Coronavirus

During the acute phase (lockdown) of the pandemic, cancellation of non-sight threatening appointments and surgical procedures along with strict social distancing has led to an unprecedented pressure on the NHS. It has resulted in decisions where the risk of delaying treatment have been balanced against the risks of continuing with assessment and treatment especially in:

• The risk of the transmission of COVID, in the case of face-to-face assessment
• The risk of mis-diagnosis in any form of remote assessment, particularly with a new patient

For orthoptic departments this had resulted in most of their booked patients being cancelled and / or safely deferred.

Whilst many services have resumed some clinical activity, seeing the medium risk patients and those who have been delayed, there is still large variation across services. It is expected that, where possible, low risk patients remain on virtual and remote consultations (See RCOphth’s interim guidance). However, patients in the medium risk categories who have been delayed may have moved into the high risk category and should be seen face to face during the recovery phase

BIOS have published updated guidance on the management of orthoptic patients during the recovery phase, available here.

[Updated 16 July 2020]

Please consider the following for all your clinical interactions with patients:

1. Keep the examination as brief as possible and pertinent to the decision making required. Perform the necessary tests, which can be repeated on subsequent appointments in order to reach a diagnosis or a clinical impression. Where appointments are held jointly with another professional, consider jointly the minimum tests that are required for a safe clinical decision to be made and document this in the notes.
2. Consider creating a COVID-19 temporary clinics standard operating procedure (SOP)
3. Keep history taking for both medical and ophthalmic history to a minimum and don’t repeat it if it has already been taken in emergency eye clinic (for example)
4. Consider a pre-appointment telephone call or a video consultation with the patient to ascertain as much information as you can (e.g. current treatment, concerns), and explain the changes to the clinical environment that you have in place to ensure the face to face consultation is safe e.g. social distancing, reduced footfall, PPE, face masks for patients and carers if applicable
5. Keep more than 2 metres away from patients, except where the clinical examination requires it
6. Limit the number of accompanying adults or siblings attending with the patient. Patients and carers should be advised of this prior to the appointment via pre appointment call, text or letter.
7. Avoid touching the patient wherever possible
8. Allow sufficient time between each appointment to maintain standards of hygiene and cleanliness including hand washing, cleaning of all equipment and clinical room used before and after patients, wiping all surfaces between consultations and of course bare below the elbow. Ensure that you follow the national recommendations on the use of PPE and that you are also familiar with your organisational guidelines, the manufacturers guidelines for cleaning specialist equipment, and local infection control guidelines.

[Updated 13 July 2020]

The latest government guidelines, relevant across the UK,  on infection control during the epidemic is available here, which includes:

• PPE Guidance
• Tables showing recommended PPE for secondary care inpatient clinical settings and for primary, outpatient and community care.
• Guidance on staff uniforms is available here. Organisations may supply you with theatre scrubs, if you do not usually wear uniform but are likely to come into close contact with patients.

Orthoptists, like other ophthalmic clinical professionals, are in prolonged close contact with patients when performing clinical assessments, and therefore may be at higher risk of infection than other specialities. The Royal College of Ophthalmologists have therefore adapted the PHE advice on infection protection, available here.

In England, the government issued guidance, as of 15 June, on the wearing of a facemask in all settings:

• NHS Employers and NHS Trade Unions have produced a Communications Toolkit for Trusts following this government guidance, available to download here. Members should also refer to their organisational guidance, which will set out local operational arrangements.
• An FAQ is available on these changes, here.

This is a useful leaflet detailing how to make a Children’s size surgical face mask.

Download our guidance document here.

There’s also published guidance from the RCOphth, available here.

NHS England have a guide to the management of remote consultations and remote working, available here.

We have developed advice with RCOphth on the sue of home vision testing apps as an adjunct to telemedicine, available here.

• The BIOS CAGs have provided resources and useful links for use by patients, many of which may be helpful, available here.
  • We have a number of leaflets and links to further resources for use with patients following strokes and brain injuries here.
  • There are a number of resources linked to on the Low Vision CAG page.
• There is a specific section on COVID-19, on the Sight Advice FAQ, which has advice on eye health and living with a sight condition.
• The Starting Point leaflet is also available for download, giving advice to parents and carers of children with a visual impairment.

• An accessible leaflet for explaining coronavirus to children under 7

NHS: ‘Open For Business’

While many eye care appointments have understandably been deferred during the coronavirus pandemic, it is important that patients are reassured that urgent and emergency eyecare, the NHS remains open for business.

There is concern around people not attending emergency eyecare and not seeking help for potentially serious conditions in the case of loss of vision or the sudden onset of double vision.

The NHS has launched a campaign, Open For Business, to emphasise that people should still seek help for urgent and emergency medical conditions. We would encourage our members to spread the word about the importance of seeking helping if people are experiencing rapid changes in their vision and for urgent and emergency eye care to help to prevent hundreds of people unnecessarily losing vision.

NHS England and NHE Improvement have released the following FAQ on the testing of asymptomatic staff:

Asymptomatic staff testing

Useful questions to ask where staff are in a vulnerable group (pregnant, have underling health issues or are over 70).  This should also be considered for staff who are named carers for vulnerable child and adult dependants who may be at significant risk should they become infected.

The main objective is to minimise exposure and risk for the employee and where possible enable them to continue working.

Your organisation may already have a risk assessment guide in place but if not the following may be useful questions to consider and it is important to link in with your HR managers and Employee Health wellbeing services.

1. Are they able to maintain social distancing in their normal duties?
2. Are they required to assess patients face to face in their normal duties?

If the answer to questions 1 or 2 is yes, then you should consider the following:

• How much exposure or interaction do they usually have with colleagues?
• Could they conduct telephone consultations to make appropriate decisions?
• Are they able to avoid direct exposure to suspect or confirmed COVID -19 cases?
• Are they able to work in another location which minimises their exposure?
• Are they able to work alternative hours to avoid risk ?
• Are they able to work remotely at home – what activities could they support at home?
• Can they attend staff meetings, huddles or other meetings by phone or video conferencing?

Make a note of all discussions and also recognise the anxiety of staff particularly as advice is changing so rapidly.

[Updated 12 February 2021]

If you’re a frontline worker, you are more likely to be exposed to COVID-19 at work. Orthoptists, orthoptic support workers and technicians, and orthoptic students working directly with patients are at much higher risk of repeated exposure to the infection. The government’s official COVID-19 guidance, known as the COVID-19 green book, makes clear that anyone working in a frontline health or care role, regardless of who for or in what capacity, is eligible for a vaccine:

“Staff involved in direct patient care […] should also include those working in independent, voluntary and non-standard healthcare settings such as hospices, and community-based mental health or addiction services. Temporary staff, including those working in the COVID-19 vaccination programme, students, trainees and volunteers who are working with patients must also be included.”

Recent Government advice makes it clear that hospital vaccination hubs are expected to be the default provider of vaccines to all health and care staff, including private and the third sector, as well as bank or temporary staff. Government guidance is being developed to clarify how private practitioners can access the vaccine and demonstrate their eligibility.

Approaches in each nation

• In England all eligible frontline health or social care workers can now book their vaccine through the National Booking Service. You are advised to try online booking first but if this is not possible, they can phone 119 free of charge, 7am to 11pm, 7 days a week.
• In Northern Ireland, information has been provided on how you can access a vaccine if working in private practice that should have been communicated to you. Please contact us if you have not received such a notification and we can pass on a link.
• In Scotland a letter has been circulated with details on how you can contact your local health board to arrange a vaccine. Although dietitians are not specifically mentioned, you are eligible for a vaccine if you work in a patient-facing role.
• In Wales independent and private frontline staff will be vaccinated alongside NHS colleagues. Health boards should be in touch with you directly, and are using HCPC registration lists to make contact. Please let us know if you feel you have been missed.

The role of vaccinator can be undertaken by anyone who can work legally under a Patient Group Direction (PGD), which includes orthoptists.

While this is outside the scope of an orthoptist, and therefore not covered by BIOS insurance, any orthoptist undertaking this procedure would be covered by their Trust or Board indemnity and support from the HCPC, so long as the correct PGD was in place and they are trained and given sufficient resources to do this task safely. The HCPC have released statements to say they understand practitioners may be taken out of scope of practice to support the pandemic.

The HCPC has published advice for registrants on how they can support the COVID-19 vaccination programme over the four countries of the UK. Read Vaccinations: what you need to know.