Guidance

Eye care case study: Bradford Royal Infirmary

Published 27 January 2020

Bradford Royal Infirmary

Bradford Royal Infirmary has identified a list of possible reasonable adjustments as potentially useful in helping someone to access good hospital eye clinic care. Most will also apply to people having sight tests with optometrists. This list includes examples about preparing the individual and the environment, the approach of the clinician and modifications to the tests.

Making the appointment:

It is useful to have a nominated lead for learning disabilities such as sister or charge nurse in charge of eye clinic. This person may pick up new referrals for people with learning disabilities. Administration staff need to be aware that changes can be made and some of the adjustments to consider are:

• early or late appointment
• an appointment at a particular time of day
• minimise the waiting time
• a visit to the department prior to appointment
• split visits to reduce the time in the eye clinic
• no eye drops or do eye drops at home first
• people with learning disability are ‘vulnerable patients’ and should be exempt from Did Not Attend (DNA) policies

Patient information

Finding out as much as possible about the individual in advance can help. This might involve asking someone who knows the person well to:

• provide information about the patient’s medical condition
• provide information about the patient’s visual performance
• explain how the person communicates
• say what the person might find difficult about the examination
• say how the person feels about being touched

The hospital can help by providing information on what sort of tests might be included in a visit to the clinic so the person knows what to expect and can be prepared.

Arriving at clinic:

• reception staff aware of the adjustments which can be made
• nursing staff alerted as patient checks in – quiet area available, if referral had not indicated a learning disability, decision made about type of vision test suitable
• medical staff alerted so they can prioritise the patient, minimise their wait, get equipment together and adjust the room so it is suitable for the patient

Checking their vision

Everyone can have a sight test with the right support. It is not necessary for someone to be able to read for example. Some of the approaches that can be used are:

• matching shapes
• orthoptist to do vision check
• functional assessment - why is there concern about vision?
• asking what has changed for the person?
• finding out what activities the patient finds difficult now

Examining the patient

There are strategies that can be used that will help the patient to tolerate the test:

• explaining what is going to happen using simple words
• warning the patient before turning lights off
• warning the patient before they are touched
• thinking of inventive ways of achieving what is needed
• using alternative ways to check eye pressure (for example iCare tonometer)
• minimal use of eye drops/appropriate preparation

Communication and providing feedback:

• copy of the GP letter to be sent to the patient
• use SeeAbility’s optometrist feedback form
• provide information leaflet/easy-read information
• consider another appointment to give an opportunity for the person to come back and ask more questions

Glasses:

• patients who cannot read should not be denied glasses to help them see close up
• ‘feeding’ glasses are as important as ‘reading’ glasses
• glasses should be discretely labelled – with the patient’s name if they live in a shared setting – and with their purpose (near or distance) if they have more than one pair

For further information, contact Rachel.Pilling@bthft.nhs.uk