Posters
I have placed two posters outside the practice and in the window. One states that we are offering emergency and essential eye care. It tells patients to call the practice number to be triaged into phone consultation or in person consultation. The second poster includes warning signs of Covid-19 and not to attend if you have a new continuous cough or a fever or have been co-inhabiting with a person who has these symptoms
Deep clean
Use virucidal cleaner where patients have been in contact within the practice such as seating and door handles. Use anti-bacterial wipes for equipment such as slit lamp, optical coherence tomographer and visual field analyser. Using separate hand
gel or soap and water for the patient, support staff and the optometrist.
Social distancing
Set up a one in, one out policy. We have two staff operating per clinic, one support staff and one optometrist. Space out seating so patients are the furthest from the support staff.
Remove any cushions and all paper to reduce potential transmission and do not allow the patient to use a pen. In addition, we have set up an isolation room for anyone who gets unwell during the consultation so they can give the patient a phone to call 111.
Tissues and bin
Have a box of tissues in the waiting area and testing room. Catch it, kill it, bin it if a patient sneezes.
Scrubs and aprons
Wear casual clothes such as a t-shirt, so arms are bare, and trousers that can be washed each evening immediately after work. Use disposable aprons.
Masks and gloves
Support staff and optometrist use disposable gloves for each patient visit and for opening of deliveries. The optometrist wears a mask fitted correctly when using a slit lamp or having to get close to the patient such as inverting lids for a foreign body.
Instrumentation
Use safety specs to prevent spread in procedures such as reviewing viral conjunctivitis. We are using a needle as the agar brush cannot be used when removing a corneal foreign body. Cut an A4 clear plastic folder to make a DIY slit lamp shield or purchase a commercial one from the suppliers.
We have an ear thermometer with disposable caps to measure before sending any life threatening or sight threatening pathology to secondary care. We are only performing contact tonometry if essential such as closed angle glaucoma and not non-contact as it is aerosol generating. We perform fundus photography where required and not direct ophthalmoscopy.
Covid-19 claim
In Scotland all patients are being seen using supplementary code 3.8 for non-IP and 4.8 IP whether the patient requires dilation or not. Software companies have adapted and introduced these new codes into software to track NHS claims and to document whether a telephone or in person assessment has paid the same for either.
Recalls
All recalls have been extended for three months using a new Covid-19 code and any patient calling for a routine sight test can be manually triaged using this code.
Risk assessment
Perform a staff risk assessment using government guidelines for patients with underlying disease to determine if they are high risk, such as patients with solid organ transfers, or low risk, such as asthma that requires only a preventer inhaler and no hospitalisation.
Review procedures
Review procedures should be performed daily. We have ordered an advance supply of contact lenses for all our patients and sent these to them by post and have posted out spectacles for collection. We will now be furloughing all remaining support staff. Thereafter, the practices will only review patients and either prescribe remotely and issue a prescription for medication if appropriate or organise within practice assessment if deemed within the remit of emergency and essential eye care. The optometrists will remain operational on a daily basis. •
References
Optometry Scotland, Bothwell PAL group, Lanarkshire IP group, NES Optometry Scotland