The advent of Primary Eyecare Acute Referral Schemes (PEARS) and Minor Eye Condition Services (MECS) has changed the landscape of optometric practice and has affected both optometrists and dispensing opticians. But it is a journey only part-travelled so far.
Despite the widespread adoption of these initiatives, there are a number of really important issues that have not been nailed down.
Fundamentally, as MECS expands, an entirely different needs-based group of patients are appearing in practice. Most schemes require a rapid response – typically the same day or within 48 hours. This means significant first point contact with reception staff and, on occasions where an appointment is not available, signposting to a fellow MECS provider or indeed A&E.
MECS diagnosis and treatment means that a high proportion of patients are not referred and the majority of MECS patients will not be sight threatening emergencies. However, some are, and managing these patients is critical for the efficient running of the practice, the credibility of the profession, the registration of the optometrist and of course the eyesight of the patient.
A handy resource
Scotland-based optometrist Stanley Keys has fully embraced the above concepts and in doing so has produced an Eye Emergency Resource Pack for practices.
At BBR Optometry, we have had the opportunity to review the pack and assess its value in managing our growing MECS clinics where we see three or four MECS patients every day, with one optometrist rostered to that clinic daily.
The Eye Emergencies Resource Pack consists of a triage sheet, an emergency eye card crib sheet and training resources.
Th triage tear off sheet is a carbonless duplicate so that when completed it can be given to the optometrist or the patient to take to the clinical service they have been signposted to. The sheet records the date and time of attendance, as well as the patient’s name, date of birth, phone number and GP details.
It is clearly laid out so that the eye affected and principal complaint can be recorded. There is a check list with symptoms ranging from redness through to discharge, double vision and headaches. Instead of recording a clinical measure of vision, the form uses patient terms which helps to focus their response.
There is space to record pain levels and duration of the symptoms, which may be important for MECS contracts, as well as clinically. There is also space to record either the optometrist’s advice or what to do if there is no optometrist available.
We have used this sheet mainly for those rare situations where we do not have an emergency slot available. The layout and design lends itself to a systematic recording which is vital, especially if the clinical assistant or receptionist is going to decide who is seen first.
Personally, I do not think it is appropriate to squeeze MECS, PEARS or any emergency patients into a fully-booked clinic. This is why we set aside an hour each day with the expectation that at least three patients will need be seen by the duty optometrist. This is relatively easy for us as we are usually running three or four clinics. However, it will be harder in a single-handed practice. Nevertheless, people have different emergencies, sometimes just broken spectacles or sometimes non-clinical contact lens emergencies, and if you don’t have a slot to see them, they may go somewhere else and you might lose them forever.
Emergency eye card crib sheet
The emergency eye card is a double-sided colour A4 landscape card with six important conditions detailed. The card is wipe clean and high quality because it is intended to live on or close by the reception desk. The six conditions detail the presentation and appearance of conditions so that non-familiar staff can learn the relative differences. These are: painful red eye, ocular injury, sudden loss of vision, flashing lights and floaters, distorted/blurred central vision, and other situations.
At BBR Optometry, which relies heavily on networked workstations and does not use paper record cards, we have found it useful to scan the documents as PDFs, which sit on the operator’s desktop.
Training resourceThe training resource is a series of flash cards that can be used as part of an educational, training and refresher session so that all staff including reception, clinical and managerial can train together. It cannot be over-estimated how useful it is, especially with new optometrists, to enable them to see the level of skill and training that exists at the front desk.
Overall, the pack is well-designed, well-produced, well-printed and clearly thought out. As more and more MECS schemes come on line and as optometric practice moves further into disease management, such a resource will be invaluable in changing the culture from a sight testing role.