patient to an ophthalmic hospital, which includes an ophthalmic department of a hospital
  • inform the patient’s doctor or GP practice that he or she has done so, and
  • give the patient a written statement that he or she has done so, with details of the referral

2) where the patient is issued a prescription for glasses the contractor shall, immediately thereafter, require the patient to acknowledge its receipt on a sight test form.
3) a prescription for glasses issued following a testing of sight under GOS shall be completed by the method recommended in british standard

60
Q

LAW5; GIVING ADVICE: what are the GOS regulations on testing of sight in Wales?

A

1) where the contractor is of the opinion that a patient whose sight he or she has tests
- shows on examination signs of injury, disease or abnormality in the eye or elsewhere which may require medical treatment OR is not likely to attain a satisfactory standard of vision notwhitstanding the application of corrective lenses

HE OR SHE SHALL INFORM THE PATIENT’s DOCTOR.

2) where the contractor is of the opinion that a patient whose sight he or she tested requires glasses he or she shall immediately after completing the test
- in every case ISSUE A PRESCRIPTION FOR GLASSES, indicating the power of the lenses required
- where the particulars of that prescription ARE THE SAME AS THOSE RELATING TO THE PATIENT’S EXISTING GLASSES, SO INFORM THE PXS

3) where the patient is issued a prescription for glasses, the contractor shall, immediately thereafter, require the patient to acknowledge its receipt on a sight test form
4) where a contractor tests the sight of a patient diagnosed as suffering from diabetes or glaucoma he shall inform the patient’s doctor of the results of the test
5) A prescription issued should be completed by the method recommended in BS

61
Q

LAW5; GIVING ADVICE: What are the GOC’s rules relating to injury or disease of the eye 1999?

A

REFERRALS:

1)where it appears to a registered optometrist or registered dispensing optician that a person consulting him or her is suffering from an injury or disease of he or she shall (subject to a few expectations) refer to a REGISTERED MEDICAL PRACTITIONER.

2) EXCEPTIONS:
- patient is unwilling to be referred (record the facts and ground of the unwillingness)
- in your professional judgement there is no justification to refer or it would be impracticable or inexpedient to do so, you must
- –record description of injury or disease
- –record for deciding not to refer
- –record details of advice or medical or clinical treatment given
- –and notify the GP with the patient’s consent

3) REFERRAL INSTEAD TO (beside medical practitioner as what has been stated in GOC’s rules relating to injury or disease of the eye 1999)
- –a person other than medical practitioner with the appropriate qualification or expertise to provide medical or clinical treatment eg. nurse, an orthoptist
- –a person or body who organises referrals to a registered medical practitioner or other person with appropriate qualificatins and expertise as above eg. NHS booking center

4) MAKE RECORDS:
- that you have made the referral
- describing the injury or disease
- of any advice or medical or clinical treatment given.

5) PROVIDE A WRITTEN REPORT OF YOUR FINDINGS WITH THE REFERRAL INCLUDING
- your grounds for thinking that the person may be suffering from injury or disease of the eye
- if appropriate, instructions for the referral booking center as to who the person should be referred eg. registered medical practitioner, nurse, orthoptist.

6) THE DUTY HOWEVER DOES NOT PREVENT YOU FROM:
- rendering in an emergency services that are in the best interests of the patient or
- giving treatment in line with the opticians act eg. emergency treatment, orthoptic treatment

62
Q

who can fit contact lenses?

A
  1. optometrists
  2. dispensing optician
  3. doctors
  4. supervised persons training as optometrist or dispensing optician (and supervised medical students)
62
Q

what are the contact lens qualifications?

A
  1. optometrist and dispensing optician shall not fit a contact lens unless
    - they have an approved qualification
    - or they have certification (‘grandfather’ right)
    - or they are working under the supervision of someone who has one of the above
  2. no one can fit contact lenses unless
    - he or she has the particulars spectacle prescription given to the px within two years ending on the date the fitting begins and
    - the fitting before any re-examination date specified in the rx
63
Q

what is fitting contact lens?

A
  1. assessing whether a lens meet the patient’s needs
    - implies that what we call ‘aftercare’ (that leads to re-issue of a contact lens specification) is really a “fitting”
  2. providing the patient with lenses for a trial period
  3. provide the patient with a signed written specification on completion of fitting (unless a contact lens is not appropriate)
  4. provide the patient with instructions and information on the care,wearing, treatment , cleaning and maintenance of the lens (could be verbal, but much safer for you and the patient if given in writing)
    [duties apply to the last person to fit a lens if a series of persons took part in the fitting]
63
Q

What are the details required for contact lens specifications?

A
  • required for powered lenses only, not plano
  • must state the period during which the specification remains valid and its expiry date
  • must include the particulars listed in the contact lens (specification) rules 1989

1) the NAME and ADDRESS of the patient
2) if UNDER 16 on the day the specification is issued, the patient’s DOB
3) the NAME and REGISTRATION NUMBER of the person signing the specification
4) the ADDRESS from which the person signing the specification practices
5) the NAME OF THE PRACTICE on whose premises the fitting was done
6) the DATE the fitting was completed
7) SUFFICIENT DETAILS OF ANY LENS FITTED to enable a person who fits or supplies a contact lens to replicate the lens
8) the DATE the specification EXPIRES
9) such information of a CLINICAL NATURE as the person fitting the lens considers to be necessary in the particular case.

63
Q

what are the regulations involve in sale of contact lenses?

A

1) must be by, or under the supervision of an optometrist, a dispensing optician or a doctor unless
- the patient is 16 or over
- the patient is not registered blind or partially sighted

2) (kebanyakan case). If not by or under the supervision of an optometrist, dispensing optician or doctor (as above), the seller must have
- the original specification or
- a copy of the specification (if cannot get the original) or an order that the SELLER VERIFIED with the person who provided the specification

3) the seller must be reasonably satisfied that the goods are intended for use by the person NAMED IN THE SPECIFICATION.
4) the specification must be in date when the sale is made
5) the seller must be under the “general direction” of an optometrist, a dispensing optician or a doctor.
6) the seller must make an arrangements for the wearer to receive “aftercare” in so far as, and for so long as, may be reasonable in his or her particular case.

64
Q

what does it mean by “aftercare” in law?

A

basic advice ( give to the px in writing to protect the patient and the seller) to the patient on:

  1. contact lens care
  2. the need for routine professional contact lens care
  3. contact details for emergency care
65
Q

what are college of optometrist guidance on aftercare?

A
  1. infection control
    - hand hygiene
    - cross contamination (solution bottles, fitting sets and decontamination)
  2. contact lens equipment and facilities
    - “essential”
    - slit lamp and keratometer
  3. fitting CLs
    - referral to a colleague
    - self-fitting (generally dont)
    - supervision of fitting
  4. contact lens specifications
    - plano lenses
    - advice for patients purchasing lenses elsewhere
  5. supplying contact lenses
    - interpretation of supervision (must be on the premises and in a position to intervene if necessary)
    - duty to provide “aftercare”
  6. care of and refitting CLs wearer
    - what we think of as “aftercare” is really “re-fitting”, COptom calls them “check-ups”
    - check ups should be at least every twelve months
  7. Specialist contact lenses
    - extended wear
    - therapeutic lenses
    - orthokeratology
65
Q

what is the patient presents with a non-CL symptom?

A
  • make it clear that a contact lens appointment is not a sight test or a full eye examination
  • note symptoms and advice given in the record
  • advise the patient
  • —either you will investigate the symptom yourself (at this appointment or at another appointment, as appropriate) and whether or not there will be a charge
  • —that you will refer to an appropriate healthcare professional with an indication of urgency (patient may not want to be examined by you or to pay)
  • it is possible to combine sight tests and contact lens appointments
  • remember to discuss contact lenses, if they would be an appropriate optical appliance, when giving advice at the end of sight test
66
Q

LAW 4: Who sets the rules?

A

1) UK Government
–Acts of Parliament and Statutory Instruments
–GOC
–NHS in England

2)Welsh Government
–Assembly Measures and Statutory Instruments
–NHS in Wales

3) Peer practice

4) Professional bodies’ guidance
–AOP
–COptom
–FODO

67
Q

LAW 4: What are the duties to be performed on sight testing?

A

•When a doctor or optometrist tests the sight of another person, it shall be his / her duty to perform, for the purpose of detecting signs of injury, disease or abnormality in the eye or elsewhere
–an examination of the external surface of the eye and its immediate vicinity
–an intra-ocular examination
–such additional examinations as appear to the doctor or optometrist to be clinically necessary

•No mention of refraction
–but you must be in a position immediately following the test to give the person you have tested either
•»>a signed, written prescription for an optical appliance
or
•»>a signed, written statement that he or she does not need to wear or use an optical appliance

68
Q

LAW 4: What are the wales eye care service on eye sight?

A

•Eye Health Examination Wales (EHEW) not defined by regulations but by “guidance”
–In most cases these are mandatory
•visual acuity measurement
•slit lamp examination of the anterior segment
•assessment of the anterior chamber angle
•contact tonometry
•dilated fundus examination with slit lamp and Volk lens
•visual field examination
–In acute cases procedures are at the discretion of the optometrist or doctor examining the patient

•“You are still responsible for

  • the overall management of the patient
  • and must ensure your patient receives the same standard of care that you would provide
  • the work of the person to whom you have delegated the procedure and any clinical findings”
69
Q

LAW 4: What are the regulations involved examining children and vulnerable adults?

A

•Professional bodies’ guidance covers
–Safeguarding children and vulnerable adults
–“Gillick competence”
•nature of consent which minor can give to medical treatment without obtaining parental consent
–protecting yourself against unfounded allegations of inappropriate conduct
•chaperones and open door policies

•A child becomes increasingly independent as he or she grows older and parental authority to make decisions for the child dwindles correspondingly so
–the law does not recognise any rule of absolute parental authority until a particular age
–parental rights
•are recognised by the law only as long as they are needed for the protection of the child and
•yield to the child’s right to make his own decisions when he or she reaches a sufficient understanding and intelligence to be capable of making up his own mind

OPTOM (8 decks)

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