Factsheets What to Expect at Hospital

Introduction

• The factsheet will help explain what to expect when someone is first referred to an eye hospital.
• It will describe the tests that you can expect to undergo when at the hospitals.
• It will explain how supporters can make things easier for people with learning disabilities when at the hospital.
• It will explain what all parties (patient, ophthalmologist and supporters) may need to do before safely agreeing to surgery.

When a person has been diagnosed with cataracts, keratoconus or other serious eye conditions, they will be referred to their local eye hospital to see an ophthalmologist.  The referral is usually made via their GP, following recommendation from the optometrist.  In some cases an optometrist may refer you directly to the eye hospital.  It usually takes about 3 months to get an appointment at the eye hospital.

On the day of your hospital appointment you will have to check in with the receptionist and you will have to wait until the eye doctor is ready to see you.

During the appointment the ophthalmologist will

• Need to look into your eyes and put some drops in your eyes.  The eye drops may make your eyes hurt in bright lights and sometimes they sting.  Things may also look fuzzy after you have eye drops but this will only last for a short time.
• Use a special torch to see right into the back of your eye.
• Ask you to put your chin on a machine.  They will have to get very close to you and touch your eyes.  This may feel strange.  It is important to sit very still when the doctor looks into your eyes. 
• Tell you if you should have an operation.

Preparing for your eye operation

Most people go into hospital for just one day to have their eye operation.  Some people stay one or two nights in hospital.  You will go home soon, as hospitals want to send people home to get better.

Lots of people worry about operations.  There will be lots of things you need to know.  You can visit the hospital before your operation.  You might want to go two or three times.  You can talk to the staff at the hospital.  They will answer your questions.  You can take a friend or someone from your family with you when you go into hospital.  They can stay with you all the time till you go home.

Before your eye operation you will have some tests at the hospital

• You will have a blood test.  The nurse will put a tight band around your arm and tell you to sit still.  They will put a needle into your arm and take some of your blood. You will see the blood flow into a needle.  Lots of people don’t want to look.  The blood is then put into a special bottle and the nurse takes the band off your arm.  The little bottle of blood will be sent away and tested.  This is to make sure you are well enough to have the operation.  Blood tests can hurt a bit.
• The nurse will take your blood pressure.  They will put a strap around your arm and pump air into the strap.  You only have the strap on your arm for a minute or two.  It doesn’t hurt but it can feel strange.
• You will be given a form to sign.  This is to say you agree to have the operation.

Planning

The success of surgery for people with learning disabilities can depend on having a clearly identified and recorded plan of support that has been prepared before the actual admission and treatment.

Staff working with people with learning disabilities may need to reassure ophthalmic consultants that an appropriate level of support will be available to individuals during their hospitalisation and after their operation. 

A staff support package (covering both pre-operative and post-operative care) is crucial - despite the fact that most operations are straightforward.  Nurses are seldom available to offer special individual care.

Please use our ‘Eye Surgery Support Plan’ which will help you plan for your hospital visit and your eye surgery.

Consent to treatment

Some adults with learning disabilities have refused to have eye surgery because they did not fully understand that they would be returning home soon afterwards.  They associated hospital admission with permanent institutional care.

Frequent pre-operative visits to the prospective ward may be necessary, with hospital staff becoming familiar with an individual and stressing that he/she will only be admitted for a very short period to a ‘day hospital’ - as against a ‘long-stay hospital’.

Supporters need to understand the law on consent.  Where people with learning disabilities are not able to consent to surgery, a multi-disciplinary ‘best interests’ meeting should be convened.

The ophthalmologist should be invited to attend - or more usually, the meeting can be held at an eye clinic to enable hospital staff to be there.

The area of consent for people with learning disabilities is complex.  Therefore, we would recommend that readers in England, Wales and Northern Ireland obtain information on consent from the Department of Health website: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Consent/ConsentGeneralInformation/fs/en

Readers in Scotland may wish to obtain advice from ENABLE Scotland Information Service, 6th Floor, 7 Buchanan Street, Glasgow, G1 3HL.  The telephone enquiry line 0141 226 4541 is open Monday-Friday.

The Independent Mental Capacity Advocate Service

• The Mental Capacity Act set up a new service, the Independent Mental Capacity Advocate (IMCA) service.
• The service helps vulnerable people who cannot make some or all important decisions about their lives.
• IMCAs  help people who have no family or friends to support them. They  help when some important decisions are made by health services and local authorities.
• The IMCA  help people who face decisions about:
  • Serious medical treatment they may need.
  • Moving to a hospital or a care home

What the IMCA will do? 

The Independent Mental Capacity Advocate (IMCA) will: 

• Speak up for and support the person who needs help to do this
• Get hold of and sort out information
• Work out the person’s wishes, feelings and beliefs and try and work out what the person might want
• Look at different ways of doing things
• Get another doctor’s point of view (a second opinion) – when they think one is needed.

June 2009  

For Further Information on this Topic Please Read: 

Eye Conditions that Require Surgery 

Eye Drops for People with Learning Disabilities

Eye Surgery for People with Learning Disabilities

Planning the Operation

Preoperative Procedures

Day of the Operation

Related Information:

Consent to Medical Treatment

Cataracts and Eye Surgery

Surgery Support Plan

Keratoconus

Glaucoma

Diabetes