- You must act in accordance with the current legislation controlling the use and supply of drugs in optometric practice.
- You should take particular care when using or supplying drugs to patients in at-risk groups.
- You must be aware of the indications, cautions, contraindications and side effects of any drugs you instil or supply.
- You must tell patients how to use the drug you supply and what to do in the event of an adverse incident following instillation of eye drops or supply of a drug.
- You should tell 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 eye drops or supply 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 prescription-only medicines (POM) 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.
A452
This Guidance does not change what you must do under the law.
A453
You must always act in accordance with the current legislation controlling the use and supply of drugs in optometric practice161, 162.
A454
You must only use and supply drugs when it is appropriate to do so.
A455
You must maintain appropriate knowledge and skills when administering? drugs in your practice. Information on this can be found in the Optometrists’ Formulary.163 Your knowledge should include:
- actions
- interactions
- cautions
- contraindications
- side effects.
A456
You should take particular care when administering or supplying drugs to at-risk groups such as very young or very old patients, those with renal or hepatic impairment or patients who are pregnant or breastfeeding.
References
161 Human Medicines Regulations 2012 SI 1916.162 MHRA. Medical devices regulation and safety: detailed information [Accessed 1 Nov 2023]
163 The College of Optometrists Optometrists’ Formulary [Accessed 1 Nov 2023]
A457
If you are prescribing antimicrobial drugs you should:164
- 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.
References
164 National Institute for Health and Care Excellence (2015) NG15 Antimicrobial Stewardship [Accessed 1 Nov 2023]Checking risks
A458
You must consider the cautions and contraindications for each drug you use in practice.165
A459
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
A460
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
A461
When you use drugs that dilate the pupil, you should consider whether to:
- check the depth of the anterior chamber, for example using the van Herick technique, for the possibility of angle closure
- measure intra-ocular pressures as appropriate, for example before and/or after dilation.
A462
The NHS Diabetic Eye Screening Programme does not consider these checks necessary when using tropicamide alone.
A463
You should check corneal integrity, if appropriate.
A464
You should ask the patient if they:
- have experienced adverse reactions to eye drops in the past
- have a history of drug-induced adverse incidents
- have any relevant medical conditions
- take any systemic drugs.
A465
You should check for possible interactions with any systemic medication that the patient may be taking.
A466
You should check:
- that you are administering the correct drug and dosage
- the expiry date.
A467
You must ensure that the correct patient is receiving the correct drug, in the correct eye, at the appropriate concentration of every drug you instil, and that it has not expired. You should record the details of all drugs used in the patient record. You should have appropriate clinical governance in place to ensure that drugs in stock have not reached their expiry date and that the batch numbers are recorded either on the clinical record or at an organisational level.
A468
You may keep a logbook of which drugs are used on each patient. This will help you if you need to recall patients.
A469
You should explain to the patient:
- why you are instilling the drug
- what effects the drops might have
- how long the effects might last
- the side effects they might experience
- 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
- if you are using anaesthetic drops, that they should avoid wearing contact lenses for an appropriate period of time after anaesthesia
- what to do if they experience an adverse reaction.
A470
You may give the patient an information sheet.166
A471
You should tell 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.
A472
You should inform the patient’s GP of any suspected adverse reaction. See also section Reporting schemes on adverse drug reactions.
Delegating the instillation of eye drops
A473
There is no legal restriction on who can instil eye drops to a person. The law only restricts supply of the drops.
A474
You are responsible for the instillation of eye drops for your patients and so, if you delegate this to another member of staff, you must ensure that they are working under direction or appropriate supervision while this is being done167. You are responsible for the management of the patient and the work of the person to whom you have delegated the procedure. You should ensure appropriate recording and clinical governance of all drugs instilled by direction or appropriate supervision.
References
165 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 7.6 [Accessed 1 Nov 2023]166 The College of Optometrists. Instillation of eye drops tear-off pads (College members only) [Accessed 1 Nov 2023]
167 Eye Drops Instillation by Unregistered Health Care Professionals for use within NHS Ophthalmic Services Royal College of Ophthalmolologists [Accessed 1 Nov 2023]
A475
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.
A476
In an emergency, in the course of your professional practice, you may sell or supply certain POM which are not for parenteral administration. You should check the Optometrists’ Formulary for further details.168 This means there is no provision for you to sell or supply a POM, unless the medication is on The Human Medicine Regulations 2012 list of POM that optometrists may supply in an emergency. Independent prescribing optometrists do not have any additional POM supply privileges.
A477
The drugs that are covered by paragraphs A475 and A476 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.
A478
The POMs that are mentioned in paragraph A476 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.
A479
You must be aware of the indications, cautions, contraindications and side effects of any drugs you supply.169
A480
You must ask patients about any drug-induced adverse incidents and known drug allergies before supplying them with drugs.170
A481
You must tell patients how to use the drug. You should tell them what to do in the case of an adverse incident.
A482
Healthcare workers can administer POM eye drops in the absence of a prescription, Patient Group Direction (PGD), Patient Specific Direction (PSD) or registrant on the premises. This is subject to the requirement that the medicines were lawfully obtained by a healthcare body, such as a hospital or optical practice. There are no restrictions on who can administer/instil eye drops such as tropicamide and phenylephrine for the purposes of dilating the pupil for screening. If a healthcare worker is instilling eye drops for your patient, you should ensure that the healthcare worker is appropriately trained, and that appropriate supervision arrangements and safe operating systems governing the administration of eye drops are in place. Please see section on Delegation.
References
168 The College of Optometrists. Optometrists’ Formulary [Accessed 1 Nov 2023]169 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 2.5 [Accessed 1 Nov 2023]
170 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians, para 7.3 [Accessed 1 Nov 2023]
A483
You should not treat yourself or someone you have a close relationship to you, or prescribe or prepare written orders for POM drugs for your own personal use or for the use of anyone you have a close personal relationship to, unless in exceptional circumstances171.
A484
If you prescribe for yourself or someone close to you, you should:
- record this in the patient notes, including your relationship to the patient and the reason for the necessity of prescribing
- 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.
References
171 General Medical Council (2013) Good practice in prescribing and managing medicines and devices [Accessed 1 Nov 2023]A485
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.172 You must ensure you meet the criteria in the PGD. You should work to local protocols.
A486
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 A475 and A476. You may do this under the authority of a PGD, see above paragraph.
References
172 MHRA (2017) Patient Group Directions [Accessed 1 Nov 2023]A487
You should:
- store all diagnostic and therapeutic drugs according to the manufacturer’s instructions, and
- keep drugs out of patients’ reach.
A488
You must follow the current legislation on the disposal of hazardous waste.173 You must ensure drug waste is disposed of in accordance with the regulations.174 See section on Infection control.
References
173 Environmental Protection Act 1990 s34 [Accessed 1 Nov 2023]174 The College of Optometrists (2014) Guidance on the disposal of waste [Accessed 1 Nov 2023]
A489
You should use reporting schemes for adverse drug reactions. There are two reporting schemes, operated by the MHRA. These are:
- the yellow card scheme which covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medication175
- the Medical Devices Reporting Form which covers adverse incidents mainly relating to contact lenses and care products, including contact lens comfort drops.176
References
175 MHRA Yellow Card Scheme: guidance for healthcare professionals, patients and the public [Accessed 1 Nov 2023]176 MHRA. Report a problem with a medicine or medical device [Accessed 1 Nov 2023]
The College of Optometrists. Optometrists’ Formulary [Accessed 1 Nov 2023]
The College of Optometrists. Clinical Management Guidelines [Accessed 1 Nov 2023]
The College of Optometrists. Guidance for Optometrist Prescribers [Accessed 1 Nov 2023]
The College of Optometrists. Higher qualification in independent prescribing [Accessed 1 Nov 2023]
The College of Optometrists. Information and guidance on myopia management [Accessed 1 Nov 2023]
The College of Optometrists. Patient information on the instillation of eye drops (tear off pad) [Accessed 1 Nov 2023]
National Institute for Health and Care Excellence (2015) NG15 Antimicrobial Stewardship [Accessed 1 Nov 2023]
National Institute for Health and Care Excellence (2016) Quality Standard QS121: Antimicrobial stewardship [Accessed 1 Nov 2023]
Royal Pharmaceutical Society (2016) A Competency Framework for all Prescribers [Accessed 1 Nov 2023]
