Remote consultations during COVID-19 pandemic

  • 1 Apr 2020

These temporary guidelines have been written to help optometrists who are conducting remote telephone/video consultations with patients.

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In-practice forms

Visual Acuity chart for remote consultations (15 April 2020)

Clinical telephone review form (1 April 2020)

Supplying replacement spectacles by phone (19 Marc 2020)

Supplying replacement contact lenses by phone (19 March 2020)

 

1.  Introduction

1.1    We are publishing these temporary guidelines to help optometrists who are conducting remote telephone/video consultations with patients rather than asking them to come into the practice, to help with social distancing during the COVID-19 pandemic. These guidelines will no longer apply when the pandemic is over, and life returns to normal.

1.2    During the COVID-19 pandemic, people have been instructed not to leave home for non-essential purposes, and so optometrists have a role to play in assessing whether or not a patient really needs to come into optical practice to be seen, whether their care can safely be delayed, or whether they can be supported to self-manage until such a time as the social distancing measures are over. This guidance aims to help optometrists in their decision making.

1.3    This guidance should be read in conjunction with the telephone triage sheets for remote spectacle and contact lens prescribing.

1.4    We understand that not all practices will be able to provide urgent/emergency and essential eyecare services. If you do not provide these services and there is a locally commissioned practice that does, you should direct patients to that practice. This may be done by way of a practice answerphone message, notice on your website and a sign on the practice door.

1.5    The GOC has clarified that ‘Uncertain times mean that our registrants may be called upon to work at the limits of their scope of practice and vary their practice for protracted periods of time and in challenging circumstances.’  They have issued a series of statements which they ‘hope to reassure our registrants and the education sector that when they act in good conscience, for the public benefit, exercising professional judgement in all of the circumstances that apply, the GOC will support them’.  (Accessed 31 March 2020)

2. Steps to take

2.1    Introduce yourself to the patient and make sure you confirm their identity and correct contact details.

2.2    Make sure you conduct the telephone/video consultation in a private place, just as you would if the patient were in the practice, even if you are doing this from home.

2.3    Check that the patient is happy to have a conversation. For example, they may wish to move to somewhere private so that they cannot be overheard.

2.4    If the patient has symptoms of COVID-19 as well as symptoms of a life- or sight-threatening condition, do not see them in your practice. Contact your local hospital for advice, telling them that the patient has symptoms of COVID-19.

2.5    Patients may contact you with a variety of concerns.  Before seeing the patient you should discuss the concerns with the patient remotely – by phone or video call – to help you decide whether you need them to come into the practice. We have issued a telephone triage sheet to help you record your conversations.  

2.6    If a patient contacts you about lost or broken spectacles or if they need contact lenses you should use your professional judgement as to whether you need to re-examine the patient, or whether you can simply post them a replacement pair of spectacles or contact lenses.  We have designed triage sheets to help you with this.

2.7    If the patient contacts you with a clinical problem you should decide which of the following categories the patient falls into:

  • If it is obvious that the patient has an emergency life or sight-threatening condition you should contact the appropriate eye casualty department for advice without the patient coming in to see you.  Follow local referral protocols if available.
     
  • If the patient has a potentially life or sight-threatening condition, consider whether you can add value by seeing the patient to potentially avoid a hospital referral.  If you are likely to refer the patient anyway, contact the hospital for advice without asking the patient to come in to see you.  Ensure you include the information that makes you feel this patient needs to be seen urgently by the HES.
     
  • If the patient has any other eye condition, consider whether the patient can self-manage the condition at home, particularly if it is self-limiting.
     
  • If the patient has no symptoms, and wishes to have a routine eye examination or contact lens check-up, postpone their appointment until social distancing measures have been lifted.

2.8    When determining what the appropriate management of the patient is, consider the following:

  • Patients with acute symptoms that are worsening are more likely to be urgent than those with symptoms that have not changed
     
  • Does the patient have any additional risk factors, such as previous ocular or family history or medical conditions?
     
  • What action is likely to be taken by the hospital if your provisional diagnosis is confirmed?  If the hospital is unlikely to see the patient, do you need to see them (remembering that routine ophthalmology appointments have been suspended)?
     
  • Do you have access to the patient’s previous optical records?  If not, do you need this to make a decision?  

2.9    You should make clear notes of any discussions you have with the patient, and any observations you make during a video call. You may do this using your usual practice record-keeping system, making it clear that this is a telephone or video consultation (as appropriate) because of the COVID-19 pandemic. Alternatively, we have a template for this that you can use.  You should clearly document the questions that you have asked, the patient’s responses, and what you have advised the patient to do.  


2.10    As for all clinical records, records of telephone or video consultations should be kept securely. This may be via the practice record system, securely in the cloud or electronically on a device, or - if you are working remotely and using paper records – in a secure place such as a locked cabinet, or in a locked room. When considering whether the storage that you are using is appropriate, ask yourself whether the patient would feel that it was reasonable in the circumstances.  If the answer is no, then you must find an alternative storage solution. The Information Commissioner’s Office has stated that you will need to consider the same kinds of security measures for home working that you’d use in normal circumstances.   

2.11    If you use a personal device to conduct the consultation, ensure any information stored on your personal device is transferred to the appropriate record system and then deleted from your device. This includes back-up data.

2.12    If you examine the patient and need to refer them, send images to the HES where appropriate, to help them advise on the best course of action.  

2.13    Self-care can be supported by emailing or posting advice to patients, for example patient information leaflets or directing patients to useful webpages.

2.14    Patients should be told to contact you again should their symptoms worsen.

Useful information

BMA guidance on conducting remote consultations and home working Accessed 31 March 2020
 

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