Raigmore Emergency ophthalmology admission protocol

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Audience

  • Highland HSCP 
  • Primary and Secondary Care 
  • A&E Clinical staff, medical clinical staff, surgical clinical staff, Raigmore ANPs 

Introduction

  • Ophthalmology cover their ward (4A) 08.00 to 20.00 with an ANP covering for the other 12 hours.
  • All patients are admitted under a named ophthalmology consultant.
  • There is agreement that emergencies are covered by the appropriate specialty if the ANP teams need help, mainly medicine via the MET team.

Quick reference guide

The admission process needs to first consider the following: 

Does the patient have a primary ophthalmology problem with no other acute medical / surgical problems?

  • If yes admit to 4A under Ophthalmology 24/7

Does the patient with an ophthalmology problem have an acute surgical or medical problem (even if the ophthalmology problem is the major concern)?

  • If yes, the patient should be admitted to the most appropriate medical or surgical admission area

Escalation criteria

  • If a patient deteriorates while under the care of the ophthalmologists, unless this is entirely due to their ophthalmology disease, the patient should be escalated to:
    • In hours: Ward 4A Junior Doctor 
    • OOH: ANP covering surgery
  • At any time, if the nursing team are concerned about a deteriorating patient under the care of Ophthalmology, they should contact the medical emergency team (MET) team on 1999.
  • If the reviewing ANP/Junior Doctor needs more support a senior MET call should be initiated: MET 1888 
    • In hours Monday to Friday: Acute Medical Consultant
    • OOH: Medical Registrar with Consultant Physician on-call
  •  24/7 The Senior MET doctor should review the patient and initiate treatment. If they need to refer to surgery this should happen.
  • When the Senior MET is carried by a Medical Registrar their senior support remains the Consultant Physician on call.
  • All need to be aware that there is no Consultant Ophthalmologist on-call between 20.00 and 08.00.

Ophthalmology on-call service and COVID-19

Although most Optometrists have closed, emergency eye patients can be seen by the following peripheral community Optometrists:

  • Inverness - Deirdre Newcomen/Andy Carr (01463 241341)    
  • Dingwall – Gavin Wreath/Assara Shaban (01349 869850)   
  • Golspie – Colin Pettinger/Donald Goskirk (01408 633448)   
  • Orkney - Graeme Clark (01856 872857)
  • Western Isles - Robert Doig/Ian Rough (01851 704200)
  • Wick - Ian Morris (01955 609939)
  • Fort William - Ian Fleming/Liz McGougan (01397 702973)
  • Skye/Kyle - Craig Campbell (01599 530022)

Abbreviations

Abbreviation  Meaning 
 ANP  advanced nurse practitioner
 MET  medical emergency team  
Related guidelines
References

Self-management information