Receptionist
1. Prior to clinic, check 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. Confirm that all correct documentation and relevant forms specific to oncology clinic are placed inside the notes, and that adequate patient identification labels (at least 30) are available
4. Check that all case note are 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, update case notes and SMS if required.
7. Complete patient identification sheet if necessary.
8. Record new patient's ethnic origin and overseas visitors status.
9. Alert nurse to patient's arrival.
10. Place casenotes in basket in sift room.
11. Book any follow up appointments for the follow-up ocular oncology clinic (OBEDOCON OBEDSPC). Use the ABC coding to ensure that patients are prioritised according to need should appointments need to be cancelled (A= can be cancelled twice, B= can be cancelled once, C = must not be cancelled).
12. Towards the end of the clinic, record all attendances, cancellations and DNA's. Arrange for the secretary to send each DNA another appointment.
13. Ensure that the case notes of ambulance patients are clearly marked for the benefit of the nursing staff. When an ambulance patient arrives, inform the nursing staff as soon as possible.
14. When booking a further appointment, check whether an ambulance is required for that appointment.
15. Ensure that an up to date clinic booking summary is complete and available.

Sifting Nurse
1. Sift each patient in the usual manner. Offer to store luggage, explaining that the hospital can not take responsibility for loss or damage and advising each patient to remove any valuables.
2. Take a general history, recording the results in the yellow form in the casenotes.
3. Measure the visual acuity. If the central vision is less than Counting Fingers, measure the eccentric (i.e., peripheral) vision in all quadrants.
4. Measure the intraocular pressure with a Tonopen.
5. Examine the pupillary reactions.
6. Dilate both pupils in all patients except those with an iris tumour. Use Tropicamide 1% & Phenylephrine 2.5%, one drop per eye.
7. Ask the patient to wait outside the registrar's clinic.
8. Place the casenotes in the registrar's clinic.

Clinic Nurse
Before the clinic starts,
1. Ensure that the ultrasound machine is in position. Provide gallipots of fresh Presept and sterile water (with the sterile water to the right of presept, filled almost to brim), tissues, syringe of hypromellose, and box of benoxinate minims. Check that eye-baths and spare roll of ultrasonography film are available. Do not connect probes.
2. Arrange the indirect ophthalmoscope with teaching mirror and 2.2 and 28D lenses.
3. Switch on the computer.
4. Arrange the tape recorder, minimum of ten tapes, model eye, sellotape (six inches to the right of the computer keyboard), Goldmann 3-mirror lens.

During the clinic
1. Call patients into and from clinic.
2. Help patients move from chair to couch and back again.
3. Give every patient a paper tissue to wipe the eye.
4. Complete forms for (a) Haematology (i.e., FBC), (2) Serum Biochemistry (i.e., U & E's and random blood glucose) including liver function tests (i.e., LFT's) and ECG on all patients admitted. Always mark 'Urgent' on request form.
5. Arrange for admitted patients to go to ward.
6. Arrange accommodation for relatives (Hilsborough Suite) or inform ward about this need.
7. Notify ward staff and admissions department of all admissions as soon as possible (i.e. after each patient is admitted).
8. Assist with anterior segment scans (i.e. inserting and filling eye-bath and then removing bath, irrigating eye with sterile saline).

At end of clinic
1. Return all special items to locked cupboard and return ultrasonography machine to its proper place.
2. Inform the consultant ophthalmologist of any problems or complaints.

Registrar
1. Obtain a full ophthalmic and medical history, asking every question in proforma.
2. Perform full ophthalmic examination (excluding gonioscopy).
3. Do not dilate pupil of patient with iris tumour until photography is completed.
4. Document all clinical findings in proforma by crossing out absent symptoms and encircling positive findings, adding notes.
5. Draw a retinal diagram on a retinal form, leaving diagram in proforma blank for the consultant.
6. Sign and date the proforma and retinal diagram sheet.
7. Complete the photography request form, indicating the area of interest.
8. Arrange liver ultrasonography at the request of the consultant, by telephoning ultrasonography receptionist and asking for scan to be performed on Monday afternoon (if there is a cancellation) or Tuesday morning.
9. Document in casenotes that ultrasonography has been ordered and inform ocular oncology office (i.e. data manager or secretary).
10. Prepare theatre list after discussion with consultant, oncology nurse and oncology secretary (in case patients from previous clinics have already been booked). List is to be given to oncology secretary by 3:00 p.m.

Photographer
1. Photograph tumour, including all tumour margins.
2. Try to obtain photograph showing disc, tumour and fovea in same picture.
3. Photograph requested area on anterior segment camera showing best magnification possible and image showing depth of area were appropriate.
4. Ask nurse to hold eyelid open if this is a problem.
5. On completing photography, ask nurse to dilate pupil if patient has an iris tumour.
6. For anterior segment lesions, photograph whole area, including images with oblique lighting to demonstrate surface texture.

Consultant
1. Review registrar's notes.
2. Perform full ophthalmic exam.
3. Perform ultrasonography.
4. Discuss diagnosis, treatment options and prognosis.
5. Computerise data.
6. Write letter to referring ophthalmologist if patient is discharged.
7. Discuss admissions with oncology nurse and registrar at end of clinic, agreeing on list order and plaque number for each patient.

Oncology/Support Nurse
1. Take patient to counselling room.
2. Explain diagnosis and treatment to patient and relatives.
3. Inform patients of what to expect during their time in hospital.
4. Advise patients to be by their bedside for ward round at 8:45 am each day.
5. Allow patient to express feelings and concerns and answer any questions.
6. Arrange for patients to speak to previously treated patients, if appropriate.
7. Direct patients to blood collection clinic and ask the staff there to direct patient to ECG department.
8. Advise patient to return to clinic and collect luggage from reception or nurse and ask for directions to ward.

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