Navigating thorny situations in practice

AOP experts addressed how to navigate challenging situations in practice during the 100% Optical presentation, Tales of the unexpected.

Director of legal and regulatory at the AOP, Ella Franci, began the session by outlining the components of clinical negligence.

She explained that clinical negligence is an act or omission that does not meet the level of appropriate care expected, which results in injury or loss.

Franci highlighted that a claim will only be successful if the claimant can establish causation as well as a breach – that the actions of the individual caused the injury or accident to happen.

Optometrists are not judged against the standard of a “super optometrist or the best of the best,” Franci emphasised.

She observed that their actions would be compared to a competent optometrist acting in a reasonable way in everyday practice.

Franci outlined limits on the time to bring clinical negligence proceedings – three years from either the date of injury, knowledge of the injury or death of the patient, or if the patient is a minor, three years from the date of the patient’s 18^th birthday.

AOP clinical and professional director, Dr Peter Hampson, outlined a series of case scenarios that illustrated challenging situations in practice.

Describing a case of amelanotic choroidal melanoma, Hampson emphasised the importance of looking at images that have been taken – including images that are part of the clinical record.

“You need to satisfy yourself that it is OK – not just follow what the last optometrist thought,” he observed.

Turning to a case that could appear to be dry age-related macular degeneration, but was in fact a macular hole, Hampson encouraged optometrists to review optical coherence tomography (OCT) scans.

“If an OCT scan exists and you have not reviewed it, you are in a fairly difficult place,” he said.

“That’s something that we are seeing increasingly often – people saying that they didn’t know there was an OCT or they didn’t see it,” he added.

Hampson outlined the case of a patient presenting with a form for completion of his HGV driving licence – but the sight test reveals incongruous findings to the patient’s last examination in practice four years ago.

Hampson revealed that this was a case of mistaken identity and encouraged optometrists to ask for photo identification when filling out licence paperwork.

He added that the regulatory team has seen a few cases where optometrists have completed a licensing form in a rush, filled in the wrong box and the patient has lost their HGV licence as a result.

The final case centred around an optometrist supervising a pre-reg who examines a patient with wet age-related macular degeneration (AMD).

Hampson emphasised the importance of checking the referral urgency and referral location when reviewing the pre-registration optometrist’s referral letter.

He outlined referral and safety netting guidance that the AOP has developed. When explaining the need for referral to a patient, Hampson recommends providing enough information so that the patient will take the appropriate course of action – while also trying not to cause them unnecessary worry.

Hampson added that the patient should also be advised to contact the practice if they have not heard from the hospital within a reasonable timeframe taking into account the referral urgency. He highlighted that this was the motivation for the new safety netting template: to keep patients and practitioners safe.