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Knowledge, skills and performance

Use and supply of drugs or medicines in optometric practice

  • You must act in accordance with the current legislation controlling the use and supply of drugs in optometric practice.
  • You should take particular care when using or supplying drugs to patients in at-risk groups.
  • You must be aware of the indications, cautions, contraindications and side effects of any drugs you instil or supply.
  • You must tell patients how to use the drug you supply and what to do in the event of an adverse incident following instillation of eye drops or supply of a drug.
  • You should tell a patient to attend the local Accident and Emergency department if you are not available to deal with an emergency or adverse reaction following the instillation of eye drops or supply of a drug.
  • You may delegate the instillation of eye drops to another member of staff but you remain responsible for the patient.
  • You should not treat yourself or someone close to you, or prescribe or prepare written orders for prescription-only medicines (POM) for yourself or someone close to you, except in the cases of minor ailments or emergencies.
  • You should store all drugs according to the manufacturer’s instructions.
  • You should report adverse reactions to medicines or medical devices using the appropriate reporting schemes.
A422
This Guidance does not change what you must do under the law.
A423
You must always act in accordance with the current legislation controlling the use and supply of drugs in optometric practice148, 149.
A424
You must only supply drugs when it is appropriate to do so. 
A425
You must maintain appropriate knowledge and skills when administering?  drugs in your practice. Information on this can be found in the Optometrists’ Formulary.150 Your knowledge should include:  
  1. actions
  2. interactions
  3. cautions
  4. contraindications
  5. side effects.
A426
You should take particular care when administering or supplying drugs to at-risk groups such as very young or very old patients, those with renal or hepatic impairment or patients who are pregnant or breastfeeding.

References

148 Human Medicines Regulations 2012 SI 1916. 
149 MHRA. Medical devices regulation and safety: detailed information [Accessed 19 Nov 2020]
150 The College of Optometrists Optometrists’ Formulary [Accessed 19 Nov 2020]
A427
If you are prescribing antimicrobial drugs you should:151
  1. consider alternative options and only prescribe antimicrobials when this is clinically appropriate
  2. be aware of local guidelines on antimicrobial prescribing
  3. not issue an immediate prescription for an antimicrobial to a patient who is likely to have a self-limiting condition
  4. only issue repeat prescriptions for antimicrobials if these are needed for a particular clinical condition or indication.

References

151 National Institute for Health and Care Excellence (2015) NG15 Antimicrobial Stewardship Accessed 19 Nov 2020]
Checking risks
A428
You must consider the cautions and contraindications for each drug you use in practice.152
A429
There is potential for interaction with some systemic drugs. For example, phenylephrine may interact with systemically administered monoamine-oxidase inhibitors and anti-hypertensive drugs.
Making the appointment
A430
If pupils are likely to be dilated, tell patients when they make an appointment that they might not be able to drive after the examination. Suggest that they bring sunglasses with them. 
Administering drugs
A431
When you use drugs that dilate the pupil, you should consider whether to: 
  1. check the depth of the anterior chamber, for example using the van Herick technique, for the possibility of angle closure
  2. measure intra-ocular pressures as appropriate, for example before and/or after dilation.
A432
The NHS Diabetic Eye Screening Programme does not consider these checks necessary when using tropicamide alone.
A433
You should check corneal integrity, if appropriate.
A434
You should ask the patient if they:
  1. have experienced adverse reactions to eye drops in the past
  2. have a history of drug-induced adverse incidents
  3. have any relevant medical conditions
  4. take any systemic drugs.
A435
You should check for possible interactions with any systemic medication that the patient may be taking.
A436
You should check: 
  1. that you are administering the correct drug and dosage
  2. the expiry date.
A437
You should record all drugs used, including the batch number and expiry date, on the patient record.
A438
You may keep a logbook of which drugs are used on each patient. This will help you if you need to recall patients.
A439
You should explain to the patient: 
  1. why you are instilling the drug
  2. what effects the drops might have
  3. how long the effects might last
  4. the side effects they might experience
  5. if you are dilating their pupils, that they might not be able to drive and must not undertake any activity which is not advised after dilation, and for how long
  6. if you are using anaesthetic drops, that they should avoid wearing contact lenses for an appropriate period of time after anaesthesia
  7. what to do if they experience an adverse reaction.
A440
You may give the patient an information sheet.153
A441
You should tell the patient to attend the local Accident and Emergency department if you are not available to deal with any emergency or adverse reaction that may arise following the instillation of the drug. 
A442
You should inform the patient’s GP of any suspected adverse reaction. See also paragraph A458.
Delegating the instillation of eye drops
A443
There is no legal restriction on who can instil eye drops to a person. The law only restricts supply of the drops. 
A444
You are responsible for the instillation of eye drops and so, if you decide to delegate this to another member of staff, you must be on the premises whilst this is being done so you can intervene if necessary.154 You are responsible for the management of the patient and the work of the person to whom you have delegated the procedure. See section on Working with colleagues.

References

152 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 7.6 [Accessed 19 Nov 2020]
153 The College of Optometrists. Instillation of eye drops tear-off pads (College members only) [Accessed 19 Nov 2020]
154 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 9.3 [Accessed 19 Nov 2020]
A445
In the course of your professional practice, you may sell or supply:
  1. all medicinal products on a General Sale List (GSL)
  2. all pharmacy (P) medicines.
A446
In an emergency, in the course of your professional practice, you may sell or supply certain POM which are not for parenteral administration. You should check the Optometrists’ Formulary for further details.155
A447
The drugs that are covered by paragraphs A445 and A446 can only be supplied to patients by a registered optometrist or dispensing optician. There is no provision for you to delegate or supervise this supply.
A448
The POMs that are mentioned in paragraph A446 can be supplied to the patient by a pharmacist on presentation of a signed order from an optometrist without it needing to be an emergency. If you write a signed order for the supply of a drug by a pharmacist you must include your GOC number on the order. You should use standard abbreviations; examples are provided in Annex 2.
A449
You must be aware of the indications, cautions, contraindications and side effects of any drugs you supply.156
A450
You must ask patients about any drug-induced adverse incidents and known drug allergies before supplying them with drugs.157
A451
You must tell patients how to use the drug. You should tell them what to do in the case of an adverse incident.

References

155 The College of Optometrists Optometrists’ Formulary [Accessed 19 Nov 2020]
156 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 2.5 [Accessed 19 Nov 2020]
157 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians, para 7.3 [Accessed 19 Nov 2020]
A452
You should not treat yourself or someone close to you or prescribe or prepare written orders for POM drugs for your own personal use or for anyone with whom you have a close personal relationship unless:158 
  1. you are treating minor ailments, or
  2. it is an emergency.
A453
If you prescribe for yourself or someone close to you, you should: 
  1. record this in the patient notes, including your relationship to the patient and the reason for the necessity of prescribing
  2. tell the patient’s GP and others treating the patient, if relevant, what you have prescribed and other information required for continuity of care, unless the patient objects.

References

158 General Medical Council (2013) Good practice in prescribing and managing medicines and devices [Accessed 19 Nov 2020]
A454
Optometrists may supply or administer drugs to patients under a Patient Group Direction (PGD). PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.159  You must ensure you meet the criteria in the PGD. You should work to local protocols. 
A455
You may be involved in community services or be co-managing patients, such as those who have had surgical procedures, and need to supply or administer an ocular medication that is not on the list of drugs you can use or supply under the exemptions in paragraphs A445 and A446. You may do this under the authority of a PGD, see paragraph A454.

References

159 MHRA (2017) Patient Group Directions [Accessed 19 Nov 2020]
A456
You should: 
  1. store all diagnostic and therapeutic drugs according to the manufacturer’s instructions, and
  2. keep drugs out of patients’ reach.
A457
You must follow the current legislation on the disposal of hazardous waste.160 You must ensure drug waste is disposed of in accordance with the regulations.161 See section on Infection control.

References

160 Environmental Protection Act 1990 s34 [Accessed 19 Nov 2020 2020]
161 The College of Optometrists (2014) Guidance on the disposal of waste [Accessed 19 Nov 2020]
A458
You should use reporting schemes for adverse drug reactions . There are two reporting schemes, operated by the MHRA. These are: 
  1. the yellow card scheme which covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medication162
  2. the Medical Devices Reporting Form which covers adverse incidents mainly relating to contact lenses and care products, including contact lens comfort drops.163

References

162 MHRA Yellow Card Scheme: guidance for healthcare professionals, patients and the public [Accessed 19 Nov 2020]
163 MHRA. Report a problem with a medicine or medical device [Accessed19 Nov 2020]

The College of Optometrists Optometrists’ Formulary [Accessed 19 Nov 2020]

The College of Optometrists Clinical Management Guidelines [Accessed 19 Nov 2020]

The College of Optometrists Guidance for Optometrist Prescribers [Accessed 1 Aug 2019]

The College of Optometrists higher qualification in independent prescribing [Accessed 19 Nov 2020]

The College of Optometrists: information and guidance on myopia management [Accessed 19 Nov 2020]

The College of Optometrists patient information on the instillation of eye drops (tear off pad) [Accessed 19 Nov 2020]

National Institute for Health and Care Excellence (2015) NG15 Antimicrobial Stewardship [Accessed 19 Nov 2020]

National Institute for Health and Care Excellence (2016) Quality Standard QS121: Antimicrobial stewardship [Accessed 19 Nov 2020]

Royal Pharmaceutical Society (2016) A Competency Framework for all Prescribers [Accessed 19 Nov 2020]

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