Efficiently run optical practices often rely on dispensers to delineate when a true ‘ocular emergency’ presents. CHEDY KALACH offers some tips to cut through the noise.
Ocular emergencies tend to be rare in optometry practices, particularly in metropolitan practices. However, when one does occur, there needs to be clear guidelines and protocols.
Firstly, you need to consider whether the problem is with their eyes, glasses or contact lenses and whether it is an emergency. Some patients may think breaking their -0.50 DS in both eyes is an emergency, while others may have severe pain and not define it this way. It’s the role of the eyecare professional to triage and manage patients’ needs. To ensure this is performed most effectively, questions are the key. Having a good combination/flow chart of open and closed questions is vital.
Before going further, it’s a good reminder to look at your practice’s policies. The policy should be reviewed regularly, and staff updated on the procedures. It’s just like first aid – vital to have the knowledge and skills, but ideally not required to use it. The policy should cover the basics, like who handles the calls (receptionist, lab technician, optometrist, optical dispenser, practice manager), what to do if the relevant staff member is with a patient/ customer or at lunch, what questions need to be asked and how to record the information.
Also, it’s good to remember, S.O.A.P:
S – subjective data is what the patient tells you,
O – objective data is what you find,
A – stands for Assessment and
P – the plan for management or treatment.
Initially, you only have the subjective data from your patients, so the better you are at eliciting the right information the easier it will be. This step becomes even more important if you’re only able to communicate with them over the phone. Australian Family Physician Vol. 37, No. 7, July 2008, mentions assessment of ocular emergencies can be made difficult. However, a concise patient history, general observation and basic ocular tests can lead to a firm diagnosis and thereby appropriate management and referral.
When asking questions remember:
• not to draw conclusions and note information, not opinions
• do not draw to conclusions too quickly
• don’t diagnose
• don’t promise anything out of your control
• avoid technical words
• don’t divulge patient confidentiality
• don’t compare your practice’s skills to those of others
• remain calm and concise
A few simple questions to ask:
1. did it happen recently?
2. any sudden vision loss?
3. any pain?
These questions are a good start to figure if it is a true emergency. For example, if it just happened and there’s vision loss and extreme pain, that will suggest they’ll need to be seen by an ophthalmologist immediately. Furthermore, if they’re describing a situation that suggests a foreign body in the eye, they should be still seen the same day. However, if they are suggesting they need a form to be filled out, then that could wait till the next available appointment. Use judgement based on the information presented.
After asking your questions, the patient essentially has one of five options:
1. take immediate action at home
2. go to hospital and ophthalmologist
3. come to the practice immediately
4. come to the practice within a day or so
5. be referred to another type of specialist/professional
Before making any recommendations, ensure you have gathered all relevant information and recorded it correctly and liaised with the relevant protocols or personnel in your practice.
Some examples of very urgent situations that will require optometrist advice:
• sudden loss of all/part of the vision
• sudden double vision
• red eye
• pain
• sudden onset of flashes or floaters
• injury to the eye
It is important to delve deeper into their situation to propose the best plan. For example, if they have a red eye, that could be a symptom of a number disorders, like a sub-conjunctival haemorrhage, allergic conjunctivitis, corneal ulcers, corneal abrasion, iritis, scleritis, acute angle-closure glaucoma, entropion or trichiasis to name a few. As you can see from the list, some are less urgent than others and many will have other symptoms present to distinguish.
The purpose of triage is to sort of patients’ allocation of care or treatment according to the urgency of their need and not to diagnose.
ABOUT THE AUTHOR: Chedy Kalach is a director of the Australasian College of Optical Dispensing. Since 2009 he has lectured throughout Australia and New Zealand across a variety of topics such as ophthalmic optics and business management. He is also the advisory board secretary of new dispensing network Optical Dispensers Australia.
More reading
Lessons for dispensers aspiring to become an optometry practice owner
Dispensing for children: Big tips for little faces – Part 1
