ODOB: New Level 2 and Level 4 reminder

The Board has also placed summary guidelines for Alert Levels 2, 3 and 4 on the ODOB website. Click here for these documents (on the top right of the page). These are “living” documents and are subject to change. This will provide a point of reference to the most current guidelines for the alert level that is applicable to you. Any ongoing changes to these documents due to advice from the Ministry of Health will also be communicated to you.

Alert Level 2 – Summary

Clinical reasoning and risk assessment remain the fundamental principles for considering care at Alert Level 2. Telehealth and virtual appointments are still the preferred option and please exercise extra caution when treating vulnerable groups

Clinicians will be able to see patients face to face if the following processes are in place:

• screening for COVID-19 symptoms prior to face-to-face appointment
• physical distancing measures
• Infection prevention control measures including PPE where required.
• Transmission precaution measures including consideration of ventilation

When considering travel within and between regions ensure all risks have been taken into account before undertaking to provide care to patients and traveling to receive training.

Group treatment (eg. exercise classes) can occur so long as physical distancing is in place. Click here for further information

While practices can reopen for routine face-to-face consultations/dispensing under Alert Level 2, protocols must be implemented by optometrists and dispensing opticians to maximise patient safety, including ongoing risk assessment and appropriate infection prevention control procedures.

Screening

Screening or risk assessment of patients/customers and any support persons for risk of COVID-19 prior to entering your practices is mandatory. If there is any risk identified do not allow them into your practice or see them in the community until they have medical clearance.

Risk screening should be based on the Covid-19 case definition click here

The Ministry of Health recommend the following screening questions:

• Do they have new or worsening respiratory symptoms including one of the following: cough, sore throat, shortness of breath, coryza (runny nose) or temporary loss of smell, with or without fever?
• In the last two weeks, have they been in contact with others who have been unwell with respiratory symptoms or fever, or are suspected or confirmed to have Covid-19?

You must continue to have a high level of vigilance to ensure hygiene protocols are maintained.

Employers are responsible for conducting risk assessments for staff moving back into work premises during Alert Level 2. This may include individual discussions with each staff member prior to returning to work.

Physical distancing

Physical distancing must occur and you must ensure that the practice environment allows for this which includes controlled entry and exit. Under Alert Level 2, in a controlled environment, 1 metre physical distancing is required.

A controlled environment (as defined by Work Safe NZ) are those in which you can:

• Reasonably require hand sanitising/cleaning
• Clean frequently including between occupancy by different groups
• Manage distancing of people
• Keep groups contained and not mixing groups
• Inquire regarding the health of users and refuse access if necessary
• Keep a record (name, phone and physical address) of people who are present to facilitate contact tracing if necessary.

Infection prevention control measures and PPE

You must continue to have a high level of vigilance to ensure hygiene protocols are maintained. The best defence against COVID-19 are basic hygiene measures, which include:

• cough or sneeze into your elbow or by covering your mouth and nose with tissues
• put used tissues in the bin or a bag immediately
• wash your hands with soap and water often (for at least 20 seconds)
• avoid touching your eyes, nose or mouth
• clean surfaces regularly

During Alert Level 2 it is now mandatory to wear a mask/face covering if you are in a public-facing business. It’s recommended that employees who are not public-facing wear a face covering if they are in close contact with others. Optometrists and Dispensing Opticians are therefore required to wear a mask, unless you fall into a category where you are exempt. Click here for further information regarding PPE

Working with vulnerable people

The government guidance for Alert Level 2 states ‘People at high risk of severe illness such as older people and those with existing medical conditions are encouraged to stay at home where possible and take additional precautions when leaving home. They may choose to work’.

Practitioners must carefully weigh up the risks and benefits of seeing patients who may have vulnerabilities to Covid-19 for face-to-face consultations/dispensing. You must discuss the risks and benefits with the customer/patient and/or carer.

Contact Tracing

Mandatory record keeping for all healthcare facilities comes into effect from 11:59 pm on 7 September 2021. Everyone aged 12 and over legally must keep a record of where they have been when visiting certain places so contact tracing can happen quickly. You must do this at all Alert Levels.

Please ensure any member of the public entering your place of business uses the NZ Covid Tracer app if they can. You must have more than one way for people to record their visit, especially for people who are not able to scan QR codes.

Contact records are personal information. They need to be collected, used, stored, disclosed, and disposed of safely and securely in accordance with the Privacy Act 2020. Do not leave paper-based records out in the open where others can see the information. This is the leading cause of Covid-19-related privacy breaches.

At all Alert Levels, businesses and workplaces legally must display an NZ Covid Tracer QR code for each location.

Alert Level 4 – Summary

Emergency and acute eye care – new restrictions

As you are aware, optometrists are recognised as essential health services in the delivery of 'emergency and acute' eye care under Alert Level 4. However, due to the increased risk of the transmissibility of the Delta variant, the scope of provision is to preserve life or limb only.

Click here for the communication from the Chief Allied Health Professions Officer.

Therefore, if your patient needs are urgent/acute and cannot be assessed, or treated via telehealth, please contact your local DHB and refer them to these services. Face to face consultation should not occur under Alert Level 4 unless it is to preserve life or limb.

The Board has be in contact with RANZCO to ensure ophthalmology is aware of these changes and the subsequent impact on DHB eye departments around the country.

Provision of optical products and devices – new restrictions

As indicated earlier the provision of optical products could be considered an essential non-food product, if it is deemed by the practitioner that it is an essential good and meets the definitions set out by the government.

However, this must be limited to instances where it is at a level of a “true emergency” only (using sound clinical judgement) and can only be done without any face-to-face contact. Optometry practices should remained closed and patients should not be invited to attend the practice. Delivery of goods should be done adhering to all strict Covid-19 protocols specified by the government. Sales and commercial gain should not influence any clinical decision making.

If any further updates become available, these will be communicated as soon as possible.

Noho ora mai / stay well

Jayesh Chouhan, Board chair and Antony McFelin, registrar