Duty to refer

C 1.1.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye.

In such cases the optician must inform the patient that s/he is referring him/her, and the reason for that referral.

The use of the ABDO triage form with the patient, and inclusion of a copy of this with any onward referral should be considered.

A referral letter or agreed electronic referral form must also be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including:

• The dispensing optician’s name and qualifications,
• The patient’s name, address and date of birth,
• The last examination date and the visual acuities on that date (if known).
• If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
• The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
• Relevant details of the patient’s history including details of current and recent patient medication
• It must be stated that no ophthalmoscopy was performed.

C 1.2.1 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. Local protocols should be followed taking into consideration any locally commissioned pathways for acute eyecare. In their absence the patient must be given a referral letter and advised to attend the Accident & Emergency Department immediately. A copy of the referral letter must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record.

For non-urgent referrals, local protocols should be followed and details of the most recent sight test should be included within the referral where possible.

C1.3.1 You may use your professional judgement to decide whether or not to refer a patient and may choose to manage the patient within your capabilities, level of qualification and scope of practice. If you decide not to refer the patient then you must record:

1. A detailed description of the injury or condition that the patient presented with.
2. Details of any advice, guidance or recommendations you have made.
3. Your reason for not referring at the present time.
4. VAs on the day you saw the patient.
5. If it is relevant you should, with the patient’s consent, inform the patients GP of any findings.

C1.4.1 A registered dispensing optician has the option of referring the patient to an optometrist or extended services qualified contact lens optician (ESCLO). In that event, it will then be the optometrist’s or ESCLO’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist/ESCLO together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

C1.5.1 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.  In the first instance talk to the patient, advise them they are unfit to drive and try to persuade them to stop. Remind the patient that s/he is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if the patient has told you that they will not stop driving, you may conclude the public interest outweighs the duty of confidentiality.You may wish to seek the advice of your professional body or the prescriber.

What to do if a patient’s vision means they may not be fit to drive flowchart.

C1.6.1 In a situation where the patient does not wish to be referred, against your advice, then you should:

1. Ensure the patient fully understands why you feel referral is necessary.
2. Record within the patients records a detailed account of the injury or condition the patient presented with.
3. Record the reason(s) for the patient’s refusal to be referred.
4. Where possible obtain the patient’s signature on a declaration (which must be kept within their record) that they have declined referral at this time.