Optometrists and Dispensing Opticians Board

November 2012 Newsletter

In this issue:

  • Annual Report
  • Re/appointments to the Board
  • Consultation on Board Fees
  • Consultation on Draft Guidelines for Optometrists on Prescribing in Glaucoma
  • Consultation on Optometrist Scopes of Practice
  • Revisions to NZAO Guidelines on Steroid Prescribing
  • Practising Safely Within Your Scope and Avoiding Prosecution
  • Driver Licence Fitness Tests
  • Update on Possible Move to Health Regulatory Authority Single Shared Secretariat
  • Feedback on Optometrist Prescribing
  • Board Self Audits - Change in Selection Process
  • Seasons Greetings

 

 

Annual Report

The Board’s Annual Report for the period 1 April 2011 to 31 March 2012 is now available on the Board’s website. Click here to view a copy of the report.

Re/appointments to the Board

In the Board’s July 2012 newsletter and again via an individual Board announcement email, the Board advised that three positions were up for re/appointment on the Board – one optometrist, one dispensing optician, and one lay person position – and that the Ministry was calling for applications for these positions.

The Minister of Health published Board appointments in the New Zealand Gazette on 8 November 2012, and the Board is pleased to announce that lay Board member, Kiri Rikihana, and dispensing optician Board member, Lorraine Helson, have been reappointed to the Board for a further 3 year term. In addition, the Board is pleased to welcome Dr Jennifer Craig to the Board to fill the optometrist Board Member position previously occupied by Auckland optometrist, Kylie Dreaver, who did not apply for reappointment.

Dr Craig qualified as an optometrist in Scotland in 1992, was awarded a PhD in 1995 from Glasgow Caledonian University, and completed her postgraduate ocular therapeutic training in Auckland in 2009.  Dr Craig is a Senior Lecturer in the Department of Ophthalmology, and holds a position as an Honorary Academic Associate in the Department of Optometry and Vision Science, at the University of Auckland.  She teaches both optometry and medical students at undergraduate and postgraduate level, and heads the Ocular Surface Laboratory, conducting and supervising research into aspects of the anterior eye with a particular interest in the tear film and dry eye.  Click here for further information about Dr Craig as well as the other Board members.

The Board would like to thank Kylie Dreaver for her valuable contributions and unwavering dedication to her work for the Board, in particular, as Convenor of the Board’s Competence Review Committee and analysing the quarterly optometrist prescribing reports received from the Ministry of Health. The Board wishes Kylie well for the future. 

Consultation on Board Fees

The Board recently issued practitioners and stakeholders with a consultation document on proposed changes to Board’s fees. Click here to view a copy of the consultation document.

Submissions on this consultation document are due by 14 December 2012. The Board welcomes any and all submissions.

Consultation on Draft Guidelines for Optometrists on Prescribing for Glaucoma

The Board has developed draft guidelines for optometrists for prescribing in glaucoma, pending revisions to the Medicines Act which will allow optometrists to become ‘authorised prescribers’. The Board seeks feedback on the draft guidelines from practitioners and stakeholders ahead of making any final decisions.

Click here to view the consultation document.

Click here to view Appendix 1 to this document. Please note, this Appendix is large. If you have trouble downloading it when clicking on the link, you can view the document on the NHMRC website by clicking on this link.

Submissions on this consultation document are due by 11 January 2013. The Board welcomes any and all submissions. 

Consultation on Optometrist Scopes of Practice

The Board recently issued practitioners and stakeholders with a further consultation document on proposed changes to the optometrist scopes of practice. Click here to view a copy of the consultation document.

Submissions on this consultation document are due by 25 January 2013. The Board welcomes any and all submissions.

Revisions to NZAO Guidelines on Steroid Prescribing

The Board and the New Zealand Association of Optometrists recently collaborated on making minor amendments to the NZAO Guidelines on Steroid Prescribing. These minor amendments bring the document into line with current standards of practice. Click here to view a copy of the guidelines.

Practising Safely Within Your Scope and Avoiding Prosecution

The Board wishes to highlight the facts of a case brought against a Dispensing Optician earlier this year by the Ministry of Health.  It is hoped this case may serve as a cautionary tale.

The Scope of Practice for Optical Dispensing permits Dispensing Opticians to interpret prescriptions for glasses and contact lenses, give advice to patients on selecting spectacle lenses, spectacle frames (including their fitting), contact lenses, and to dispense optical appliances. It does not allow dispensing opticians to prescribe an ophthalmic appliance, optical appliance or ophthalmic medical device intended for remedial or cosmetic purposes, or for the correction of a defect of sight. These restricted activities are confined to optometrists and ophthalmologists only under the HPCAA.

In this case, Patient Y had an appointment with Dispensing Optician X.   Patient Y requested that a test be performed so she could choose some glasses. Dispensing Optician X performed an auto-refractor test on Patient Y, printed the results, took Patient Y’s glasses and put them in the automatic vertometer to check the prescription of the lenses, and printed off the results. Patient Y was shown the two printouts and compared them with her spectacle prescription. Dispensing Optician X then explained that the results indicated a ‘tweak’ was required, as her lenses were stronger in the right and weaker in the left, and his testing showed that they should be the other way around. Dispensing Optician X then indicated that he ‘ended up putting the same script in both eyes because there is not very much variation.’

Dispensing Optician X then checked the patient’s inter-pupillary distance, put the new script into a trial frame, asked her to look at the vision chart at the other end of the room and found Patient Y was able to read the bottom line of the chart. Dispensing Optician X told Patient Y that with ‘this kind of script’ she could have her glasses the next day.  He took her to choose a new frame. Dispensing Optician X gave her a written quote outlining the different options for lenses, frames and glazing. On the quote it also included ‘Rx check’ which indicated that an eye prescription check had been done. A fee of $20 was written beside the words ‘Rx check’, and was paid in cash by Patient Y. Dispensing Optician X did not ask Patient Y for her name or personal details, nor did he advise her that she should have an eye examination.

The case brought against Dispensing Optician X alleged that a new prescription had been formulated from the auto-refractor test performed, for the purpose of making up a new optical appliance, and that, therefore, Dispensing Optician X had performed a restricted activity. This was based on the fact that there was no conversation about Patient Y needing to see an optometrist, nor any suggestion that she would need an eye examination. Use of the words ‘new script’ and ‘Rx check’ were also sighted as evidence for believing a restricted activity had been performed.

When this case was heard before the District Court, Dispensing Optician X entered a guilty plea on his first appearance, accepting that he made a professional error in judgement in using the terminology ‘Rx check’.  He recognised that this could be interpreted in more than one way, and asserted that at no stage had he intended for the quote to be used as a prescription nor had he intended to act outside the confines of the law and regulations imposed on persons in his professional capacity.

The Judge noted that no harm was caused as the discrepancy between what was prescribed and what was required was small.  The Judge accepted Dispensing Optician X’s position that this was an error in judgement, not intentional conduct. Dispensing Optician X was discharged without conviction and permanent suppression of Dispensing Optician X’s name and any identifying details was granted.

The Board believes this case highlights the need for practitioners to be fully versed in the limits of their scopes of practice and the way their actions can be interpreted by members of the public. It also highlights a need for practitioners to take extra care that they are not performing any restricted activities in the course of practising their professions, inadvertently or otherwise.

Information on scopes of practice and Board standards of clinical competence for the two professions can be found on the Board’s website located at www.odob.health.nz.

Information on activities restricted to particular health practitioners under the HPCAA can be found by  

Driver Licence Fitness Tests

The document ‘Medical Aspects of Fitness to Drive’ issued by the New Zealand Transport Agency sets out how to assess fitness to drive, and while primarily aimed at medical practitioners, the ‘Visual Standards’ section is applicable for optometrists as well. Optometrists should ensure they are familiar with this document in the event they are asked to conduct an eye test to confirm a patient’s fitness to be issued with a driver licence. However, the Board reminds optometrists that their role is to consider each case individually and to advise the patient when a full examination may be appropriate.

Update on Possible Health Regulatory Authority Single Shared Secretariat

As previously advised in the Board’s July newsletter, at the request of the Minister of Health the Board has been exploring the benefits of establishing a shared secretariat with the other 15 health regulatory authorities to assist the collaboration and cost reduction initiatives of the government.

The 16 Chairs of the health regulatory authorities chose a Steering Group of 6 members to work with an Independent Chair, Professor Ron Paterson (former Health and Disability Commissioner) to develop a detailed business case.  This Steering Group is working on  the development of a detailed business case to clearly identify any organisational and business changes required, the potential risks associated with these changes, and any efficiencies and potential cost savings to be gained from all 16 secretariats coming together. The Board’s Deputy Chair is part of this group and is keeping the Board updated as these matters progress. At present, a ‘Request for Proposal’ (RFP) has been issued and the group is waiting to hear from independent third parties who would like to be considered for the task of carrying out the detailed business case.

The Board is aware that any move to a single shared secretariat could carry significant cost and risk, particularly for the smaller regulated professions.  It is therefore  considering all options and will consult with the professions and stakeholders at such time as it becomes necessary for the Board to commit to a way forward and/or if it becomes necessary to commit significant practitioner funds to advancing investigations into this matter.

The Board will keep practitioners and stakeholders updated on any further progress made with regards to this matter.   

Feedback on Optometrist Prescribing

The Board monitors optometrist prescribing to ensure optometrists registered in the Optometrist (TPA Endorsement) Scope of Practice are prescribing safely within their scope, and that optometrists not registered in that scope are not prescribing. The Board receives quarterly reports on optometrist prescribing from Sector Services, a business unit within the Ministry of Health, and makes enquiries with any optometrist who:

  • has prescribed 20 percent or more of the total volume of any scheduled medicine for the quarter; or
  • is alleged to have prescribed a medicine that is not on the schedule of medicines optometrists may prescribe; or
  • is not TPA endorsed and who is reported to have issued a prescription.

The Board reports that high prescribers of a scheduled medicine have all provided excellent reasons for their usage. Reasons have included working in an eye department in a public hospital, working for an ophthalmologist, working in collaboration with an ophthalmologist, being in a small centre where there is no ophthalmology cover. The Board is reassured to see so many optometrists using their skills so effectively and frequently.

There have been less than 5 cases where an optometrist has prescribed a non-scheduled medicine. The main medications that were prescribed in these cases were for the treatment of glaucoma, and in these instances, an ophthalmologist was consulted. However, Ministry of Health advice states there are no circumstances under which an optometrist may prescribe outside of their scope, even in an emergency situation. There should never be an emergency situation where an optometrist needs to prescribe something not on the optometry approved medication list, as an ophthalmologist can always phone a pharmacist and have an emergency prescription issued if necessary and/or an ambulance can be called to take the person directly to hospital.

The data obtained through the quarterly reports from Sector Services has not been without fault. The data is collected electronically via information submitted directly from pharmacies, and there have been repeated instances of incomplete data, most notably incorrect registration numbers entered, which has lead to an inability to analyse the data received.

There have also been about 80 instances of prescriptions of non-scheduled medicines allegedly being prescribed by optometrists. These have included medicines for hypertension, asthma, reflux, and depression. In every case investigated to date, the reason for this reporting anomaly has been as a result of incorrect registration numbers being entered by the pharmacist issuing the prescription. These anomalies have been raised with the Pharmacy Council of New Zealand and the Board understands that an item will shortly appear in the Council’s next newsletter highlighting these issues and asking pharmacists to be extra careful when entering prescription information.

Thank you to all optometrists who have responded to our enquiries.  This analysis has even prompted many optometrists to audit their own prescriptions for usage. In all cases, the Board has been very impressed with the responses received and no further action has been required. The Board intends to continue to monitor TPA use over the next year and will report the results of this analysis at the end of 2013.

Board Self Audits - Change in Selection Process

The Board recently reviewed the process it undertakes in selecting practitioners to complete a Board self audit and whether this process was adequate to assure the public that optometrists and dispensing opticians are competent to practise.

The current process randomly selects 40% of all practising practitioners to be screened within a recertification cycle. While a practitioner will not be asked to complete more than one audit within a 2-year recertification cycle, they may well get selected again during the next 2-year cycle, where others may not get selected in either cycle, due to the random nature of the selection process.

As a result of the Board’s review, the Board has decided that the self audit selection process will no longer be random, and that all practitioners will be asked to complete a Board self audit within an 8-year period. The question of when a practitioner will be audited will remain random; however, the new selection process will ensure all practitioners are audited on a regular basis and that no practitioner is audited twice within 4 years of being audited, unless concerns are noted at the time of audit.

This change will ensure, as far as possible, that in combination with completing CPD programme requirements, optometrists and dispensing opticians are competent to practise, and that any practitioners not meeting the required standard of competence are identified and assisted to remedy the deficiencies in their standard of practice. The new selection process will commence from January 2013.

Please note, this self audit selection process is different from the deficit self audit selection process. Practitioners are selected to complete a deficit self audit where their CPD is in deficit at the end of a recertification cycle. The deficit self audit is different from the general self audit in that it includes additional questions relating to CPD and a request for a plan to be created for meeting the shortfall in CPD. Where a practitioner’s CPD is in deficit at the end of a recertification cycle, they will be asked to complete a deficit self audit, unless a successful application has been to the Board for consideration of extenuating circumstances. For more information on the deficit self audit process click here and review the recertification policy for your profession.

Seasons Greetings

This is the Board's final newsletter for the year, so the Board extends its warmest wishes for a safe and happy festive season.

Please note, the Board's office will be closed from 24 December 2012 until 7 January 2013. Emails sent and phone messages left over this period will be attended to promptly when the office re-opens.

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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