In daily practice, tasks are delegated in order to ease the workload on the optometrist. Optometrists should be aware that if they delegate a task, they are 100% responsible for that test and its results. They need to be assured that the people they are delegating to are competent, capable and trained to undertake the task safely.
This assurance should come easily to those who work full-time in a practice and relatively easily to those who work part-time in a practice. However, it can come with considerable difficulty to those who are a locum.
In this instance, I think that the best a locum can do is to ask questions. This could be done with a standard question such as ‘What training have your support staff had?’ or ‘How sure are you of their competence?’ in each new practice they work. I would also encourage locums to make a note of the answers in, for example, their AOP Locum Logbook.
Another suggestion is, if they have time, re-check the odd result in order to assure themselves of a person’s competence.
“At no point should a delegated task be undertaken and the optometrist not see the results”
What tasks to delegate
Prior to delegating tasks, I would urge all optometrists to read and be familiar with advice from optical bodies on their views on delegation. This includes information from the General Optical Council in relation to its Standards of Practice, the AOP and the College of Optometrists.
When it comes to identifying the tasks that can safely and appropriately be delegated, there are some obvious ones such as visual fields, tonometry and taking fundus photographs.
However, what is key with any delegated task is that the result must come back to the optometrist for approval and sign off.
At no point should a delegated task be undertaken and the optometrist not see the results. This particularly applies when delegating a task to be repeated at a future date. For example, if an optometrist requests repeat visual fields on another day, it is easy enough if they are in for the results to be brought to them – and they need to make sure that they are. However, if they are a locum and are not going to be in on the day of repeat, they need to ensure that there is a system in place for them to see the result when they are next in, or that responsibly has been transferred to a resident optometrist in the practice to see and act on the results.
This is one of the classic ways that things fall through the cracks – a repeat test gets done, but it does not feel like it is particularly anyone’s responsibility to look at the results, so it does not happen.
“When delegating, be very clear about what you want done, how you want it performed and that you want to see and sign off the results”
On the premises
A question I am commonly asked is: ‘Do I have to be on the premises when a delegated task is being undertaken?’
The College of Optometrists has extremely useful advice on this. It says: “If harm could result from the procedure, you must remain on the premises so you can intervene if necessary.”
In my opinion, harm is unlikely to occur from performing visual fields, or from non-contact tonometry (assuming the results are reviewed). But, it might occur from Goldmann tonometry, for example. Therefore, optometrists should use their judgement accordingly.
When delegating, be very clear about what you want done, how you want it performed and that you want to see and sign off the results. And remember, you shouldn’t be delegating a task to someone who does not know how to do it. Therefore, you shouldn’t be explaining how something is done.
Image credit: Getty