Bringing optometric injections into the office starts with the basics
ATLANTA – Regulations governing the use of injections in the optometric practice vary from state to state.
Scott Moscow, OD, advised SECO attendees on how to introduce these procedures into practice and detailed the in-office essentials.
Moscow said different states may permit optometrists to perform intradermal, intravenous, subcutaneous and/or intramuscular injections. He noted that while chalazion injections may be mistakenly categorized as subcutaneous, they are actually intradermal, as there is no defined subcutaneous space in the eyelid.
He stressed the importance of providing informed consent to patients in layman’s terms. The practitioner should describe the procedure, the rationale for the treatment, alternative treatments, and any risks or uncertainties, he said. Additionally, abnormal and off-label uses must be documented.
“Informed consent is a bit of a dynamic target,” he said. “It’s something that we’re constantly updating in our office. If you are always getting the same question after patients go through informed consent with you in your office, you may want to tweak that informed consent to be clearer.”
He said he is also sure to tell patients that they may look worse when they leave the office after the procedure than before they came in.
“The leading cause of malpractice claims against ODs is a misdiagnosis that leads to a failure to refer,” he continued. “If you have a chalazion that keeps coming back in the same spot, it’s important to document appropriately where that chalazion is on the eyelid. You may want to biopsy it, as it could be a sebaceous cell carcinoma. My general rule is only to only perform a chalazion twice.”
Equipment choice is also important. For example, he advised against using latex gloves due to allergies and vinyl gloves due to reduced barrier protection. Nitrile gloves are a better choice, and proper sizing is important. Similarly, he noted to use latex-free needles and syringes.
Practices in which injections are performed should have in place needle stick protocols.
Needle stick transmission rates are 0.3% for HIV, 2% for hepatitis C and 6% to 30% for hepatitis B, Moscow said.
“Never bend or re-cap contaminated needles,” he said. “We need to make sure that our whole office is vaccinated for hepatitis B and that we’re communicating about hazards and keeping records.”
Moscow said that all staff should be aware of the procedures for evaluating an incident and the protocol following a stick, including washing hands, notifying a superior, detailing the incident in a log and identifying the patient if possible.
Following this, have the employee tested regularly for 6 months to a year, he said.
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Moscow S. Injecting injections in your practice. Presented at: SECO; Atlanta, Georgia; April 28-May 2.
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