The College of Optometrists

Use and supply of drugs or medicines in optometric practice

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Sub-sections

Key points

  • You must act in accordance with the current legislation controlling the use and supply of drugs.
  • You should take particular care when using or supplying drugs to patients from at-risk groups.
  • You must be aware of the indications, cautions, contraindications and side effects of any drugs you instil or supply.
  • You must inform patients how to use the drug you supply and what to do in the event of an adverse incident following instillation or supply of a drug.
  • You should instruct a patient to attend the local Accident and Emergency department if you are not available to deal with an emergency or adverse reaction following the instillation of a drug.
  • You may delegate the instillation of eye drops to another member of staff but you remain responsible for the patient.
  • You should not treat yourself or someone close to you, or prescribe or prepare written orders for POM drugs for yourself or someone close to you, except in the cases of minor ailments or emergencies.
  • You should store all drugs according to the manufacturer’s instructions.
  • You should report adverse reactions to medicines or medical devices using the appropriate reporting schemes.

Principles of the use and supply of drugs or medicines

A363
You must always act in accordance with the current legislation controlling the use and supply of drugs in optometric practice.127, 128
A364
You must only supply drugs when it is appropriate to do so.  
A365
You must maintain your knowledge and skills to use the drugs in your practice. Information on this can be found in the Optometrists’ formulary.129 Your knowledge should include:  
  1. actions
  2. interactions
  3. cautions
  4. contraindications, and
  5. side effects.
A366
You should take particular care when using or supplying drugs to at-risk groups such as very young or very old patients, those with renal or hepatic impairment or who are pregnant or breastfeeding.

References

127 Human Medicines Regulations 2012 SI 1916.
128 MHRA (2008) Medicines and medical devices regulation, what you need to know [Accessed 30 Oct 2017]
129 College of Optometrists Optometrists’ formulary [Accessed 1 June 2017]

Antimicrobial stewardship

A367
If you are prescribing antimicrobial drugs you should:130
  • consider alternative options and only prescribe antimicrobials when this is clinically appropriate
  • be aware of local guidelines on antimicrobial prescribing
  • not issue an immediate prescription for an antimicrobial to a patient who is likely to have a self-limiting condition
  • only issue repeat prescriptions for antimicrobials if these are needed for a particular clinical condition or indication.

Instilling eye drops

Checking risks

A368
You must consider the cautions and contraindications for each drug you use in practice.131
A369
There is potential for interaction with some systemic drugs. For example, phenylephrine may interact with systemically administered monoamine-oxidase inhibitors and anti-hypertensive drugs.


Making the appointment

A370
If pupils are likely to be dilated, tell patients when they make an appointment that they might not be able to drive after the examination. Suggest that they bring sunglasses with them. 


Administering drugs

A371
When you use drugs that dilate the pupil, you should consider whether to: 
  1. check the depth of the anterior chamber, for example using the van Herick technique, for the possibility of angle closure, and
  2. measure intra-ocular pressures as appropriate, for example before and/or after dilation.
A372
The NHS Diabetic Eye Screening Programme does not consider these checks necessary when using tropicamide alone. 
A373
You should check corneal integrity, if appropriate.
A374
You should ask the patient if they:
  1. have experienced adverse reactions to eye drops in the past
  2. have a history of drug-induced adverse incidents
  3. have any relevant medical conditions, or
  4. take any systemic drugs.
A375
You should check for possible interactions with any systemic medication the patient may be taking. 
A376
You should check: 
  1. that you are administering the correct drug and dosage, and
  2. the expiry date.
A377
You should record all drugs used, including the batch number and expiry date, on the patient record.
A378
You may keep a logbook of which drugs are used on each patient. This will help you if you need to recall patients. 
A379
You should explain to the patient: 
  1. why you are instilling the drug
  2. what effects the drops might have
  3. how long the effects might last
  4. the side effects they might experience
  5. if you are dilating their pupils, that they might not be able to drive and must not undertake any activity which is not advised after dilation, and for how long
  6. if you are using anaesthetic drops, that they should avoid wearing contact lenses for an appropriate period of time after anaesthesia, and
  7. what to do if they experience an adverse reaction.
A380
You may give the patient an information sheet.132 
A381
You should instruct the patient to attend the local Accident and Emergency department if you are not available to deal with any emergency or adverse reaction that may arise following the instillation of the drug. 
A382
You should inform the patient’s GP of any suspected adverse reaction. See also para A398


Delegating the instillation of eye drops

A383
There is no legal restriction on who can instil eye drops to a person as the law only restricts supply of the drops. 
A384
You are responsible for the instillation and if you decide to delegate this to another member of staff you must be on the premises whilst this is being done so you can intervene if necessary.133 You are responsible for the management of the patient and the work of the person to whom you have delegated the procedure. See section on Working with colleagues

Supply of drugs in optometric practice

A385
In the course of your professional practice, you may sell or supply:
  • all medicinal products on a General Sale List (GSL)
  • all pharmacy (P) medicines.
A386
In an emergency, in the course of your professional practice, you may sell or supply certain Prescription Only Medicines (POMs) which are not for parenteral administration. You should check the Optometrists’ formulary for further details.129
A387
The drugs that are covered by paragraphs A.385 and A.386 can only be supplied to patients by a registered optometrist or dispensing optician. There is no provision for you to delegate or supervise this supply.
A388
The POMs that are mentioned in paragraph A.386 can be supplied to the patient by a pharmacist on presentation of a signed order from an optometrist without it needing to be an emergency. If you write a signed order for the supply of a drug by a pharmacist you must include your GOC number on the order. You should use standard abbreviations; examples are provided in Annex 2.
A389
You must be aware of the indications, cautions, contraindications and side effects of any drugs you supply.134
A390
You must ask patients about any drug-induced adverse incidents and known drug allergies before supplying them with drugs.135
A391
You must inform patients how to use the drug. You should inform them about what to do in the case of an adverse incident.

Prescribing and treating yourself and others close to you

A392
You should not treat yourself or someone close to you or prescribe or prepare written orders for POM drugs for your own personal use or for anyone with whom you have a close personal relationship unless:136 
  1. you are treating minor ailments, or
  2. it is an emergency.
A393
If you prescribe for yourself or someone close to you, you should: 
  1. record it in the patient notes, including your relationship to the patient and the reason for the necessity of prescribing, and
  2. tell the patient’s GP and others treating the patient, if relevant, what you have prescribed and other information required for continuity of care, unless the patient objects.

Patient group directions and co-management schemes

A394
Optometrists may supply or administer drugs to patients under a Patient Group Direction (PGD). PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.137  You must ensure you meet the criteria in the PGD. You should work to local protocols.  
A395
You may be involved in community services or be co-managing patients, such as those who have had surgical procedures, and need to supply or administer an ocular medication that is not on the list of drugs you can use or supply under the exemptions in paragraphs A385 and A386. You may do this under the authority of a PGD, see paragraph A394.

References

137 MHRA (2017) Patient Group Directions [Accessed 30 Oct 2017]

Storage and disposal of drugs

A396
You should: 
  1. store all diagnostic and therapeutic drugs according to the manufacturer’s instructions, and
  2. keep drugs out of patients’ reach.
A397
You must follow the current legislation on the disposal of hazardous waste.138 You must ensure drug waste is disposed of in accordance with the regulations.139 See section on Infection control

References

138 Environmental Protection Act 1990 s34.
139 College of Optometrists (2014) Guidance on the disposal of waste [Accessed 3 Nov 2017 2017]

Reporting schemes on adverse drug reactions

A398
You should use reporting schemes for adverse drug reactions . There are two reporting schemes, operated by the MHRA. These are: 
  1. the yellow card scheme which covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medication,140  and
  2. the Medical Devices Reporting Form which covers adverse incidents mainly relating to contact lenses and care products, including contact lens comfort drops.141

References

140  MHRA Yellow Card Scheme [Accessed 2 Nov 2017]
141  MHRA. Report a problem with a medicine or medical device [Accessed 2 Nov 2017]

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