Receptionist
1. Prior to clinic, ensure that all appointments are recorded on the
SMS system.
2. Ensure all case notes are extracted and new case notes made up before
the start of the clinic.
3. Ensure all correct documentation and relevant forms specific to oncology
clinic are placed inside the notes( ie follow-up form and retinal diagram
sheet), and that adequate patient identification labels (at least 30)
are available.
4. All case notes should be booked to the clinic on the hospital information
support system.
5. Register patient's arrival.
6. Check address and telephone number of patient and general practitioner,
updating case notes and SMS if required.
7. Complete patient identification sheet if necessary.
8. New patients ethnic origin and overseas visitors status should be
cleared.
9. Alert nurse to patient's arrival.
10. Place casenotes in basket.
11. Any follow up appointments should be booked for the ocular oncology
clinic for a Thursday (OBEDOCON OBEDSPC). ABC coding should be used
to ensure correct criteria implemented should appointments need to be
cancelled in the future.
12. Towards the end of the clinic, attendances, cancellations and DNA's
should be recorded. DNA's will be sent a further appointment by the
secretary if appropriate.
13. Ensure that the case notes of ambulance patients are clearly marked
for the benefit of the nursing staff (nursing staff should also be informed
directly of the arrival of an ambulance patient).
14. When booking a further appointment, check whether an ambulance is
required for that appointment
15. Ensure up to date clinic booking summary is complete and available.
Sifting Nurse
1. Sift patient in usual manner.
2. Ask patients if they would like to leave luggage in safe cupboard
(reminding them to remove any valuables as hospital cannot take responsibility
for loss or damage to belongings).
3. Measure visual acuity. If central vision is less than Counting Fingers,
measure eccentric (i.e., peripheral) vision in all quadrants.
4. Measure intraocular pressure with Tonopen.
5. Examine pupillary reactions.
6. Dilate both pupils in all patients except those with an iris tumour.
7. Ask patient to wait outside the registrar's clinic.
8. Place casenotes in registrar's clinic.
Clinic Nurse
Before clinic starts
1. Ensure that ultrasound machine is in position. Provide gallipots
of fresh Presept and sterile water, tissues, syringe of hypromellose,
and benoxinate. Check that eye-baths are available. Do not connect probes.
2. Arrange indirect ophthalmoscope with teaching mirror and 2.2 and
28D lenses.
3. Switch on computer.
4. Arrange tape recorder, minimum of two tapes, model eye, sellotape,
Goldmann 3-mirror lens.
During clinic
1. Call patients into and from clinic.
2. Help patients move from chair to couch.
3. Give every patient tissue to wipe the eye.
4. Assist with anterior segment scans (i.e. inserting and filling eye-bath
and then removing bath, irrigating eye with sterile saline).
5. Check all patients have fundal photographs taken before leaving the
clinic area.
If patient is
admitted from clinic
1. Complete forms for (a) Haematology (i.e., FBC), (2) Serum Biochemistry
(i.e., U & E's and random blood glucose and LFT's) and ECG on all
patients admitted. Always mark 'Urgent' on request form.
2. Arrange for admitted patients to go to ward.
3. Arrange accommodation for relatives or inform ward about this need.
4. Notify ward staff and admissions department of all admissions as
soon as possible (i.e. after each patient is admitted).
At end of clinic
Return all special items to locked cupboard and return ultrasonography
machine to its proper place.
Registrar/ SHO
1. Obtain full ophthalmic and medical history update, asking every question
in proforma. Cross out every negative symptom and encircle every positive
symptom. Be careful to exercise tact and compassion when asking patients
about fears of local tumour recurrence, loss of the eye, and metastatic
disease.
2. Perform full ophthalmic examination (excluding gonioscopy).
3. Do not dilate pupil of patient with iris tumour until photography
is completed.
4. Document clinical findings in proforma, adding notes.
5. Draw retinal diagram on a retinal form, leaving diagram in proforma
blank for consultant.
6. Sign and date proforma.
7. Complete photography request form.
Photographer
1. Photograph tumour, including all tumour margins.
2. Try to obtain photograph showing disc, tumour and fovea in same picture.
3. Ask nurse to hold eyelid open if this is a problem.
4. On completing photography, ask nurse to dilate pupil if patient has
an iris tumour.
5. For anterior segment lesions, photograph whole area, includind images
with oblique lighting to demonstrate surface texture.
6. Ask nurse to dilate pupils if necessary.
7. Ask patient to wait outside consultant room.
Oncology Nurse
1. Be available to provide support and information to patients and their
families.
2. Assist consultant with the clinic.
3. Support and assist the clinic nurse.
Consultant
1. Review registrar's notes.
2. Supervise and train junior staff.
3. Perform full ophthalmic examination.
4. Perform ultrasound scans as appropriate.
5. Counsel patient.
6. Computerise data.
7. Dictate letter.
8. Organize further care.
9. Store ultrasound probes at end of clinic.
