Dear optometry colleagues
I am hoping to announce next week that we will be offering an emergency eye services to prevent people attending the hospital. Their resources are being tied up really quickly and without any elective work for the small number of emergencies that are seen, we will be able to support.
Following yesterday’s email, I have had quite a number of queries and have placed them in themes, as most were very similar.
From Community Eyecare perspective, we have limited access to hand gels, face masks and wipes for our medical services. These are being rationed. There is no quick fix. However, due to the space and footfall through our surgical units, we have initiated practical solutions to conserve our PPE.
- As this CV-19 situation will be a long term situation we want to protect our staff as well as patients. We have had slit lamp guards bespoke made to prevent airborne transmission when we are close up examining patients. I have attached a picture. We have taken a long term view that even when we get to some normality, the new norm will mean we need to protect ourselves. I have enclosed a picture. They are about 400mm high and 500mm wide with a hole in the centre (this was a quick fix). These have been great and have ordered another 50 which are approx. 350mm x350mm with a rectangular hole for our practices. We are paying about £28 for the big ones and £24 for the slightly smaller. If anyone wishes to have these, our contractor is making them and I am happy to send through your details to deal with him directly.
- Cleaning and disinfection are 2 different things. Cleaning is simply removing germs, dirt etc from surfaces. It does not kill germs. Disinfection refers to using chemicals to kill germs on surfaces.
Remember when cleaning and disinfecting, clean all surfaces high and low, not just surfaces you use. CV-19 is airborne and can land everywhere. When cleaning use gloves if possible with soapy water with a liquid such as fairy. For disinfection, you need to use 70% alcohol which is at a premium. An alternative is household bleach that is unexpired. Generally 5 tablespoons of bleach per gallon of water is enough.
Remove carpets from your practices or anything that isn’t easily cleaned.
At Community Eyecare cataract and surgical centres we have made a policy of deep cleaning with the required disinfecting fluids daily, wiping all chairs, floors, doors…..anything we need and can see to clean. This is now routine.
Similarly we have numbered our chairs in the waiting room to ensure the correct 2metre separation. For those at risk, over 70 year olds we have designated set waiting areas away from other patients.
- If all else fails, you can use soapy water but please please please please wash your hands properly before touching a patient or equipment. This is so important. Patients will really appreciate that you have taken measures for there safety. Even when they are in the shop looking at frames just politely ask them to ensure they only touch select frames, clean after them but keep your distance.
- Community Eyecare we are ‘business as usual’ as best as can be. I understand we are different in that we are medical and not necessarily retail but we have started lengthen all appointments to double time so there isn’t much overlap between patients.
Post op cataracts.
We are in a situation that essentially we are now triaging as many patients as possible and trying to isolate those patients who have potential problems. Most patients with post op inflammation are asymptomatic and when referred, it is not uncommon not to treat. If patients are symptomatic with red eye and reduced vision (when immediately after surgery it was good) should be referred. IOP spikes post op are generally steroid induced and when seen by optoms, they are either stopping or have stopped treatment so when they come to an ophthalmologist the IOP is essentially normal. I cannot tell you what to do with every patient but I would recommend to be sensible. If you think a patient needs to be seen urgently, then refer. If you are unsure, book the patient in to see you when open but have a risk register of these patients so they will not get lost. there is currently quite a lot of flexibility with governing bodies.
Flashing lights and floaters
The current principle is to limit patient contact for all health professionals. A simple rule of thumb is that if symptoms have developed within 7 days they need to be seen within 48 hours and after 7 days then need to be seen within a week. This does depend on a few scenarios which probably isn’t sensible going into every scenario. However, the general principle is that the pathway should be one clinician. If you can confidently see a patient and not find signs of RD then discharge with RD advice, do not refer ‘just in case’. If you feel the risk is high, e.g. very high myope, then refer urgently to an ophthalmologist.
I could go through many conditions in a similar way but the principles are the same, keep yourself and patients safe, maintain hygiene, distancing measures and limit contact with patients.
We are in discussions with all our commissioners to instigate our virtual AMD clinics. These were planned in for April 2020 but will be brought forward. I will provide greater detail hopefully next week.
By way of CV-19, the numbers are escalating rapidly and with bars, cafes etc all now closed it is important we ensure social distancing. It is a time that we do need to look after our elderly neighbours so if you do have neighbours nearby, please help out. We are instigating a red and green card system in all of our practices, where red means we have a high risk patient and green a low risk patient. this is given to the patient and the clinician immediately knows the risks are higher. This can be adapted to neighbours who you may provide a green and red card, if they leave it green they do not need help, but if red then knock on the door and offer assistance. It means you don’t have to keep knocking and it’s an easy way of monitoring.
For obvious reasons, please do not send referrals via post. Please can you use our referral portal so no patient gets lost in the system.
Finally, before my next update on Monday, where I will hopefully add some clarity on the emergency pathways we will be starting, commissioned or not it’s the right thing to do.
Again, we added on another 20 or so optometrists from yesterday so the messages are being disseminated which is great. Once again forward to any of your colleagues for information.
Imran Rahman MB BS FRCOphth
CEO and Consultant Ophthalmologist
Dear Optometry colleague,
I hope this email finds you well as possible in the current climate. These are unprecedented times for us all with concerns centring around our loved ones and our businesses. As many of you work extremely closely with Community Eyecare across the UK, you will know that we will be as supportive and interactive as possible. A key part of the anxiety is the fear of the unknown so I will be sending almost daily updates of CHEC’s Readiness Plans and how we aim to support the optometric community.
All elective work in every NHS acute hospital will cease on the 14th April 2020, with most already stopped. However, Community Eyecare clinics will remain open throughout the entire period of the coronavirus epidemic in all areas. We remain fully staffed, bar some isolations, from a clinical and administration viewpoint. As guidance, those areas around the country where we hold contracts with CCGs for optometry and ophthalmology should function in a normal manner sending referrals direct to us through our referral portal or other agreed local pathways. It is evident that the NHS are increasing the readiness for acute hospitals to take on those unfortunate sick individuals who need acute care, so we are taking the initiative in ensuring all ophthalmic patients are seen by our ophthalmologists in the community. Indeed, we are fortunate that Community Eyecare are unique in that we manage all patients with all conditions from wAMD to general ophthalmology and are supported strongly by optometry colleagues.
For guidance to those many optometrists who work with us delivering optometry, ophthalmology or surgical pathways, we would recommend the following:
- For pre cataract assessments, these patients are generally already in attendance at practices so please send patients through our portal or the optometry pathways of our electronic system.
- For post cataract assessments, we are recommending a telephone consultation with the patients. No formal vision or refraction is required at this time. The electronic pathway is to be completed as normal which will register the patient and generate the episode. We have to be pragmatic and ensure patient safety, so this is the best way to protect yourselves and the patients, yet maintaining much needed income. If clinical issues are found at the time of telephone consultation then this is escalated through the electronic pathway in the normal manner and an ophthalmologist will review as deemed appropriate.
- Minor eye conditions should continue as normal, but once again telephone consultations would be preferable, as in point 2 above. If an examination is required then we will organise with our ophthalmologists.
- Childrens pathways. If appropriate these should continue, but if not possible please arrange to see the patient in 3 months time and ensure this is logged so that no patient is missed once we are at the back end of the coronavirus pandemic.
It is important that no patients are lost in the system, so we are recommending that all new or urgent referrals are sent through our portal so that we may prioritise. Emergencies are to be sent directly through existing pathways for patients needing immediate review, although do ring our office first and we maybe able to relieve this burden on the emergency services at the hospital. It maybe that we feel the patient does not need to be consulted, in which case the patient will be contacted and remain live on our task list to prevent patients being lost in the system, as this will be the biggest concern. As most who have worked us will know, we have robust monitoring processes to prevent patients being lost. Being in a unique position that we manage all aspects of ophthalmology, it will prevent several referrals to differing providers and mitigate this risk to patients and limit visits to one visit rather than several if required.
As a general principle we have instigated some safety principles in all of our clinics. We are being called constantly by worried patients enquiring whether we are open and if they should attend. As a general guideline we are following Department of Health and Public Health England Guidelines, which are currently updated daily. The general principles are:
- Each ophthalmologist clinic in the community and at our cataract centres are provided with a new self-developed slit lamp shield to prevent transmission.
- Every patient is undergoing screening as per DoH guidelines attached before seeing a clinician. I would suggest that you instigate this in your own practices. The guidelines are also available on our website www.communityhealthservices.co.uk.
- All patients undergo temperature testing on entry to the unit. If greater than 37.8 degrees we ask the patient to go home and self-isolate as per government guidelines.
- Patients over 70 are being asked to self-isolate for 12 weeks. We are contacting these patients and will offer special individual appointments if required. We advocate using telephone consultations in these patients where possible.
- We will continue to offer door to door transport for all patients as required.
The RCO have issued guidance on specific patient conditions.
I understand that colleagues are concerned about the future, but I do wish to reiterate that we are in an unprecedented time period. We will 100% support our staff and optometrists in all aspects. We want, and are confident, that when we all come through the other end we will be stronger, more robust and the demand for all services will peak.
I am intending to email daily updates to optometry colleagues and provide some practical advice on patient management. Feedback we have is that volumes in the high street have dipped by 70-80% in some areas. However, we remain fully booked for 3-4 weeks in our ophthalmologists clinics and expect community ophthalmology and optometry to continue to be delivered during the period unless government guidance changes.
I would be happy for optometry colleagues to contact me directly via email if they wish to discuss patients, the coronavirus readiness, personal issues or how others maybe getting ready to ensure their businesses remain viable and staff retained during this period.
All my very best and lets keep ourselves and our loved ones safe.
Imran Rahman MB BS FRCOphth
CEO and Consultant Ophthalmologist
Community Health and Eyecare Ltd
6 Fulwood Park