Guidance and Advice for Orthoptists2020-06-05T15:00:00+01:00

Guidance and Advice for Orthoptists and Orthoptic Professionals

Below you will find guidance on working and keeping safe, as well as updates on the effect of this on BIOS events and ongoing work.

We hope you find this helpful but please do let us know if you have any specific concerns or enquiries.

The priority for BIOS in such a challenging time is, as always, the physical and mental health of our members.

Follow official guidance and organisational action plans which are changing daily – the most up to date details from each country can be found here:

If you do not feel well and have any of the symptoms described you should not attempt to go into work and should follow the guidance about self-isolation – this is to keep you and your work colleagues safe.

BIOS have put together some guidance on telephone consultations and social distancing.

Follow all infection control guidelines in line with the public health guidance and your own organisational policies.

The advice of your HR directors and advisors will support those staff currently off work and returning to work following self-isolation or absence, cancellation of holidays, school closure plans, and caring for relatives and dependents.

If you are asked to support other areas outside of your department, you will have been graded on the type of skills you have and, in general, we would expect this to consist of tasks common to a HCA role (feeding patients, escorting patients, basic care, etc).

If you are asked to do any specific tasks outside of your existing skill set, you should receive relevant training and be signed off as competent. You should not be asked to do anything outside of your own skill set.

Heads of service – please ensure you have risked assessed all your staff members in case of them being asked to support other wards and departments. Staff with long term conditions, or those who are immunocompromised may not be safe to be moved into another working environment, as this would put them at risk.

A number of statements have been put out relating to working flexibly and outside of you usual scope:

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

  1. Keep your assessment and examination as brief as possible
  2. 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)
  3. Aim to keep your interaction to under 15 minutes
  4. Keep more than 1 meter away from patients except where the clinical examination requires it
  5. Limit the number of accompanying adults with the patient
  6. Avoid touching the patient wherever possible
  7. Only do the minimum of relevant clinical tests to reach a diagnosis – this might be a VA, CT, OM only
  8. Do not spend excessive amounts of time measuring deviations and finding a prism to correct diplopia. It is acceptable to use blenderm or another form of occlusion as a temporary measure where the strength of prism cannot quickly be identified
  9. For visual acuity testing, where possible start with the lowest achievable line where possible and avoid near visual acuity testing where possible.
  10. Maintain standards of hygiene and cleanliness including hand washing, cleaning of all equipment used before and after patients, wiping surfaces between consultations and of course adhere to bare below the elbow.

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

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.

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.

On the specific issue of using tele-ophthalmology apps for vision testing in young children, we have published a joint-statement with RCOphth, available here.

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.

During the response to COVID-19, many Orthoptists may be asked to work outside of their normal scope of practice. This should in most cases be covered by your employer’s insurance scheme and the emergency legislation passed by the Government (Coronavirus Act 2020) includes a safety-net indemnity clause, designed to close any gaps in cover for healthcare workers assisting with the response. However, it is recommended that you clarify this with your employer before agreeing to any extra duties.

BIOS members gain full coverage for anything that falls within the the scope of orthoptic practice. There is more guidance for members on liability insurance here. For specific advice on remote consultations, we have a guidance document here.

You can find full details of the Professional and Public Liability Insurance available through BIOS on the Graybrook website: https://www.graybrook.co.uk/bios-members.

It is very likely all departments will be asked to reduce orthoptic activity and make plans for managing high and low risk patients. Where your organisation has a risk stratification in place you will be guided by that, especially where you support extended roles services for ophthalmology. Ophthalmology sub specialities will have their own risk stratification in place and may be advised by the RCOphth or large units.

  • Many core orthoptic patients can be safely triaged or have a follow up conversation by telephone or video / skype call. You can read our guidance on remote consultations here.
  • A significant number of patients can be safely delayed for a face to face consultation for up to 3 months, for example children having amblyopia treatment or monitoring of strabismus, but you may consider swapping children from atropine to patching in this instance. There is specific guidance from the RCOphth on the management of plans for children and young people, available here.
  • Many can be safely delayed for a 6-month period, for example those on no active treatment but being monitored or patients with Fresnel prisms not reporting any diplopia on phone conversation.
  • New patients can be triaged safely by phone call or video, making a judgment on the nature of the referral as to how urgently this patient needs to be seen, in line with risk stratification guidelines.
  • As a HCPC registrant use your judgement to mitigate the risk and identify truly urgent patients that require face to face consultations.
  • Many non-essential community services may be stopped entirely. For example, recent NHS England guidance on COVID-19 Prioritisation within Community Health Services advises that child vision screening services are to be halted. The inevitable backlog will have to be managed once these services are able to resume.

The RCOphth have published an escalation policy on their website which you might find helpful in making some decisions

https://www.rcophth.ac.uk/2020/03/covid-19-update-and-resources-for-ophthalmologists

With many active treatments and appointments delayed during the lockdown phase of the COVID-19 pandemic, there are a range of principles to consider in planning for the reopening of services in the initial recovery phase.

We have produced a guidance document, available for download here.

This builds on and can be used in conjunction with the guidance from RCOphth, available here.

On the specific issue of using tele-ophthalmology apps for vision testing in young children, we have published a joint-statement with RCOphth, available here.

Find out more about returning to the NHS 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.

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.

Other Useful Links

Public Health England are constantly updating and adding to the advice and resources available to health professionals and the public:

There is also a huge amount of regularly updated information available from the Royal College of Ophthalmologists – https://www.rcophth.ac.uk/2020/03/covid-19-update-and-resources-for-ophthalmologists/

The North West AHP Network produce a regular summary of resources for the AHP workforce, available from their website: https://www.ahpnw.nhs.uk/latest-news/422-covid-19-information-and-resources-for-ahps-latest-version-now-available

Letters and Statements

Joint letter on supporting AHPs and Support Workers during the COVID-19 epidemic – https://www.england.nhs.uk/coronavirus/publication/letter-supporting-allied-health-professionals-and-allied-health-professional-support-workers-during-the-covid-19-epidemic-in-the-uk/

Statement from UK’s Chief AHP Officers and the HCPC regarding returnees to the register – https://www.hcpc-uk.org/news-and-events/news/2020/statement-from-uk-chief-ahp-officers-and-the-hcpc/

Four-Nation statement from UK’s Chief AHP Officers on allied health professionals’ roles in rehabilitation during and after COVID-19 – https://www.england.nhs.uk/coronavirus/publication/allied-health-professionals-role-in-rehabilitation-during-and-after-covid-19/