Optometrists and Dispensing Opticians Board

 

Optometrist Prescribing

From 1 July 2014, the Medicines Amendment Act 2013 and Misuse of Drugs Amendment Regulations 2014 came into effect.

These amendments:

  • name nurse practitioners and optometrists as authorised prescribers
  • create a new delegated prescriber category
  • change the definition of medicines and medical devices
  • change the restrictions on nurse practitioners’ prescribing of controlled drugs
  • change the controlled drugs that midwives can prescribe
  • allow for controlled drug prescriptions to be generated electronically.

The changes to the Act name optometrists as authorised prescribers. This change enables optometrists to prescribe all medicines appropriate to their scope of practice, rather than limiting them to a list of medicines specified in regulation. This recognises the safe and appropriate prescribing practice of optometrists over the past nine years.

In anticipation of the above mentioned changes, the Board has developed guidelines for optometrists for prescribing in glaucoma. The guidelines set out what the pre-requisites are for optometrists before they may commence treatment of glaucoma using glaucoma medications and in what circumstances referral to an ophthalmologist is required. The guidelines are intended to assist optometrists to prescribe medications that control intra-ocular pressure, with the goal of preserving optic nerve structure, visual function, and the patient’s quality of life, within accepted best-practice standards and to identify those patients who are suitable to treat independently. The guidelines can be viewed by clicking here and these were sent to practitioners and stakeholders ahead of 1 July. The guidelines will be reviewed by the Board on a regular basis to ensure they remain fit for purpose.

If you wish to apply to the Board to be approved to independently manage glaucoma patients please click here for the application form and send this into the Board's office with the requested supporting material. The Board has also developed the following guidelines for formatting the case studies to accompany the application, for those intending to submit case studies. Click here to view these. For those intending to submit evidence of 20 hours of attendance in a clinical setting where glaucoma management is the major focus, please click here to access the template case log.

Optometrist prescribers should click here and ensure they are familiar with this important information about prescribing.

Optometrist prescribers should click here and familiarise themselves with the Guidelines on the prescribing of corticosteroids.

Practitioners who are unsure whether they are able to prescribe should contact the Board for advice on 04 474 0705.

 

Approved Optometrist Glaucoma Prescribers

To view an up-to-date list of Approved Optometrist Glaucoma Prescribers, Click here.

 

Monitoring of optometrist prescribing

The Board receives quarterly reports on optometrist prescribing from HealthPAC, a division of the Ministry of Health. This report details all optometrist prescribing, including levels of prescribing. Optometrists who have prescribed a high volume of a medicine or a medicine that may not be within their scope of practice will be contacted by the Board for explanation.

This explanation will assist the Board in determining whether there may be any concerns regarding the optometrist's prescribing that require follow-up and/or whether an entry error may have resulted in medicines being listed as prescribed by optometrists where they should have been listed as prescribed by another health practitioner, i.e. a medical practitioner.

This monitoring assists the Ministry of Health and the Board to ensure that optometrists are prescribing safely and appropriately.

 

Statement on Collaborative Care

The Board recognises that not all prescribing optometrists will wish to apply to the Board for approval to independently prescribe for glaucoma patients, and that they may prefer to form a collaborative care relationship with their ophthalmologist colleague/s to assist in managing the care of glaucoma patients. 

The Board has therefore developed a statement to ensure that all prescribing optometrists, irrespective of their decision to apply for approval to prescribe independently or not, are aware of the distinction between collaborative care and independent prescribing.

Please click here to view the statement.

If you have questions after reading this statement, please contact the Board’s office for further clarification.

 

Use of Atropine

The Board has developed guidelines for prescribing optometrists on the safe use of topical atropine for myopia control. Click here to view the guidelines.

 

Oral medicine guidelines

The Board has developed guidelines for prescribing optometrists on:

  • Allergic Eye Disease – click here to view this document
  • Herpes Simplex Virus (HSV) Keratitis – click here to view this document
  • Herpes Zoster Ophthalmicus – click here to view this document
  • Acute Angle Closure - click here to view this document
  • Pain Management - click here to view this document
  • Meibomian Gland Dysfunction - click here to view this document

These guideline documents are not exhaustive and should be considered ‘living’ documents that will be added to over time. Additional guideline documents will be available soon. 

 

Standing Orders

The Medicines Amendment Act 2013, enacted in July 2014, provided optometrists with the same prescribing authority as nurse practitioners, medical practitioners, dentists, and midwives, in line with a policy to improve access to healthcare by removing barriers to health practitioners practising to the full extent of their scopes of practice. The Board is now pleased to advise that in addition to this, the Medicines (Standing Order) Amendment Regulations 2016 have very recently been enacted and these authorise prescribing optometrists to issue Standing Orders, effective from 17 August 2016.

A Standing Order is a written instruction issued by an authorised health practitioner (doctor, dentist, nurse practitioner or optometrist) which authorises a specified person or class of people who do not have prescribing rights to administer and/or supply specified medicines. The intention is for Standing Orders to be used to improve patients’ timely access to medicines, and the Board also sees that teamwork and efficiency between health providers will be fostered, and that use of Standing Orders will see the best use of optometrists’ knowledge and skill implemented and will reduce the burden on other health practitioners to deliver the right care at the right time. Although the ability to issue Standing Orders includes the ability to issue Standing Orders for some controlled drugs, the Board does not endorse optometrists issuing Standing Orders for controlled drugs under any circumstances.

It is paramount that prescribing optometrists considering the use of Standing Orders read the Medicines (Standing Order) Regulations 2002 and also the Ministry of Health’s Standing Order Guidelines to ensure that they comply with all legal requirements and suggested best practice for the issuing of a Standing Order. 

Here is a link to the Standing Order Guidelines issued by the Ministry of Health on the role and responsibilities of health professionals issuing standing orders and those working under standing orders - http://www.health.govt.nz/publication/standing-order-guidelines  

Here is a link to the Medicines (Standing Order) Regulations 2002 - http://www.legislation.govt.nz/regulation/public/2002/0373/10.0/DLM170107.html

The Standing Order guidelines also include a Standing Order Template guide, which prescribing Optometrists should use for all Standing Orders issued. Click here for an example Standing Order prepared by the Board.

Prescribing Optometrists are bound by their scope of practice and the HPCA Act and are professionally responsible to undertake only those activities within their scope of practice, and within their knowledge and skill set. It is the Board’s position that Optometrists take their prescribing responsibilities as seriously as other authorised prescribers and understand the accountability for their prescribing decisions. Board monitoring of optometrist prescribing has demonstrated that Optometrists are safe and cautious prescribers, and the Board expects Optometrists to apply this caution and adherence to safety when issuing any Standing Order.

Important information –

To follow are the situations under which the Board considers it may be appropriate for a prescribing optometrist to issue a Standing Order:

  • In-practice to suitably trained staff, for example dilation and cycloplegia, so long as they are very aware of, and understand, the limitations of their peers’ knowledge and skill in the administration of medicines.
  • In a hospital care setting, where appropriate, to maximise the benefit of having optometrists working to the full extent of their therapeutic scope.
  • For mobile clinics (e.g. diabetic photo screening).

Standing Orders are a significant and specific authorisation from the issuer. The issuer of the Standing Order retains overall responsibility to:

  • ensure the legislative requirements for the Standing Order are met;
  • ensure that anyone operating under the Standing Order has the appropriate training and competency to fulfil the role; and
  • countersign, audit and review the Standing Order.

A person who is permitted to administer and/or supply medicines under a Standing Order must be engaged in the delivery of a health service, and to meet regulatory requirements, must have the competency and training to be able to make an assessment that the Standing Order applies to the presenting patient, the competency to administer and/or supply the medicine, and the knowledge to assess the contraindications and/or exclusions.

For clarification, a standing order does not allow a person to generate a prescription and provide it to a patient to take to a pharmacy to be dispensed (with the prescription signed later by the issuer of the standing order). Pharmacies cannot lawfully dispense unsigned prescriptions. Nor does a standing order allow a person to provide a patient with a prescription that has been ‘pre-signed’ by the issuer of the standing order.

If after reviewing the Standing Order Guidelines and template you have questions about the use of Standing Orders by Optometrists, please contact the Board for further advice.

 

Occular therapeutics training available

The following training providers offer Graduate Certificate(s) in Occular Therapeutics for those who wish to obtain a therapeutics qualification that would enable them to prescribe medicines within their scope of practice:

The Australian College of Optometry (ACO) - More information on this qualification can be found by clicking here and visiting the ACO website.

The University of Melbourne - More information on this qualification can be found by clicking here and visiting the university website.

The University of New South Wales - More information on this qualification can be found by clicking here and visiting the university website.

The Queensland University of Technology - More information on this qualification can be found by clicking here and visiting the university website.

 

Prescription pads

The issuing of prescription pads to optometrists is managed by the New Zealand Association of Optometrists (NZAO). Optometrists who are new to prescribing or require more prescription pads should contact NZAO on 0800 439 322 or email info@nzao.co.nz.

 

Useful Links

Medsafe Website - directly access the Medsafe website by clicking here.

Statement on Internet Medicines - click here.

Contact Us

Optometrists and Dispensing Opticians Board

Level 5, 22 Willeston Street,
Wellington 6011
PO Box 9644, Wellington 6141
Tel: +64 4 474 0705, Fax +64 4 474 0709

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