ODOB: The dos and don'ts for Level 3... UPDATED

The Ministry of Health has indicated the following for optometry services:

‘Appointments for allied health services, such as physiotherapy, podiatry, optometry and Well Child Tamaraki Ora services, will continue to be mainly online or over the phone. Some face-to-face physiotherapy, podiatry, optometry appointments may be provided for urgent appointments only, so long as professionals can take appropriate measures to manage public health risks.’

If you decide to practise:

The MoH has advised that acute/emergency or ‘urgent care’ consultations that cannot be postponed are allowed. Virtual and non-contact consultations where possible are the preferred method of service delivery. Sales and commercial gain should not influence any clinical decision making.

‘Urgent care’ for community allied health professionals is defined as:

1. a condition which is life or limb threatening; or
2. treatment required to maintain the basic necessities of life; or
3. treatment that cannot be delayed or carried out remotely without risk of significant harm or permanent and/or significant disability; and
4. treatment which cannot be delivered by a service which is currently operating or by health professionals that are already in contact with the patient.

You are not allowed to physically open your practice or have consultations for ‘retail’ purposes. Practitioners who want to engage in ‘retail’ selling must do so without members of the public entering the practice and without physical contact, eg. through phone/online orders and delivery (following all MBIE hygiene protocols). This includes the provision of optical devices as per Alert Level 4:

• The repair and/or supply of prescription glasses and contact lenses required to ensure that a person has the ability to carry out their usual life activities
• The supply of new eye wear only in circumstances where the customer cannot make do with their current eye wear because it is either broken, lost or is no longer providing them the vision they need to operate a normal life

Routine examinations, recall examinations, ‘browsing’ practice visits or examinations that could be deferred are not allowed.

Continue to triage all patients and follow the triage guidelines as indicated in Alert 4, including asking the Covid-19 screening questions before permitting patients to enter premises. This should not be done face to face, where possible: https://tinyurl.com/OptomEssentialServices

If you are using messaging, telehealth or virtual technology, the MoH has created advice that you should follow: https://www.health.govt.nz/system/files/documents/pages/covid-19-information-sharing-advice-for-health-care-workers-31mar2020.pdf

People at higher-risk of severe illness from Covid-19 (eg. those with underlying medical conditions, especially if not well-controlled, and the elderly) are encouraged to take additional precautions when leaving home. We recommend that unless necessary you should not see patients in this category.

Entry by members of the public to your practice should be by arranged appointment only.

You must record details of all members of the public entering your place of business to ensure effective contact tracing. The information you record when having a face to face consultation should include the purpose of the consultation and how it fits into one of the defined urgent care categories. You should comply with record-keeping and privacy obligations in the usual way. This includes informing patients how information collected from them may be used or disclosed, including for the purpose of contact tracing should that be required. The Board may, at any time request this information and it should be readily available. For further information: https://covid19.govt.nz/covid-19/about-covid-19/contact-tracing-for-covid-19/

If a patient has a support person(s) with them, please ask the support person to wait in their car/outside the practice. If the patient requests or needs a support person then allow them to enter the practice (remember to ask Covid-19 screening questions, follow all physical distancing and hygiene protocols)

Ensure that any person entering the practice, sanitise their hands and follow MoH hygiene protocols.

Physical distancing must occur and you must ensure that the practice environment allows for this. This includes controlled/restricted entry (one patient in the practice at a time rule) and restricting staff numbers. With the exception of a consultation, two metre physical distancing should occur with members of the public, and in a controlled environment, such as a workplace, one metre distancing is required.

Allow adequate time between appointments to allow to properly clean and disinfect equipment that the patient came in contact with (eg. slit-lamp, camera, OCT etc) and any areas of physical touch made by the patient (e.g. handrails, reception counter, EFTPOS terminal).

Minimise any close contact assessment, such as slit lamp examination, to less than 15 minutes.

We advise not to use aerosol generating procedures (eg. the use of non-contact tonometry). The MoH advises that they pose a higher infection risk for health professionals.

PPE should be worn when in close contact with patients (eg. consultations). You should continue to follow the advice issued for Alert 4: https://tinyurl.com/OptomEssentialServices

You should be familiar with how to safely apply and remove PPE. Incorrect use of PPE can create more risk. The Board’s dedicated Covid-19 webpage has further information on PPE, including an instruction video: https://www.odob.health.nz/covid-19-information/

Staff working within 2 metres of a patient should wear a mask.

Domiciliary visits and rest home/aged care facility visits should not occur

The Board also recommends that you continue to work collaboratively with your DHB. Follow, at a minimum, the current MoH guidelines, published on their website, and stay in contact with your professional bodies, including the NZAO and ADONZ.
To reduce the risk of transmission, all therapeutic prescriptions should be sent to pharmacies via fax or NZePS. In addition, the MoH has introduced new rules for electronic prescriptions to support virtual care in the community: https://www.health.govt.nz/system/files/documents/pages/covid-19-new_rules_for_electronic_prescriptions-3apr20.pdf
The above information is subject to change and the Board will communicate any updates as soon as they are available.
The Board would like to thank you all for your efforts in complying with guidelines during Alert Level 4. It has been tough, and we know it will still be tough as we move into Alert Level 3, but together we will get through this.

Jayesh Chouhan, ODOB Board chair and Antony McFelin, ODOB registrar

For further, detailed practical guidelines for optometrists in Level 3. refer to the New Zealand Association of Optometrists (NZAO) latest Practical Guidance document: https://tinyurl.com/NZAOLevel3