10Domains and learning outcomes (C110416)

• One distance learning CPD point for optometrists and dispensing opticians.

• To take part in this module visit opticianonline.net/cpd.

• Leadership and accountability

(12.1.1) After successful completion of this CPD practitioners be able to evaluate practice protocols and compliance with health and safety legislation ensuring their protection and well-being and that of their patients and colleagues.

• Professionalism

(11.5) After successful completion of this CPD practitioners will recognise the potential risks from inadequate premises, equipment, resources or policies and raise a concern if the situation cannot be corrected so that patient safety can be maintained.


Health and safety at work is something that many workers often take for granted; it is something that is always present and often is assumed a ‘given’.  

In the UK, in the optical sector, we are fortunate to work in an environment that is not only highly regulated clinically and professionally, but also in workplace legislation, which is designed to keep us as employees or contractors and our patients and clients safe from harm. 

The Health and Safety at Work Act: 19741 is the primary piece of legislation covering occupational health and safety in Great Britain.  

It sets out the general duties which: 

  • Employers have towards employees and members of the public. 
  • Employees have to themselves and to each other. 
  • Certain self-employed have towards themselves and others. 

  

Addressing health and safety within a workplace should be tackled in a pragmatic and methodical manner. Many larger optical practices, or those within a corporate setting may have an HR department who will help setting up policy and procedures, however a small independent is subject to the same laws and regulations and should have a similar approach to policy as their larger counterparts.  

It is also worth noting that within the General Optical Council (GOC) Standards of Practice for optometrists and dispensing opticians, optical students and businesses all have contained within them specific sections about keeping the public safe from harm within optical premises and while under the care of the practice, its registrants and students in training.2-4 The GOC also specifically states in the Standards of Practice for Optometrists and Dispensing Opticians Standard 12.1.1:5 ‘Be aware of and comply with health and safety legislation.’ 

  

Getting Started: Managing health and safety  

As an employer, practice owner or sometimes the manager, you are responsible for managing health and safety in your business. This includes managing risks and taking practical steps to protect workers and others from harm. 

Managing risk forms one part of health and safety management, it also requires arrangements to be made to: 

  • Make the right plans 
  • Implement those plans 
  • Check they are working 
  • Act if they are not 

  

This then means it can be ensured that risks remain controlled and a safe working environment is provided for staff and patients. These measures or protocols should form part of the daily processes of business management. 

For most small, low-risk businesses a formal management system is not necessary. Following the Plan, Do, Check, Act5 system will help to effectively manage health and safety in the workplace. 

Under the Management of Health and Safety at Work Regulations 1999,6 the minimum you must do is: 

  • Identify hazards – what could cause injury or illness 
  • Determine the risk – how likely it is that someone could be harmed and how seriously 
  • Eliminate the hazard or where this is not possible, control the risk 

  

Risk management is a step-by-step process for controlling health and safety risks caused by hazards in the workplace. The following steps can be employed to identify and manage risk. 

All optical practices should display a health and safety poster, often in staff areas (not in patient facing areas), see figure 1 (below). 


Identifying hazards 

Consider the whole working environment within your practice, and think about what may cause harm (hazards). When conducting a risk assessment consider, 

  • How people work and what equipment is used 
  • What chemicals and substances are used 
  • What safe or unsafe work practices exist 
  • The general state of the premises 

  

Review accident and ill health records as these can help to identify less obvious hazards; also remember to include maintenance and cleaning. Think about hazards to health, which may be physical as well as work-related stress. 

For each hazard, think about how employees, patients, contractors, or members of the public might be harmed. 

  

Vulnerable workers 

Some workers have particular requirements, for example young workers, new or expectant mothers and people with disabilities. 

  • Talk to workers 
  • Encourage workers’ involvement; they often have good ideas 

  

Assess the risks 

Once all hazards have been identified assess the level of risk, how likely someone could be harmed and how serious it could be.  

Determine: 

  • Who is at risk? 
  • What can be done to control the risks? 
  • What further action is needed to control the risks? 
  • Who will carry out the risk control action? 
  • When should this risk control action be carried out? 

  

Control the risks 

Always consider what you are already doing to control the risk along with questioning the following: 

  • Can the risk be completely eliminated? 
  • If not, how can the risk be controlled so that harm is unlikely? 

  

It may be clear that further risk controls are required or it may even be necessary to: 

  • Redesign the job 
  • Replace materials or equipment 
  • Reduce exposure to the risk 
  • Identify and implement practical measures needed to work safely 
  • Provide personal protective equipment and ensure it is worn 

  

It is not expected that all risks will be eliminated, but everything ‘reasonably practicable’ must be done to protect people from harm. This will mean balancing the level of risk against what measures are needed to control the real risk in terms of money, time or trouble. 

  

Record your findings 

If more than five people are employed, which can be the case even for smaller practices, there must be a record of the significant findings and these should include: 

  • The hazards 
  • Who might be harmed and how? 
  • What is being done to control the risks? 

  

An example of a risk assessment template can be seen in figure 2 and can be downloaded from the Health and Safety Executive website hse.gov.uk/simple-health-safety/risk/risk-assessment-template-and-examples.htm. 

  

Figure 2: Health and safety risk assessment template


Review the controls 

It is essential to review risk controls put in place to ensure they are working or if they have become ineffective. There may also be workplace changes leading to new risks for example, from staff changes, a new working process or new equipment. 

Always check if any staff have found any concerns or there have been any accidents or near misses. The risk assessment should also be continually updated and any changes recorded. 

  

Provide information and training for staff 

All employees need to know how to work safely and without risk to their health. This includes contractors and self-employed people. 

All workers must be given clear instructions and information, as well as adequate training and supervision. Make sure to include employees with training needs, for example new recruits, people changing jobs or taking on extra responsibilities, young employees and health and safety representatives. 

When determining the extent of required training, the specific needs of the workers must be considered. Low-risk environments such as office-based settings may only require simple information or instructions. 

Ensure all employees have the correct level of information on: 

  • Hazards: Potential sources of harm 
  • Risks: The probability and severity of harm occurring 
  • Preventative Measures: Strategies implemented to mitigate hazards and manage risks 
  • Emergency procedures: Steps to follow during emergencies 

  

Ask your workers if the training is relevant and effective. Maintaining detailed training records is crucial for assessing the need for refresher courses. The information and training must be clear and easy to understand. Everyone should be aware of their responsibilities and expected actions. 

Health and safety training should take place during working hours and be provided at no cost to employees. While external trainers can be used, in-house training can also be effective. Additional training should be provided when new equipment is introduced or when there are changes to working practices. 

For new staff members, or those with additional needs, training should be customised to their specific requirements and delivered in a clear, understandable format. 

Supervisors and/or managers should be well acquainted with the company health and safety policy, as well as expectations for both themselves and employees. It is essential that workers know how to raise concerns and supervisors are aware of the potential problems arising from unfamiliarity, inexperience and communication difficulties. 

  

Risks specific to Optical Practice 

Optical practices whether small brass plate practices within a house, or a ‘super optical’ within a large shopping centre have limited risks when compared to large industrial settings, such as a foundry or large car manufacturing plant.  

This said, they are not free of risk – simple tasks will involve electricity; trips and falls can and will happen – think of door mats or a wet floor on a rainy day. Also, ophthalmic diagnostic drugs or cleaning solutions for spectacle lenses, which can be accessed by people who do not know how to use them correctly.  

  

Control Of Substances Hazardous to Health 

Under the Control of Substances Hazardous to Health Regulations (COSHH),7 employers are legally required to manage and mitigate exposure to materials in the workplace that could cause ill health. 

Many materials and substances used or generated at work pose potential health risks. These can include dust, gases, fumes or liquids, gels or powders that come into contact with your eyes or skin. Such substances can also cause infections, allergic reactions, or toxicity when inhaled, ingested or when they come into contact with skin or eyes. 

Hazardous substances can be found in common items such as paints, cleaners, flour dust, solder fumes, blood and waste. However, the adverse health effects of these substances are preventable if they are used correctly. 

To prevent or minimise workers’ exposure to hazardous substances, employers should do the following: 

  

  • Identify health hazards 
  • Assess the risks associated with those hazards 
  • Implement control measures to mitigate the risks 
  • Ensure the control measures are effectively used 
  • Maintain control measures in good working condition 
  • Provide workers with information, instruction and training 
  • Conduct monitoring and health surveillance where necessary 

  

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (Riddor) 20138 

In cases where an individual has died or sustained an injury due to a work-related accident, it may be necessary to file a report. However, not all incidents require reporting. A Riddor report is mandated only when: 

  

  • The accident is work-related 
  • The injury falls under the category of reportable injuries 

  

Reportable incidents can range from the most severe cases, such as fatalities and physical assaults, to occupational diseases and conditions like carpal tunnel syndrome and occupational dermatitis.  

Full information can be found on the HSE website on all aspects of Riddor: hse.gov.uk/riddor/reportable-incidents.htm. 

  

Signage 

To alert colleagues and patients to potential hazards within optical practices, effective signage is essential. These signs help highlight risks and communicate what actions are permitted within specific areas. A ‘traffic light’ colour system is often used to indicate the severity and nature of hazards, red means prohibited, blue means you must obey, yellow means potential danger, green means safe to proceed. 

Using clear and consistent signage helps ensure that everyone is aware of the risks and knows how to respond appropriately. From the above examples, it is relatively easy to see by means of a picture what is permitted within the practice, what should be done and where there may be a risk. Even if a patient is not a fluent reader, the pictures help safeguard them by showing pictures and colours what should happen – red is often associated with danger and green is the usual colour to represent go. 


Figure 3: Examples of signage found in optical practice  


First Aid 

Building on the principles of COSHH, first aid is essential. If a staff member or patient encounters an irritant, experiences a trip, or fall, first aid may need to be administered. 

What ‘adequate and appropriate’ first aid arrangements are depends on the work you do and where you do it. It is crucial to understand the work environment and assess the first aid requirements accordingly. 

Appointing a dedicated ‘first aider’ in your practice is preferable, though not legally required. This individual will manage all first aid arrangements, including maintaining equipment, facilities, and contacting emergency services. There can be more than one appointed person, and formal training is only necessary if significant health and safety risks are present. 

An appointed person must always be available during working hours, and employees must be aware of first aid arrangements. 

Every optical practice should have a first aid kit, with contents based on the first aid needs assessment. For low-risk activities (desk-based work), a basic first aid kit might include the following: 

  

  • A leaflet with general first aid guidance (HSE’s leaflet Basic Advice on First Aid at Work) 
  • Individually wrapped sterile plasters in assorted sizes 
  • Sterile eye pads 
  • Individually wrapped triangular bandages, preferably sterile 
  • Safety pins 
  • Large and medium-sized sterile, individually wrapped, unmedicated wound dressings 
  • Disposable gloves 

  

When purchasing a first aid kit look for British Standard (BS) 8599-1:2019.9 While not legally required, it is your responsibility to ensure the kit meets your needs assessment criteria. 

  

Maintaining or replacing contents of a first aid kit 

First aid kits should be checked regularly, as many items particularly sterile ones, have expiry dates. When disposing of expired items this should be done safely. If a sterile item does not have an expiry date, check with the manufacturer to find out how long it can be kept. For non-sterile items without dates, check that they are still fit for purpose. 

If a trained first aider is deemed necessary, there are no set rules on the number first aiders that are required; this depends on the work nature and location.  

  

First aiders training 

  

  • Emergency First Aid at Work (EFAW): Qualified to provide emergency first aid for injuries or illnesses occurring at work. 
  • First Aid at Work (FAW): Qualified to EFAW level and can apply first aid to a range of specific injuries and illnesses. 

  

It is important to use the results of the first aid needs assessment to decide: 

  • If a trained first aider is required 
  • The adequate and appropriate level of training 
  • The number of people needing training 

  

To maintain these skills, it is essential to ensure training is kept up to date with regular refresher courses. Many professional bodies, local NHS trusts and local authorities, as well as charity groups run first aid courses at little or low cost and can be accessed by practice staff and registrants alike.  

  

Fire Safety 

Most fires are preventable. Those responsible for workplaces and buildings accessible to the public can mitigate fire risks by adopting proper behaviours and procedures. Employers (and/or building owners or occupiers) must conduct and update a fire safety risk assessment, similar to health and safety risk assessments, either as part of an overall risk assessment or as a separate exercise. 

Based on the assessment findings, employers must ensure adequate and appropriate fire safety measures to minimise injury or loss of life in the event of a fire. The fire safety risk assessment must be regularly reviewed and updated when necessary. 

To help prevent workplace fires, your risk assessment should identify what could cause a fire to start, such as ignition sources (heat or sparks), flammable substances, and at-risk individuals. Once all risks have been identified then appropriate action can be taken to control them. Consider whether these risks can be avoided altogether or, if this is not possible, how to reduce the risks and manage them. 

  

  • Keep ignition sources and flammable substances apart 
  • Prevent accidental fires (ensure heaters cannot be knocked over) 
  • Maintain good housekeeping (avoid rubbish build-up that could burn) 

  

Consider how to protect people if a fire occurs and implement fire detection and alarms to warn people quickly, such as smoke alarms and fire alarms or bells. Ensure the correct fire-fighting equipment is available to quickly extinguish fires. Keep fire exits and escape routes clearly marked and unobstructed at all times. All workers should receive training on emergency procedures, including fire drills. 

The Regulatory Reform (Fire Safety) Order 200510 covers general fire safety in England and Wales. In Scotland, requirements on general fire safety are covered in part three of the Fire (Scotland) Act 2005,11 supported by the Fire Safety (Scotland) Regulations 2006.12  

In most premises, local fire and rescue authorities are responsible for enforcing the fire safety legislation. 

If the worst happens and a fire breaks out within any optical practice, it is imperative that everyone stays calm – this is often easier said than done – then the fire policy should be started. It may be explicitly written down as part of standard operating procedures or contained within the wider health and safety protocol.  

A written emergency/evacuation plan may look like this:  

  • Stay calm 
  • Raise the alarm/strike a call point (if fitted) 
  • Call 999 
  • Evacuate the premises/DO NOT stop to collect possessions. 
  • Close doors behind you 
  • Assemble at muster/evacuation point 
  • Perform a head count and raise the alarm if anyone is missing/unaccounted for 
  • Do not re-enter the premises until permitted by a fire officer 

  

Regular fire drills (often done in conjunction with landlords within larger shopping centres) ensure everyone is aware of procedures and in a smaller stand-alone setting are helpful to reinforce training received and that all staff are aware of what to do should a real emergency happen. Being familiar and prepared and knowing what to do and where to go to be safe will be helpful for all staff and reduce the panic that may cloud their judgement in an emergency situation. 


Figure 4: Examples of firefighting equipment and what to use


Conclusion 

Health and safety in the workplace is an essential part of what we do in the optical sector – every employee and patient deserves to be safe, and workplaces should not expose them to danger. 

Many large companies specialise in assessment and recommendations that may be applicable to your particular setting, however, compliance with the law and government agencies have readily accessible information and advice which can be accessed freely for all.  

  • Fiona Anderson BSc(Hons) FBDO R SMC(Tech) FEAOO is past president of the International Opticians Association, ABDO past president, past chair Optical Confederation, Optometry Scotland member, past Grampian AOC member, EAOO – co-opted trustee, ECOO European Qualifications board member, Renter Warden: Worshipful Company of Spectacle Makers, Worshipful Company of Spectacle Makers Liveryman & Fellow of the European Academy of Optometry & Optics. 


References 

  1. Great Britain. Health and Safety at Work etc. Act 1974: Chapter 37. Elizabeth II. London: The Stationery Office; 1974 
  2. General Optical Council. Standards of Practice for Optometrists and Dispensing Opticians. 11. Protect and safeguard patients, colleagues and others from harm. London: General Optical Council; 2016 p. 16-17 
  3. General Optical Council. Standards for Optical Students. 11. Ensure a safe environment for your patients. London: General Optical Council; 2016 p. 22-23 
  4. General Optical Council. Standards for Optical Businesses. 1.2. Patient care is delivered in a suitable environment. London: General Optical Council; 2019 p. 12-13 
  5. General Optical Council. Standards of Practice for Optometrists and Dispensing Opticians S.12.1.1 London: General Optical Council; 2019 p. 18 
  6. Health and Safety Executive. How to manage health and safety. Available from: https://www.hse.gov.uk/managing/introduction/how-to-manage.htm [Accessed 27th November 2024] 
  7. The Management of Health and Safety at Work Regulations 1999. SI 3242. London: The Stationery Office; 1999. 
  8. Health and Safety Executive. COSHH basics. Available from: https://www.hse.gov.uk/coshh/basics/index.htm [Accessed 27th November 2024] 
  9. The Reporting of Injuries, Disease and Dangerous Occurrences Regulations 2013. SI 1471. London: The Stationery Office;2013 
  10. British Standards Institution. BS 8599-1:2019. Workplace first aid kits. Specification for the contents of workplace first aid kits. London: 2019 
  11. The Regulatory Reform (Fire Safety) Order 2005. SI 1541. London: 2005  
  12. Scotland. Fire (Scotland) Act 2005 Part 3. Scotland; 2005. 
  13. The Fire Safety (Scotland) Regulations 2006. SI 456. Scotland: 2006