Practice Standards Audit Tool

Practice Standards Audit Tool

Welcome to the Optometry Australia Practice Standards Audit. The information is organised into five chapters. Please click on the blue Chapter Heading links below to open the drop-down menu and:

 1. Review the Learning Objectives for that chapter.

 2. Use the GREEN menus to learn about the principles and criteria for best practice, and link to
     further information and support.

 3. Use the Practice Checklist tick boxes to self-assess your own practice and procedures against
     the recommended Practice Standards.

  • 1 > Patient Access

    LEARNING OBJECTIVES
    1. Understand the significance and importance of equitable access to care.
    2. Identify frameworks for assessing, benchmarking and maximising the accessibility of your practice for specific groups of patients, including patients from diverse cultural backgrounds, and patients with physical or other disabilities.
    3. Understand your legal requirements in relation to privacy and informed consent, and why supporting informed patient decision making is an important principle of quality clinical care.
    4. Review, and identify and gaps in your knowledge of, legislative requirements, clinical guidance and frameworks describing and supporting quality, best practice primary eye care.
    5. Identify specific steps your practice can take to support inclusive, continuous and appropriate clinical care.

    • 1.1 PRINCIPLE: Equitable access to care

      Why is this important?

      The Australian Commission on Safety and Quality in Healthcare has developed a Charter of Healthcare Rights which begins with the affirmation of a basic right to health care.

      Decisions about providing care for any particular patient should be taken in a way that is consistent, and free from bias related to personal behaviour, cultural identity/background, sex/gender, disability, or financial circumstances. In most situations, it would be ethically inappropriate to deny in an emergency or life-threatening situation and that may put you at risk of breaching your legal duty of care.

      There may be legitimate circumstances where it may not be appropriate for you to provide services to a particular patient. For example:

      • you are not the most appropriate person to clinically manage that patient;
      • the patient would be better served by an optometrist competent in that patient’s language or culture;
      • the patient may be behaving inappropriately towards you.

      There is a potential conflict of interest if you provide health services to dependents, family members, or people with whom you have a sexual relationship. The Optometry Board of Australia comments on this in Section 2.14 of its Code of Conduct. Services should not be provided under Medicare to a provider’s employers, employees, dependent children or spouse/partner: (see Section O.4 of the Optometric Services Schedule).

      Federal and State legislation protects people from discrimination in health services based on age, disability, race, and sex or gender.

      GUIDE AND CRITERIA: 
      EQUITABLE ACCESS TO CARE
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      Practice opening hours are reasonable and consistent. Practice hours are clearly described on the premises and elsewhere as appropriate.
      • Practice checklist

        There is clearly written signage on the front of the practice with the practice name, contact information, and other relevant details.

        Information on the practice website or in-practice advertising clearly describes the usual operating hours.
        The practice is generally open at least some week days during ordinary business hours, and if appropriate, offers weekend hours.

        There is information in advertising displayed on the practice door/window, on the telephone answering machine, and on your website describing where patients can go for after-hours urgent or emergency care.

        If you change your operating hours or days, you have system in place to inform your patients, and to update advertising material and website as soon as is practical.

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      The practice is consistently and appropriately staffed during opening hours
      • Practice checklist

        At least one staff member is always present in the practice during advertised opening hours. That person need not be an optometrist, but should have first aid training, and be able to identify, triage or refer patients with ocular emergencies.
        There are documented procedures and protocols for dealing with patients needing emergency care, including outside of hours care.
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      Practice has a flexible appointment system able to accommodate emergencies, longer consultations where needed, delays, and review visits
      Why is this important?

      It is essential to have systems in place to anticipate and manage the workload during your opening hours to ensure you meet the eye care needs of all your patients. These systems are also important from a staff management and occupational health and safety perspective, ensuring that optometrists and practice staff are working appropriate and manageable hours, and have the time they need to provide the required level of care or to manage patients in waiting areas without avoidable stress.

      • Practice checklist

        The practice maintains an appropriate appointment and booking schedule accessible to and able to be used by all applicable staff.

        Optometrists have sufficient flexibility in their appointment and booking schedule to allow them to provide quality care, review patients at the appropriate time, and to follow up.
        The system can accommodate emergencies and urgent reviews.
        Practice staff members are trained in and understand the practice systems and expectations around appointment scheduling (e.g. the standard length of a comprehensive consultation in the practice).
        Patients in the waiting area are kept reasonably informed of foreseeable delays.
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      All patients are treated and considered equally, and cultural differences are respected
      Why is this important?

      The way patients seek and obtain health care often has a cultural dimension. Factors including religious beliefs or practices, gender/sexual identity, language barriers, or cultural history or practice can all affect the way patients access care, and their health care decisions. It is important to be sensitive to and aware of what any individual patient’s needs might be and how relevant cultural factors might affect that patient’s needs and management.

      You may want to consider investing in staff training or in developing information for staff members about how to understand particular cultural circumstances which might be relevant in your practice demographic, and how to support the needs or expectations of diverse patients in your practice community.

      • Practice checklist

        Patients are not discriminated against or treated differently on the basis of cultural or language background, place of birth, religious beliefs, sexuality or gender identity, age, appearance or health status. All staff members understand their legal and ethical obligations and the practice’s expectations about this.
        Your patients’ personal health choices and decisions do not adversely affect decisions about the level of care you provide to them.
        Culturally appropriate care is provided. You refer to other appropriate practitioners if necessary, or on request.
        Staff members all understand and can respect cultural differences within the practice demographic.
        Your practice can reasonably manage or refer requests relating to gender (e.g. a patient request to see a female optometrist), privacy, the presence of third parties, and other issues of potential cultural sensitivity.
      >
      The practice is accessible to patients with a disability
      Why is this important?

      People with disabilities or health concerns affecting their physical/mental capacity may have particular needs when they access the practice. This will include but is not limited to patients with low vision, physical disability (including patients in wheelchairs), and those who have mobility issues relating to health or age. Your practice should be reasonably accessible to these patients during your advertised opening hours. If the practice is not able to facilitate some kinds of access (e.g. cannot safely accommodate a large wheelchair) it is important that patients are informed about this when enquiring about appointments, offered an explanation, and provided with information about alternative accessible services.

      There are building standards and codes relating to the physical accessibility of premises, under federal disability discrimination laws. If you are opening a new practice, or upgrading or fitting out existing facilities, you must comply with these standards unless exempt.

      • Practice checklist

        Staff members are prepared for and aware of the fact that people will have a range of needs when accessing the practice, and are able to assist these patients. There is capacity to provide physical assistance if needed.

        The practice is able to reasonably accommodate the needs of people with physical disability.
        The practice is able to provide low vision services and prescribe low vision aids, or your staff members are able to refer or direct patients to appropriate low vision services or practitioners.
        Patients with guide or assistance dogs are able to access the practice.
        Staff members are aware of the communication needs of patients with a disability and have access to information or services that may help them (e.g. the National Relay Service for patients who are deaf or hearing impaired).
      • More information

        Practice accessibility: considerations and requirements

        The key legislative framework relating to practice accessibility is the federal Disability Discrimination Act 1992 (DDA) which, in broad terms, makes it unlawful to discriminate against a person in terms of access to services on the basis of a temporary or permanent physical or intellectual disability. The Human Rights and Equal Opportunities Commission has developed a guide describing legal obligations in relation to disability access to buildings and physical premises. There are some exemptions for existing premises and older facilities. However, if you are fitting out, building, or upgrading/modifying a practice, you must do so with reference to these obligations. These cover aspects of the practice including:

        • signage;
        • width and accessibility of spaces like doorways and passageways; and
        • additional considerations: railings, ramps and accessible parking.

        Ensuring any practice renovations or new fit outs comply with these standards will minimise the risk of successful legal action being taken under the DDA.

        If your practice is presently not accessible to some patients with physical disabilities or needs (e.g. cannot accommodate large wheelchairs due to steps or door width), there needs to be an alternative strategy to ensure that patients are able to obtain care, such as offering home visits.

        Low vision accessibility

        It is important that your practice is physically accessible to low vision patients, who are also protected from discrimination under the federal Disability Discrimination Act 1992. This will include ensuring that guide or assistance dogs are able to come into the premises if required.

        Vision Australia can provide information about ensuring your practice is accessible for low vision patients.

        Vision Australia’s Digital Access Consulting service is available for practices wanting to ensure that their online and digital presence is best-practice, and accessible to people with low vision.

        Low vision services

        You may see low vision patients in your practice who need particular care, testing, equipment/vision aids or clinical experience. There are a number of practices where there are optometrists who are experienced and have the equipment needed to be able to provide this kind of care. Optometry Australia’s Low Vision Services Guide provides an outline of optometry and other services in each state for people with low vision needs. Keep a copy handy in the practice, or make sure that staff members know how to access this information online and are familiar with service providers and options in your community.

        Optometry Australia also has some informative videos about providing low vision clinical care.

        Interpreter service for deaf, hearing impaired or speech impaired patients

        The Australian government’s free National Relay Service can assist patients who are deaf/hearing impaired, or speech impaired, through the telephone, using internet relay. The technology allows you to type your side of the conversation on a computer, laptop or internet-enabled mobile device (smartphone or tablet), and to read the other person’s responses on your screen.  You can both make and receive internet relay calls through this app. 

        Assistance with languages

        Unfortunately the national Translating and Interpreting Service that can be used by medical practitioners and specialists is not available for optometry consultations. There may be local health care interpreter services in your state.

        Cultural competence

        The Centre for Culture, Ethnicity and Health has information and resources about cultural competence in health care, with a particular focus on refugee and migrant backgrounds. Gay and Lesbian Health Victoria provides information, resources and some training about understanding health needs for gay, lesbian, bisexual and transgendered/intersex communities. The Royal Australasian College of General Practitioners (RACGP) has some information on cultural competence relating to the delivery of care for patients with a mental health condition or concern. The Ethnic Communities’ Council of Victoria has some general protocols and checklists to assist in developing cultural competence.

        There are a number of opportunities for health care workers interested in indigenous cross-cultural competencies, through various providers, with online and face-to-face options, some of which are listed here. The Centre for Cultural Competence Australia offers general courses in indigenous cross-cultural understanding.

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      Care is equitably available for patients with a variety of economic needs and circumstances

      Why is this important?

      Sustainable and suitable billing in your practice will be dependent on a range of factors, including what your overall patient population is likely to be able or willing to pay. Following changes to Medicare arrangements 2015, many optometry practices have successfully adopted a system in which fees are charged for at least some consultations.

      The key to introducing private billing is to be mindful that there will likely be at least some patients in your practice for whom a fee is a genuine barrier to seeking care, and to apply a clear and consistent policy. As far as is possible, your patients should be informed in advance of any known expected fee attaching to a service. They should be free to choose an alternative practitioner if they are unwilling or unable to pay any stipulated fees and the practice cannot accommodate the need, for example, by bulk-billing.

      • Practice checklist

        The practice provides clear and written information within your practice, and in advertising such as on the practice website, about the cost of services, including written information about any fees or standard charges associated with the services you provide.
        If bulk-billing is not generally available, or is only available to some patients, this is explained up front by practice staff, using clear and consistent language. Patients are made aware of any known fees up front, and informed of the potential for additional fees or charges up front when this is reasonably anticipated.
        Practice policies and practices ensure that emergency or urgent eye care is not denied to any patients on the basis of their income or ability to pay fees.
        There are appropriate payment systems in place to reflect patient needs and community expectations.
        Advertising and information about the cost of optical devices conforms to all legal and statutory requirements, including advertising guidelines developed by the Optometry Board of Australia/Australian Health Practitioner Regulation Agency and relevant consumer advertising legislation and codes, including legislation relating to the display of price components for complete products like glasses.
        Staff members are aware of any available subsidised eye health services and/or low cost vision aid schemes, and can advise patients on this if needed.
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      The practice is able to manage, or refers, patients who need domiciliary care

      Why is this important?

      Most optometry practices will encounter situations where patients who need care can’t physically get to the practice. This might be due to the patient not being ambulatory, being very unwell, being in a care facility, or other personal circumstances. It’s not necessarily feasible for optometry practices to provide domiciliary care for all requests. The practice’s capacity might be limited by staffing levels, the distance an optometrist is prepared or able to travel, equipment, what tests can reasonably be performed, insurance, and fees.

      Practices should develop a written policy around managing requests for domiciliary services, which is consistent, and describes:

      • whether they are provided at all;
      • if domiciliary services are provided, to whom they are available and under what circumstances;
      • any fees associated with the service;
      • what equipment is to be carried and what testing is available to domiciliary patients;
      • alternative service options (such as telehealth consultations with the patient’s ophthalmologist, or referral to mobile eye care services);

      how the record of the consultation will be taken and maintained (for example, a manual or handwritten record will need to be entered electronically into the practice management record system, or you may use a virtual private network or VPN to allow you to remotely access the record system through a laptop).

      • Practice checklist

        All practice staff understand and are able to explain to patients the practice policy regarding the provision of domiciliary care. That policy is documented and accessible to all staff.
        If your practice does not provide domiciliary services, there is an up-to-date register of practices or services in the area that do.
        If your practice does offer domiciliary services, there is a list of the equipment to be taken for each visit.
        Appropriate comprehensive clinical records are taken. If there is no mobile access to the practice patient record system, there is a system for entering this information into the practice management system’s clinical record as soon as practical following the consultation.
        If the practice offers alternative options, such as telehealth services for consulting with ophthalmologists, patients are made aware of this opportunity.
      • More information

        Telehealth services

        It may be an option for your practice to offer telehealth consultations for patients who cannot physically access the practice. Medicare rebates are available for telehealth services with an ophthalmologist provided to patients outside of major metropolitan areas who live 15 km or further by road from the ophthalmologist’s practice, and for services provided to patients in residential care or an Aboriginal Medical Service.

        More information about eligibility for telehealth, including information about equipping your practice for this service, is available in this Optometry Australia Telehealth Practice Note.

    • 1.2 PRINCIPLE: Quality and best practice in clinical care

      Why is this important?

      Optometrists should manage the primary eye health and vision needs of all patients in a manner consistent with and with reference to:

      • the practice of peers, and professional expectations and standards;
      • any Guidelines, position statements or standards set by the Optometry Board of Australia;
      • clinical care standards and evidence-based guidance on clinical practice issued by recognised arbiters of care standards (e.g. the National Health and Medical Research Council); and
      • knowledge of professional practice updated through continuing professional development.

      If a practice is for any reason unable to provide the necessary care for a particular patient, the patient should be directed to a suitable health practitioner to manage their needs.

      GUIDE AND CRITERIA: 
      PROVIDING QUALITY AND BEST PRACTICE CLINICAL CARE
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      All practising optometrists meet the legislative requirements for registration and other requirements for clinical practice
      • Practice checklist

        All optometrists employed in the practice hold the correct registration for their duties, whether they are seeing patients, or employed in other roles (such as providing education or training).

        The practice has a written policy describing how continuing professional development (CPD) for optometry staff is supported and facilitated (for example, by providing time off, support with cost, or in-house professional development). The policy applies equitably to all optometrists.

        All registered optometrists hold professional indemnity insurance at the levels specified by the Optometry Board of Australia.

        All optometrists who are required to do so by legislation have completed a Working with Children Check, and hold the appropriate confirmation or certification.

        Optometrists who prescribe scheduled medicines hold the appropriate endorsement to do so, and undertake any continuing professional development required to maintain this endorsement.

        Approaches to history-taking, examination, diagnosis, management and referred/shared care are consistent with clinical best practice.

        Patient information is correctly and consistently recorded, and appropriately stored and managed in accordance with the requirements of all relevant legislation. Record-keeping should also meet the standards required by the optometrist’s professional indemnity insurer.

        Optometrists have CPR certification, and this training is undertaken as per the requirements of the Optometry Board of Australia.

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      Non-optometrist staff members are appropriately trained and have the necessary qualification or skills for any roles involving patient care
      • Practice checklist

        Staff members are offered and participate in relevant in-house or other training (such as external training courses).

        If staff members are undertaking particular practice procedures such as ancillary testing, they have had adequate training and, if relevant, this is supported by records or certification (such as certificates of courses completed).

        There is appropriate training for all staff members who may be required to assist or manage patients presenting to the practice in need of emergency care when an optometrist is not present. This might include first-aid courses, or in-house training. There are staff members with up-to-date first aid certification.

        Staff members with CPR certification have a refresher course annually.

        There is a written reference guide for staff members who are not optometrists to help identify and appropriately manage and refer emergencies, including contact details for emergency GP or ophthalmology care, and local hospitals.

        Staff undertaking any ancillary testing (e.g., visual fields) are trained in the proper method and use of any equipment, and understand their role.

        Staff members who are instructing patients in the use, insertion or cleaning of contact lenses have the training needed to do so safely and in accordance with Optometry Australia infection control guidelines and recommended procedures.

      • More information

        First Aid courses

        There are a number of nationally accredited registered providers of first aid training and certification. Information about courses and accredited providers is available at myskills.gov.au.

    • 1.3 PRINCIPLE: Continuity and appropriateness of care

      As providers of primary eye care, there will, from time to time, be patients requiring a level of expertise or kind of care not able to be provided solely by the optometrist to whom the patient presents in the practice.

      • The presenting condition might require a treatment not within an optometrist’s scope (e.g. treatment with a scheduled medicine which the optometrist is not able to prescribe).
      • The patient might need testing, equipment, or monitoring not available in the practice to which they present.
      • The patient’s eye problem might be related to a systemic health condition requiring GP assessment, treatment or management.
      • The patient may need specialist ophthalmic examination, care or surgery.
      • The optometrist may identify a colleague who has greater experience, knowledge or capacity to manage particular patients or conditions.
      • There may be particular language or cultural barriers to providing the best care for a particular patient or individual.
      • The patient might be seen in a setting outside a primary optometry practice, such as through a work or school eye examination program, a health screening, an Aboriginal health service or an aged care facility.

      There should be policies, systems and procedures in place to support all patients to meet their complete eye and vision care needs.

      Why is this important?

      As providers of primary eye care, there will, from time to time, be patients requiring a level of expertise or kind of care not able to be provided solely by the optometrist to whom the patient presents in the practice.

      • The presenting condition might require a treatment not within an optometrist’s scope (e.g. treatment with a scheduled medicine which the optometrist is not able to prescribe).
      • The patient might need testing, equipment, or monitoring not available in the practice to which they present.
      • The patient’s eye problem might be related to a systemic health condition requiring GP assessment, treatment or management.
      • The patient may need specialist ophthalmic examination, care or surgery.
      • The optometrist may identify a colleague who has greater experience, knowledge or capacity to manage particular patients or conditions.
      • There may be particular language or cultural barriers to providing the best care for a particular patient or individual.
      • The patient might be seen in a setting outside a primary optometry practice, such as through a work or school eye examination program, a health screening, an Aboriginal health service or an aged care facility.

      There should be policies, systems and procedures in place to support all patients to meet their complete eye and vision care needs.

      GUIDE AND CRITERIA: 
      PROVIDING APPROPRIATE AND CONTINUOUS CARE
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      Practice systems and procedures support appropriate care
      • Practice checklist

        Patients making appointments are able to request the optometrist of their choice.

        All staff members, including those who are not optometrists, are able to identify the most appropriate practitioner for patient needs.

        Practice staff members are aware of the optometrists in the practice who have therapeutic endorsement, and where direct patients to appointments indicated with those optometrists.

        If a therapeutically endorsed optometrist is not available, staff members are able to refer patients to an alternative practice if required.

        Staff members know when to direct presenting patients to other health services, such as a general practice, or hospital emergency unit.

        The practice keeps and maintains up-to-date information about other health practitioners in that area, including GPs, ophthalmologists, hospitals, emergency clinics and pharmacies, and staff can provide directions to those services.

        The practice has both standard and specialised equipment for conducting primary care optometry consistent with guidelines from Optometry Australia and the Optometry Board of Australia.

        There is equipment and capacity to examine and provide eye care for patients with diabetes and glaucoma consistent with National Health and Medical Research Council guidelines, and Optometry Board of Australia scheduled medicines guidelines.

        Optometrists and staff have access to the current Medicare Schedule of Optometric Benefits, and if relevant, the Schedule of Pharmaceutical Benefits, and know how to get information from these resources.

        In consultations, optometrists explain the significance and relevance of symptoms and findings to patients.

        Services are only provided when necessary for appropriate clinical management, or if specifically requested by the patient.

        Patient histories and records are taken and managed in accordance with Optometry Australia guidance on clinical record keeping.

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      Practice systems and procedures support continuous care
      • Practice checklist

        There are systems, documents and procedures to support patient referral as needed, and referrals are in accordance with clinical guidelines developed by Optometry Australia.

        Optometrists have ready access to current vision standards for driver’s licenses, and for health assessments (such as eligibility for financial assistance for the vision impaired), through a written document or online. If a patient requires certification that they meet a statutory vision standard (e.g. to hold a license or undertake a particular job), the practice has a procedure to confirm their identity with a photograph and signature before documentation is issued.

        Vision screenings or vision examination reports for employment purposes only are not billed to Medicare.

        Optometrists provide timely written reports to other practitioners involved in patient care about key clinical findings or outcomes. These reports are filed with patient records and/or clearly cross-referenced.

        Optometrists are familiar with the requirements of the Optometry Board of Australia for practitioners participating in the collaborative (shared) care of patients. There is a written policy/procedure which reflects these requirements. An alternate optometrist is specified if the primary collaborating optometrist is unavailable.

        There are systems in place to identify patients who may have other needs, such as welfare or safety concerns, and to report these concerns as required or appropriate to the patient’s medical practitioners or to a relevant authority such as a teacher or carer.

        There are procedures and systems for following up patients with significant conditions who do not show for clinically indicated follow-up care.

        All staff members are aware of their legal obligations if it is suspected that a child presenting at the practice has been harmed, or is at risk of harm from physical or sexual abuse, neglect, or lack of appropriate medical treatment. There is a documented policy and procedure for managing these situations, which is understood and followed by all staff.

        There are regular times scheduled for meetings in which optometrists are able to discuss concerns relating to patient management.

        There is a documented policy describing how alternative care is available to patients when optometrists are absent from the practice due to leave or illness.

      • More information

        Clinical guidelines for referral

        Providing quality eye care includes referring patients to another practitioner when that is in the best interests of the patient. Part of your professional responsibilities includes understanding and accepting limitations in your own knowledge, skill, training and clinical competence. Referrals made under Medicare must be valid for the patient to receive Medicare benefits. Optometry Australia has produced a guideline on clinical referral describing responsibilities and requirements for referring patients. Optometry Australia also has a Practice Note on referrals between optometrists.

        Prescribing scheduled medicines: support, resources and information

        NPS MedicineWise is a comprehensive resource and website with a wide range of information and tools to support best practice in the prescribing and use of scheduled medicines, including guidelines around the Quality Use of Medicines (QUM). NPS MedicineWise is independent, and not-for-profit.

    • 1.4 PRINCIPLE: Respect for patient freedom, choice and rights

      Why is this important?

      The Australian Charter of Healthcare Rights was developed, following extensive consultation, by the Australian Commission on Safety and Quality in Healthcare. It describes, in seven principles, what members of the community should be able to expect when they visit a health practitioner. The charter outlines that patients have a right to be shown respect and treated with dignity, and to be informed of their health care choices, and to participate in any decision making processes. It encourages a genuine partnership approach to achieve good health outcomes.

      There are a number of legal principles which underpin these rights, including the principle of informed consent. This applies not only in the research setting, where it is a well-established legal principle, but also in the general clinical and primary care setting. Before any kind of procedure or testing is undertaken, the patient should understand why the test is recommended, and should be informed of any risks or potential concerns (such as minor discomfort or pain or that a cycloplegic drop may affect their capacity to drive).

      A patient is free to refuse permission for any test or procedure to be undertaken. There is no obligation for a patient to explain why, but discussion of any issues should be encouraged if the patient is prepared to do so. To protect the health practitioner, if a patient chooses not to have a procedure that an optometrist thinks is clinically important or necessary, this discussion should be documented on the record card.

      GUIDE AND CRITERIA: 
      RESPECT FOR PATIENT FREEDOM, CHOICE AND RIGHTS
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      Practice systems support patients to freely make decisions about their clinical care
      • Practice checklist

        Appointment booking systems for group practices enable patients to nominate an optometrist of their choice.

        Optometrists acknowledge the right of patients to choose the optometrist they consult, and to seek a second opinion about their clinical care at any time.

        Optometrists can describe how they manage patients who seek alternative care or a second opinion. (This may include facilitating transfer to another carer through sending copies or summaries of the patient’s health record if requested by the patient.)

        Optometrists are willing and able to assist the patient to understand why a particular examination, procedure or treatment is being recommended, and respect the patient’s right to make an informed decision about that test and whether it is performed or not. If a patient elects not to have a particular test or procedure that the optometrist thinks is clinically necessary, it should be noted in the patient record that the examination or procedure was recommended by the optometrist, but refused by the patient, with any relevant reason indicated by the patient also recorded.

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      Practice systems support patients to freely exercise their consumer choices
      • Practice checklist

        Optometrists and all other practice staff are aware that patients are legally entitled to be provided with a copy of their optical prescriptions when a prescription has been generated as part of a consultation. There is no charge for providing this at the conclusion of the consultation.

        Patients are always provided a copy of their optical prescription if they request it. The prescription copy includes all relevant and necessary information, including information about expiry. If PD was measured, this should be included.

        Patients are always provided with copies of their health records or summary information if they request it, within an appropriate timeframe.

        If a fee is attached to the provision of a copy or summary of health information or to the provision of a script, it is within the limits set by any legislation/statutory authority, and does not unreasonably discourage the patient from requesting the information or script.

        Advertising and information about the cost of products dispensed at the practice conforms to legal and statutory requirements, such as advertising guidelines set out by the Optometry Board of Australia or the component laws and other pricing legislation.

        There is a clear and consistent written policy on refunds.

        Marketing practises comply with privacy laws or guidelines, and patient requests not to be sent marketing materials are respected.

        The practice stocks a range of suitable patient information in consumer-friendly language to support their healthcare choices, including information about eye care and other relevant health issues such as diabetes.

      • More information

        Patient entitlement to optical prescriptions

        Patients are legally entitled to access their health records, including their optical prescriptions. If a patient asks for a copy of their prescription, this cannot be withheld from them, regardless of whether or not their intention is to have it made up elsewhere.

        In some states, health records laws regulate administrative fees that may or may not be able to be charged for provision of extracted information from or copies of health records. The Optometry Board of Australia policy position is that no fee should be charged for providing a patient with a copy of their script at the end of the consultation where it was initially generated. An optical prescription is the property of the patient under common law. The Medicare Schedule of Optometric Benefits (Section O.9) requires the optometrist ensure patients are aware of their entitlement to a copy of their script and are provided with this if they request it.

        If it is your practice policy to charge a fee for providing a copy of their prescription at date subsequent to the consultation where it was generated, you must ensure that (1) this fee does not exceed any level specified by State legislation; (2) it is clear that the fee is only to cover reasonable administrative costs and is not a disincentive to access; and (3) in the event the patient cannot pay a fee, the script is not withheld, as it is legally a part of their medical record.  

        If the optical prescription is an old one, and the optometrist does not feel they could vouch for its current clinical suitability, it can be marked EXPIRED, FOR INFORMATION ONLY.

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      Patient privacy is respected
      • Practice checklist

        The practice has a privacy policy that is available to patients on request and complies with legal responsibilities laid out in the Australian Privacy Principles.

        Patient privacy is respected at all time during consultations. The door is closed (unless inappropriate to do so), consultations are not interrupted except in emergencies, and third parties are present only with the express verbal or written consent of the patient. Consultations cannot be overheard by others present in the practice.

        The privacy of all patient records and information is maintained in accordance with all legislative requirements. All members of staff understand privacy requirements and expectations. Sensitive or other health information is never disclosed or provided to third parties without the patient’s knowledge and consent.

        Computer screens, record cards, patient reports or imaging devices are all arranged so that information displayed on them is not visible to people in the waiting room or service areas. There is password protection on computers with patient information, including screensaver passwords.

        Staff members are aware of their privacy responsibilities in the use of social media. There is a documented social media policy.

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      Patient complaints are dealt with appropriately
      • Practice checklist

        There is a documented procedure about the process to be followed in the event of a patient complaint. The policy deals with both clinical or care complaints and consumer/product/service complaints.

        All members of staff are aware of and can access the document, and know which members of staff are responsible for handling any complaints.

        There are processes in place to support staff members if there is a complaint about them.

        There is a list of health and consumer complaints agencies in the practice and/or staff know how to access information about these agencies.

        If a clinical complaint is made about an optometrist, this is noted on the patient record. The optometrist’s professional indemnity insurer is notified of this complaint as required or specified by the insurer.

        Where there has been an error in clinical decision making or the management of a patient, this information is used to improve future patient management. If applicable, changes are introduced to practices or procedures to prevent the recurrence of the situation or issue.

        If a complaint is made about the provision or quality of an optical appliance, this is dealt with in accordance with consumer laws.

        The practice is aware of, and adheres to, the Open Disclosure Framework and the Australian Charter of Healthcare Rights.

        All staff members who are registered health practitioners are aware of any obligations to report or notify under circumstances where an optometrist or another member of staff’s behaviour, health or conduct may be putting patients at risk.

      • More information

        Health practitioner conduct: Mandatory notifications

        Under specific circumstances, registered health practitioners are obliged by law to notify the Australian Health Practitioner Regulation Agency (AHPRA) if they believe another health practitioner’s conduct or practice is placing the public at risk. Notifiable conduct is:

        • practising while intoxicated by alcohol or drugs;
        • sexual misconduct;
        • practising with a health impairment affecting professional capacity/judgment; or
        • putting patients at risk by practising in a way significantly differing from accepted practice in that profession.

        If you have formed the reasonable belief that another health practitioner’s conduct (whether an optometrist or other registered health practitioner) fits any of these criteria, then you are obliged to notify the Australian Health Practitioner Regulation Agency.

  • 2 > Physical Environment

    LEARNING OBJECTIVES
    1. You are familiar with legislative and other requirements relating to the safety and physical accessibility of your practice and premises.
    2. You are familiar with and understand the compliance requirements to satisfy the Optometry Australia/Optometry Board of Australia Infection Control Guidelines for Optometrists.
    3. You are able to identify any gaps within your own practices or procedures which might affect the safety or amenity of the environment for patients or staff, where to go for more support and information, and how to address those gaps.

    • 2.1 PRINCIPLE: A safe physical environment

      Why is this important?

      Your patients and your staff are protected when there is a safe physical work space and practice environment. The business is protected too. There are a range of legal obligations and responsibilities relating to safe practice premises and a safe working environment.

      Safety and health issues in an optometry practice may pertain to:

      • the clinical, dispensing and general practice environment;
      • the potential for communicable disease or infectious disease to be transmitted in the practice of clinical care;
      • the potential for injury; and
      • general occupational health and safety concerns for staff: hours of work, physical workspaces, and the protection of emotional and physical wellbeing.

      It is important that you:

      • understand and comply with all legal obligations to staff and patients;
      • are able to identify and minimise the risk of patient injury, illness or infection in clinical care.
      GUIDE AND CRITERIA: 
      A SAFE PHYSICAL ENVIRONMENT
      >
      Practice has adequate resources, space and equipment to provide quality and comprehensive primary eye care
      • Practice checklist

        There is a sufficient number of consulting rooms to meet patient volume.

        Information on the practice website or in-practice advertising clearly describes the usual operating hours.

        There is an appropriately staffed reception area of adequate size for patient volume.

        The waiting room has sufficient suitable seating.

        The practice has both standard equipment and any specialised equipment to provide comprehensive primary care for the practice population. There is equipment for examination, monitoring, and clinical care that meets the standards and expectations of the profession, health regulators, and the community.

        There is adequate and appropriate lighting, heating and cooling.

        Noise levels, including music, are appropriate and allow conversation.

        There are clean and accessible toilets with facilities for hand washing.

        In the waiting room, reading materials, if provided, are properly cared for and stored. Children’s facilities are safe. Toys, are kept clean, are properly stored, and are not a trip hazard.

      >
      The practice, its staff and patients are secure at all times
      • Practice checklist

        There are locks on all doors and windows. Doors to areas not used by the public or not needed for emergency/fire access are locked at all times.

        Fire exits are always clearly signed and unlocked, and unobstructed.

        A documented policy states that only authorised staff members are able to access locked areas. All staff members with this authorisation have the necessary keys, swipe cards and alarm codes. There is a log book and register for managing the access keys/cards.

        There are secure facilities for staff members to store personal belongings.

        There is a documented procedure and staff training around appropriate management and handling of cash in the practice and when banking.

        There are documented and understood emergency procedures in the event of a violent incident or robbery. Staff working alone are trained and supported to protect their personal security.

        All scheduled medicines and potentially hazardous materials such as cleaning chemicals or sharps are correctly and appropriately stored e.g. in locked cupboards.

        There are members of staff trained in first aid, the practice has a first aid kit and the contents are checked and replenished regularly. The first aid kit contains a log book to record injuries or incidents.

        There is a system for recording workplace incidents such as injuries as required by WorkSafe or WorkCover insurance.

        There are fire extinguishers and safety measures which comply with occupational health and safety standards. Fire drills are conducted as required.

        Materials safety data sheets are available for chemicals used in the practice. Procedures around management and storage of hazardous goods, including cleaning items, are documented.

      >
      The practice is cleaned and well-maintained
      • Practice checklist

        There is a regular cleaning schedule. If staff members undertake any cleaning duties they are given adequate and appropriate time, equipment and instruction.

        There is regular practice maintenance, including maintaining carpets and painting, and cleaning air conditioners, fans etc. Maintenance is recorded in a log. Urgent maintenance needs are attended to promptly, and staff members are able to contact appropriate tradespeople in an emergency.

        The electrical arrangements are safe (e.g. no frayed wires, cords across walkways or overloaded power devices).

        Cleaning materials used are safe and properly stored in labelled containers in locked facilities.

      >
      The clinical consultation facilities are safe and clean
      • Practice checklist

        Therapeutic goods, medicines and devices are accessible only to the appropriate staff members.

        Pharmaceuticals and contact lens solutions are properly stored (e.g. refrigerated or kept in locked cabinet if required) and managed, checked, and disposed of according to manufacturers’ specifications, expiry dates and recommended procedures.

        Equipment is cleaned, calibrated, tested and maintained according to a documented procedure and schedule, which observes any manufacturer specifications.

        If it is necessary to clean equipment or consultation room facilities between patients, this is undertaken.

        Appropriate practice hygiene and infection control procedures are followed. Detailed information about this indicator is available in Criterion 1.3.1 of the Practice Standards. Staff members are trained in and can describe infection control procedures, and have ready access to documentation and instruction.

        There are hand washing facilities in all locations where patients are fitted with contact lenses or have contact lenses delivered. If there is no direct access in the consulting room, hand washing is available in a nearby location that doesn’t require the optometrist or patient to touch handles, fittings or fixtures to enter the room. Clean, lint free towels are available for each individual consultation.

        In consultation rooms where contact lenses are not fitted, there is a hand washing facility OR hand and skin disinfection products, with disposable paper towels.

        Equipment and instruments are cleaned, disinfected or sterilised according to manufacturer recommendations and/or infection control guidelines.

        Computer keyboards, telephones, general equipment and surfaces in the consulting room are cleaned.

        There is appropriate lighting, cooling and heating.

        There is no food or drink consumed in clinical areas.

      • More information

        Infection control: comprehensive Australian guidelines

        Optometry Australia produces and updates comprehensive Infection Control Guidelines for Optometry Practices.

        Occupational Health and Safety

        Laws and regulations relating to occupational health and safety are generally state-based (with some exceptions for Australian government employees and certain national safety regulators, like the Civil Aviation Safety Authority). Safe Work Australia is a statutory body established in 2008 to lead improvements in work health, safety, and workers’ compensation arrangements across Australia.

        On the Safe Work website, you can find links to your State work safety regulator. You can also find information about model codes of practice in areas including workplace first aid, which might be helpful reference tools if you want to develop practice policies.

        The responsibilities of your state regulator will include administering acts codes, and guidelines relating to workplace health and safety, and setting out the insurance requirements and standards for your employees. They are also responsible for workers’ compensation arrangements.

        State regulators will also have information about arranging or undertaking work safety checks, and training courses for staff.

      >
      The dispensing environment is clean and safe
      • Practice checklist

        There is a suitable area for patients to select and choose frames and lenses, and repairs/adjustments can be made.

        In a contact lens prescribing practice, there is a private area where patients can learn and practice inserting and removing contact lenses, with a table, a mirror and hand washing facilities.

        If your practice has on-site dispensing facilities, there is appropriate equipment to dispense and fit lenses in accordance with all relevant standards. Contact lenses are sold or supplied in accordance with guidelines issued by Optometry Australia, the Optometry Board of Australia, and all therapeutic goods legislation/regulation.

        Prescription glasses or lenses are supplied only to patients who have a valid prescription, unless there are exceptional circumstances.

        The dispensing area is kept clean tidy and free of obstruction.

      >
      Safety or health hazards, concerns or issues are managed promptly and safely, including the risk of infectious disease
      Why is this important?

      The federal Disability Discrimination Act 1992 (DDA) makes it unlawful to discriminate against a person in terms of access to services on the basis of a temporary or permanent physical or intellectual disability.  However, ensuring your practice is safe and accessible for people with disabilities is not something which should be considered merely a legislative duty. Optometry practices, like other health practices, need to be able to effectively and safely provide health care for all members of the community. While practice locations and premises might present some intrinsic access difficulties, all practices undertaking renovations and upgrades are encouraged to explore best practice in terms of disability access, and where possible, aim to meet those recommendations. At a minimum, any new work such as a practice redesign or fit out must comply with premises standards underpinning the DDA, although there are some exemptions and special considerations.

      • Practice checklist

        There is written documentation about vaccination, including a recommended schedule of vaccination for all staff. Staff members understand the principles of and need for vaccination.

        The practice follows any advice issued by Optometry Australia or health bodies and agencies (e.g. state or federal health departments) in relation to outbreaks, management or risk reduction procedures for infectious disease.

        Staff members adhere to documented guidelines and procedures for occupational health and safety, and there is a documented procedure for the regular assessment and management of risks.

        Spills are handled and cleaned appropriately, safely and quickly. This includes spills of hazardous and non-hazardous materials.

        Any human waste (blood, vomit, urine etc.) is cleaned and disposed of promptly and in accordance with a protocol that observes occupational health and safety requirements for the management of biohazards.

      • More information

        Vaccination

        Like all health care workers optometrists need to be aware of the potential risk of infectious disease, and should have an understanding of how common infections are spread. Vaccination protects practice staff and patients from pathogens including influenza, hepatitis B and measles.  Communicable diseases like whooping cough continue to occur in the Australian community, with unvaccinated children at particular risk. Some common infectious conditions, like influenza, may represent a greater risk risks for some patients, particularly the elderly. Seasonal vaccination among optometrists is relatively low. Despite recommendations, only about one third of optometrists are adequately vaccinated, despite the risks from relatively close patient contact, according to one study (Vosseler, Wilson and Wilson, 2014, ‘Uptake of influenza vaccination and risk reduction behaviour for respiratory infections: a survey of optometrists in New Zealand’, Clin. Exp. Optom. 97(5): 419-421).

        Vaccination is unfortunately controversial for some members of the community. You may have patients with strong beliefs that vaccination is harmful. While the evidence overwhelmingly supports the safety of routine vaccination, and in particular, shows that it does not increase the risk of autism, it may be difficult to influence some patients’ views.

        To minimise risks for you, patients and the community:

        • ensure all practice staff adhere to government advice or recommended schedules of vaccinations for health care workers;
        • always give appropriate and evidence-based advice about vaccination to patients, or refer them to their GP if they have concerns; and
        • follow any advice given by health authorities in the event of a communicable disease outbreak, including any advice about unvaccinated children or patients accessing the practice.

        The Australian government presently recommends health care workers are vaccinated against hepatitis B, influenza, MMR (measles/mumps/rubella), pertussis (whooping cough) and varicella (chicken pox). In overseas or remote Australian settings, there might be additional recommendations.

        Patient and health care provider information about vaccination, including community resources, is available through the Australian government’s Immunise Australia program.

    • 2.2 PRINCIPLE: An accessible physical environment

      Why is this important?

      The federal Disability Discrimination Act 1992 (DDA) makes it unlawful to discriminate against a person in terms of access to services on the basis of a temporary or permanent physical or intellectual disability.  However, ensuring your practice is safe and accessible for people with disabilities is not something which should be considered merely a legislative duty. Optometry practices, like other health practices, need to be able to effectively and safely provide health care for all members of the community. While practice locations and premises might present some intrinsic access difficulties, all practices undertaking renovations and upgrades are encouraged to explore best practice in terms of disability access, and where possible, aim to meet those recommendations. At a minimum, any new work such as a practice redesign or fit out must comply with premises standards underpinning the DDA, although there are some exemptions and special considerations.

      GUIDE AND CRITERIA: 
      AN ACCESSIBLE PHYSICAL ENVIRONMENT
      >
      The practice is accessible to and safe for patients with disabilities
      • Practice checklist

        The location and design/layout of the practice takes into account the needs of patients with physical disabilities.

        There is a documented protocol for staff assisting and meeting the needs of patients with disabilities.

        The practice is accessible to patients in wheelchairs, and wheelchairs are able to be safely manoeuvred into and through the premises.

        If this is NOT reasonably possible due to limitations or design constraints on the practice then either (a) there are alternative strategies to manage patients with disabilities within that design constraint (alternative entrances or physical assistance is available), OR (b) patients with disabilities are referred to other practices able to accommodate their needs. Information about practices which support disability access is available to all staff, and provided on request e.g. if patients telephone for an appointment.

        In any new practice design or re-design, disability access issues are considered, including: suitable width of passageways, doors and consulting rooms (to accommodate wheelchairs), proximity to car parking, external access (e.g. ramps).

        There is attendance to factors that may increase the risks of harm, including harm from falls, in elderly, less mobile or vision-impaired patients.

        External and internal signs are able to be read by patients with reduced vision.

  • 3 > Business Systems

    LEARNING OBJECTIVES

    1. You have the tools and information to assess your business practices and procedures, and to identify any weakness or limitations in those procedures.
    2. You are able to identify your legislative requirements, principles for best practice, where to find information and support, and how to apply this information in your practice.
    3. You are able to identify specific activities to improve your compliance and procedures, address weaknesses, and have a basis for assessing the value of new opportunities and technologies that can support your business.
    4. You understand and can document the principles and procedures for correctly employing, paying, managing, reviewing and supporting practice staff.tice staff.

    • 3.1 PRINCIPLE: Practice administrative, policy and business procedures meet legislative and other requirements, are documented, and are regularly reviewed

      >
      Practice policies and procedures are clear, and are documented in a policy and procedures manual
      • Practice checklist

        The practice keeps and maintains clear, comprehensive documentation of all protocols relating to the day-to-day operations of the practice in electronic and/or hard copy.

        Staff members are familiar with and have easy access to the practice protocols and procedures documentation or manual. Detailed information about this indicator is available in Criterion 1.6.1 of the Practice Standards. There is a specified process for regular review of this information.

        Information on the practice website or in-practice advertising clearly describes the usual operating hours.

        There is a process for updating this information in the event of changes to legislation, guidelines, or changes to your business practice.

        Staff members understand and can describe the roles and responsibilities of other members of staff.

      >
      The practice is correctly and appropriately insured
      • Practice checklist

        All optometrists employed in the practice hold the level of professional indemnity insurance (PII) required by the Optometry Board of Australia.

        Optometrists working in the practice are able to identify and know how to contact their PII insurer.

        All optometrists understand the expectations and obligations around their PII policy, including the level of cover, the extent of their coverage, and all requirements of the policy relating to the reporting of adverse events.

        The practice has all of the necessary and required insurance cover for staff (e.g. work cover insurance).

        The practice has all of the necessary and required insurance cover for staff (e.g. work cover insurance).

        The practice has appropriate insurance cover for the contents of the practice (equipment, IT systems, frames etc.).

        Practice owners have any additional cover appropriate for their circumstances (e.g. death and disability insurance; income protection insurance).

        The details of all insurance policies, including contact information enabling people to identify and contact insurance providers, are maintained in an up-to-date accessible online and/or written register.

        If music, television or radio is played, the practice has any necessary performing rights licenses.

      • More information

        Professional Indemnity Insurance

        The Optometry Board of Australia sets the requirements for Professional Indemnity Insurance for optometrists. All registered optometrists, except those with non-practising registration, must hold the specified level of PII, including the level of cover (amount insured for) and the arrangements of that cover (e.g. run-off and retroactivity).

        Current Optometry Australia members are automatically insured under a fully compliant policy. Members of Optometry Australia can obtain a copy of the policy, or confirmation of their insurance, by contacting the office.

        Optometrists employed in your practice who are not members of Optometry Australia will need to source their own insurance. Optometrists may also work under a PII policy offered through their employer. It is the responsibility of the optometrist to be informed and assured that any insurance policy they purchase meets the OBA requirements.

        Your practice should keep a record for each optometrist of who their specified insurer is, the insurer contact details, and a copy of the policy.

        There are severe consequences, including the possible cancellation of registration, for optometrists practising without the proper level of PII.

        There are also severe financial risks and exposures in the event a patient takes legal action over an event which occurred while the optometrist was not insured.

        Optometrists should be familiar with key aspects of their PII policy, including:

        • amount of insurance cover;
        • extent of the cover (e.g. it may not cover all kinds or locations of practice, such as overseas practice, or may be employer-specific); and
        • the reporting and notification requirements for adverse events.

        Public liability insurance

        Public liability insurance covers you if a person sues for some form of injury, death, or damage to property which occurs on the practice premises. This is separate to any kind of accident or injury occurring in a clinical consultation, which is covered by PII. It might include falls, trips, or damage/ injury caused by a falling object.

        If you practice in an environment like a shopping centre, your rent and lease arrangement may already provide some or all the public liability insurance you need. Your practice will otherwise need to purchase insurance. An option is to do this as part of an overall business insurance package.

        Your practice staff should be aware of who provides your insurance, and how to contact them.

        Other kinds of insurance

        General information about the sorts of insurance that small business may need or should consider is available through the Australian government’s small business assistance website.

        Performing rights licenses

        If music, radio or television is played in your practice, in most cases, licenses are required to protect the copyright owners. Licenses may be required from both the Australasian Performing Rights Association/Australasian Mechanical Copyright Owners Society (APRA/AMCOS), and the Phonographic Performance Company of Australia. You can check with these organisations to find out more about what licenses you may require and why.

      >
      The practice has computerised practice management and accounting systems, with appropriate protocols for secure financial management and transactions
      • Practice checklist

        The practice has a computerised practice management and accounting system to manage cash, banking, invoicing, and billing and payments, including GST and tax.

        The system in place enables patients to make electronic payments and online claims for the purposes of Medicare, DVA and private health insurance. Staff members understand and comply with all terms and conditions of any online claims system used.

        There is a system for electronically managing staff salaries and leave, and taxation and superannuation requirements, including the production of group certificates, pay slips and other necessary documentation.

        The practice has a documented disaster recovery plan to cover computer data loss. This process and plan is maintained and tested.

        There is a process for the regular assessment/review of any risks to computer security.

      >
      There are documented procedures and policies relating to the secure and clear management of cash, and of the practice finances
      • Practice checklist

        There is a document describing who has access to the practice finance systems, including, as required, who is authorised to make online payments, access bank accounts, transfer funds, and handle cash.

        All electronic financial information is on a password-protected computer system that is not accessible to those without the necessary authority. There is a secure record of passwords accessible only to authorised staff.

        Passwords provide adequate security and are regularly changed.

        Financial and accounting reports and records are regularly produced by practice staff or through a qualified consultant, using an acceptable and recognised accounting method.

        There are systems in place to detect and prevent fraud or theft.

        There are systems in place to detect human error in the accounting or finances.

        There is a system in place for the payment of creditors.

        The financial system is regularly backed up.

      >
      The practice has clear fee structures and billing procedures that are communicated to patients
      • Practice checklist

        All practice staff understand the practice billing policies and protocols.

        There is clear, written information in the practice and in advertising (including on the practice website) about the cost of services. This includes written information about fees or standard charges associated with the services you provide.

        If bulk-billing is not generally available, or is only available to some patients, this is explained up front. Patients are made aware of any known gap fees up front, and informed of the potential for additional fees or charges up front when this is reasonably anticipated.

        Staff members understand how to use billing technologies, such as online claims systems, in accordance with all legislative requirements or conditions of use.

        Patients are issued with tax invoices or receipts which clearly distinguish those services provided under Medicare from any services which have attracted an additional fee.

        When ordering optical devices, patients are advised of the complete cost, and provided with an invoice which clearly indicates any amount deposited and any amount owing.

        There is an appropriate system for managing patient debt or unpaid invoices.

    • 3.2 PRINCIPLE: Conditions of employment are consistent, fair, and support staff wellbeing

      GUIDE AND CRITERIA: 
      CONSISTENT, FAIR AND SUPPORTIVE CONDITIONS OF EMPLOYMENT
      >
      Terms and conditions of employment meet all legislative requirements and are properly documented
      • Practice checklist

        The practice has a written procedure relating to the advertising of vacancies and hiring of staff, which describes the process for accepting and assessing applications, conducting interviews, reference checks, and undertaking all necessary verification.

        The practice has a policy affirming equal opportunity and non-discrimination in employment.

        There is written formal documentation of employment terms (letters of offer/contracts) for all staff. These incorporate and conform to all minimum standards or requirements including those specified in the National Employment Standards and in any applicable industrial award.

        There are written agreements with any locums employed by the practice outlining fees, roles and contract duration.

        Staff members are provided with a copy of or link to the Fair Work Information Statement on commencement of employment, as required by law.

        All staff members have a written job description, and are able to access information about any relevant employment awards on request. Job descriptions detail expectations around staff handling of confidential information and the protection of patient privacy.

        On commencement with the practice, all staff members are invited to provide details of a nominated contact, such as next of kin, to be kept on file in case of an emergency.

        All staff members are provided with and understand the expected process and cycle for their probation and performance management.

        There is a documented process and cycle for salary review.

        The practice has written policies and procedures for the disciplining and/or the dismissal of staff. The terms comply with national employment standards and any applicable award.

      >
      All practising optometrists meet the legislative requirements for registration and other requirements for clinical practice
      • Practice checklist

        There is a process for verifying that optometrists employed in the practice hold the correct type of registration needed for their duties, whether practising optometrists (seeing patients), or optometrists employed for other duties (such as providing education or training).

        There is a process for verifying that optometrists employed in the practice hold the correct level of professional indemnity insurance for their registration and role.

        There is a process for verifying that all optometrists who are required by legislation to do so have completed a Working with Children Check, and hold the appropriate confirmation or certification.

        There is a process for verifying that all optometrists who prescribe scheduled medicines hold the appropriate endorsement to do so, and undertake any professional development required to maintain this endorsement.

      >
      Staff are paid appropriately and correctly, including all entitlements
      • Practice checklist

        The practice has a consistent process for setting and reviewing salaries, with reference to appropriate considerations such as industry benchmarking and employment awards.

        All staff members whose jobs are covered by an industry award are paid at or above the level specified in that award, and all entitlements or conditions of employment in the employee contract meet or exceed those in the award.

        Optometrists who are employed as locum optometrists meet the criteria for being a considered as an independent contract worker. Casual optometrists who do not fit the ‘contractor’ criteria are correctly paid all employment entitlements as required by law, including superannuation.

      • More information

        National Employment Standards

        The National Employment Standards (NES) are comprised of 10 minimum entitlements for all employees in Australia.  An employee’s contract cannot provide for conditions any less than those specified in the standard or exclude or trade these minimum conditions.

        All employees must be provided with a copy of or an online link to the NES on commencement of their position.

        Locums

        Employing optometrists on a locum basis is not cut and dried.  The Australian Taxation Office (ATO) has specific definitions as to when a person is considered to be an independent contractor. A ‘locum’ needs to meet the definition of an independent contractor, or they may be considered by the ATO to be more correctly defined as a permanent part-time or casual employee, which would mean that the employer is obliged to pay superannuation and payroll tax, and the optometrist would be entitled to holidays, sick leave and other National Employment Standards entitlements on a pro rata basis.

        Optometry Victoria has produced a locum guide for optometrists outlining this and other considerations for locums and those using their services.

        Employment advice and assistance

        Optometry Australia provides members with access to a service which can advise employee optometrists or optometrists who employ staff on a range of industrial and employment issues. Basic telephone advice or information is usually free of charge.

        Members may also retain the services of the advisors for an agreed fee, usually at a discounted rate. (These services include preparing contracts, mediation, and assistance with recruitment).

        Wages

        Optometrists are not covered by an industrial award. Contracts will therefore be negotiated between employer and employee. In determining an appropriate wage for an optometrist, you may want to take into consideration:

        • the level of experience of the practitioner;
        • the skill set (for example, the optometrist may have desirable experience in an area of particular clinical relevance to your practice);
        • expected patient numbers;
        • location of practice; and
        • present wage levels in the profession.

        Depending on their duties, other employees in your practice may fall under awards, typically for clerical or retail roles.

        Additional general information about employment law, awards and industrial issues is available through the website of the Fair Work Ombudsman.

      >
      Staff management procedures are consistent and fair, support staff wellbeing and facilitate good communication
      • Practice checklist

        There is a documented induction procedure which is followed for all new members of staff.

        Staff members undertake appropriate formal review of their performance, with the outcomes documented.

        There are documented policies and procedures to ensure that the workplace is free from harassment (including sexual or physical harassment); bullying; and discrimination.

        There is the opportunity for regular staff meetings to share information and discuss or raise issues, practices or concerns.

        There is a documented policy and procedure for managing staff grievances.

  • 4 > Communications

    LEARNING OBJECTIVES
    1.  You are familiar with legislation, regulations, standards and professional guidelines relating to the collection, use and disclosure of patient health information.
    2.  You have a basis for assessing the compliance of your patient communication management systems with relevant legislative frameworks.

    • 4.1 PRINCIPLE: The practice collects and maintains appropriate records for all patients

      GUIDE AND CRITERIA: 
      APPROPRIATE RECORDS AND INFORMATION COLLECTION
      >
      Patient record systems comply with all legal and regulatory requirements, professional standards, and community expectations.
      • Practice checklist

        Comprehensive records, ideally in electronic form, are collected and stored for all patients at the practice, with information enabling the practice to identify and contact the patient.

        If you use or retain paper records, these are kept in a secure area of the practice accessible only to the optometrists and other authorised staff.

        A comprehensive clinical record is kept for each patient recording each episode of clinical care at the practice. Detailed information about this indicator is available in the Practice Standards indicators at 8.1.1.

        A comprehensive patient history is taken for all new patients.

        Entries into the patient record are consistent with expected professional standards, care guidelines, any legal or regulatory requirements, and any advice or guidance issued by the optometrist’s professional indemnity insurance provider.

        All patient records are maintained, stored, and accessed in accordance with national health privacy laws, regulatory requirements, and any other additional relevant legislation (such as State-based health records legislation). There are documented policies and procedures for health records management covering collection, storage, access and disposal.

        All practice staff understand and can describe their responsibilities as regards the collection and use of patient health information.

        The practice has a privacy policy that is available to patients on request. This must comply with the Australian Privacy Principles.

        Patient financial information is stored, protected and accessed in accordance with legislative requirements.

        Patients requesting access to or a copy of their health records, including optical prescriptions, are always provided with this in a timely manner consistent with any legal and regulatory requirements. Any fees or charges associated with this comply with limits set in state or Federal legislation, and do not discourage patients from seeking access to their records.

        There is a documented process and protocol for backing up critical health information.

    • 4.2 PRINCIPLE: The practice information technology (IT) and communication systems support comprehensive primary care

      >
      Practice IT and communication systems enable optometrists and staff to access all necessary information
      • Practice checklist

        Optometrists have quick access, preferably online, to all the information they may need to provide quality clinical care, including current clinical care guidelines/recommendations, and vision standards. There is a process for updating documented versions or links, and verifying they are current.

        Optometrists are aware of how to access any professional support services or advice available to them, such as that provided by Optometry Australia.

        Optometrists and practice staff have quick access, preferably online, to a current version of the Optometric Benefits Schedule, and the Pharmaceutical Benefits Schedule.

        Optometrists with therapeutic endorsement are able to access relevant supporting materials for best practice prescribing.

      >
      Patient record and communication systems support follow-up care
      • Practice checklist

        If a patient needs follow-up care, this advice is clearly communicated to the patient and recorded on the patient record card.

        Practice front of house staff routinely inquire whether follow-up appointments are to be scheduled.

        There are procedures and systems for following up patients with significant conditions who do not show for clinically indicated follow-up care. Practice management software or a manual system is used to record scheduled follow up visits, and attendance with other practitioners for follow-up care.

        There are procedures for directly contacting patients who have life or sight threatening conditions needing follow-up. The practice uses all reasonable available technologies as appropriate, such as SMS messaging or direct phone calls, to remind and follow up patients in urgent need of follow-up care. There is a record of the date and time of all efforts to follow up patients.

        Recalls and reminder notices are worded appropriately to reflect that only clinically indicated services are paid for by Medicare. If your practice recommends patients have comprehensive or other exams more frequently than specified in Medicare items, it is made clear in recall or reminder correspondence that the service is not able to be charged to Medicare, and all fees that will apply to the service are clearly stated.

    • 4.3 PRINCIPLE: Communication systems are adequate for the practice’s needs

      GUIDE AND CRITERIA: 
      ADEQUATE COMMUNICATION SYSTEMS
      >
      There are clear systems for patients to contact and access the practice
      • Practice checklist

        The practice has a suitable telephone/fax system. There is an answering machine with a message providing information about opening hours and emergency after-hours contacts such as a hospital or GP clinic.

        The practice has a reliable system for email contact.

        The practice has internet access sufficient for its needs.

        There is a clear and consistent procedure for conveying phone messages to the relevant staff member.

        There are systems in place to allow appropriate time for optometrists or other staff members to attend to and return calls or respond to emails.

      • Practice checklist

        The practice communication system is set up to allow for telephone conversations to be conducted in privacy as needed.

        There is a system in place, such as the use of encryption software or a secure messaging service provider, to ensure that the electronic transmission of patient health information is in accordance with all legislative requirements.

        There are private, secure individual email addresses for all staff members who require this for their work.

        The practice has a written policy covering the use of email, social media, and internet access. If a social media page, such as a Facebook page, is used in the practice, there is a clear and documented process about how it is managed and updated, and it is regularly monitored to ensure compliance with relevant legislation.

        The email systems provide for privacy of email transmissions relating to confidential patient information.

        The practice has a system that allows patients to obtain information or advice about their clinical care if a consultation is impractical. (For example, it may be appropriate to offer telehealth services to facilitate access to ophthalmology care in rural or remote practice).

        The practice has access to mail/courier services, and a documented system is in place for collecting, sorting, posting and dispatching completed optical devices, and recording that.

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      Patients are provided with important information about changes at the practice in a timely fashion
      • Practice checklist

        There are systems in place allowing automated or bulk communication with patients. This might allow for electronic communication (such as email), telephone communication (such as bulk texting) and postal communication, to ensure that all patients are able to access communications.

        There is a protocol for informing all patients about significant changes to the practice. This might include change of opening hours, change of address, change of name, change of key clinical staff, changes in billing arrangements (e.g. cessation of bulk-billing), important new services (such as the availability of telehealth facilities), or the sale of a practice.

        The practice collects information about the patient’s preferred method of contact and any specifications around contact (such as requesting not to be sent marketing information).

        If a practice is sold or closed, patients are informed of the sale/closure, all records are sold, transferred or retained in accordance with legislative requirements, and patients are provided with information about where they are able to access their health records.

        On closure of a practice or practice site, patients are informed of the sale in advance or as soon as is practical. All health records are either sold or transferred to an alternative provider, or retained by the optometrist. If records are retained, patients are provided with information about and means to access their records for the duration of any relevant statutory period.

      • More information

        Secure messaging and electronic exchange of patient information

        There are national privacy laws that regulate the collection, use, disclosure and storage of personal information by individuals, and private and public organisations, including optometry practices; most notably the federal Privacy Act 1988, the Australian Privacy Principles (APPs) and the Electronic Transactions Act 1999. These laws also apply to the electronic exchange of patient information between health care providers and from a health care provider to a patient. Health care providers and entities must take ‘reasonable steps’ to protect patient information from unauthorised access, modification or disclosure. This includes information sent or received electronically such as a patient referral. You can familiarise yourself with these requirements, and options for ensuring compliance, by looking at guidance for health practitioners provided by the Office of the Australian Information Commissioner. Optometry Australia has produced a document answering some general questions about secure messaging.

  • 5 > Quality Improvements

    LEARNING OBJECTIVES
    1.  You understand the significance and principles of a quality improvement framework.
    2.  You are able to identify ways to incorporate quality improvement, staff training, and continuing professional development into your practice model.

      

    • 5.1 PRINCIPLE: Quality improvement is an ongoing and continuous process

      GUIDE AND CRITERIA: 
      QUALITY IMPROVEMENT
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      The practice culture and procedures support a process for reviewing systems and identifying areas for improvement
      • Practice checklist

        The practice sets targets for the delivery and efficiency of patient services. The targets are agreed by all staff, and reviewed at regular intervals.

        All staff members have an opportunity to make recommendations about targets or about the improvement of services in their area.

        Specific tasks are assigned to relevant staff members with completion timelines and dates. This process is built into staff work plans and management reviews.

        There are procedures for identifying, reviewing and acting on any risks. If there are statutory obligations for risk management, these are met (for example, appropriate insurance is in place, fire drills are conducted, and infection control guidelines are followed).

        The practice has a system to collect, collate and analyse data relating to practice performance, and appropriate budgets and benchmarks for comparison.

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      Staff members are supported with opportunities for further training, continuing professional development and skills building
      • Practice checklist

        The practice has a written policy describing how continuing professional development (CPD) for optometry staff is supported and facilitated (for example, by providing time off, support with cost, or in-house professional development). The policy applies equitably to all optometrists.

        Staff members are offered and participate in relevant in-house or other training (such as external training courses). The practice facilitates this by appropriate policies, such as providing time off for training courses, organising external trainers, or supporting staff with part or all of the cost. The policy applies equitably to all staff.

        Staff are provided with appropriate opportunities to learn new skills or techniques and supported to identify these opportunities through the performance management system.

        Staff involved in ancillary testing or providing instruction on lens insertion, removal and care are appropriately trained, and able to communicate any findings to patients succinctly and accurately. All training undertaken is documented.

        There is a record and register of staff training completed.

        Performance reviews are conducted annually and include planning, goal setting, review, and the acknowledgement of achievements. The reviews are documented and retained.

        There are regular staff meetings which include the chance to discuss training opportunities and raise quality improvement proposals or concerns.