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GOC Standard 11: Safeguarding Adults at Risk in Optical Practice (Level 2)

Protecting Vulnerable Adults Through Awareness and Action (Within S11)

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GOC Standard 11: Safeguarding
Why Safeguarding Matters
Legal & Regulatory Framework
Categories of Abuse and Neglect
Recognising Adult Abuse
Mental Capacity Act 2005
Capacity and Consent
Raising a Concern
Info Sharing & Recording
Escalation & Info Sharing
Complex Safeguarding Risks
Preparing the Practice
Reflection & Improvement
Exam Pass Notes
Reading List
Course Completion & Next Steps
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Scenarios: Capacity and Consent

Scenario 3: Patient with Dementia (Dilation Decision)

Scenario

You are assessing an older patient in clinic with known moderate dementia. The patient looks anxious in the chair and, when you mention dilation, asks in a worried voice, "Will those drops make me blind?" A family carer at their side urges, "Just do it - we don't have time to argue." You explain briefly but the patient seems uncertain and keeps looking to the carer for an answer.

How should you assess capacity and proceed?

Support decision‑making first: adjust information (simple short explanation, large‑print leaflet, demonstrate likely light sensitivity), allow time, and check understanding using teach‑back. ^[4]^[1]
If doubt remains, formally assess capacity by documenting the patient's ability to:
Understand relevant information about dilation. ^[2]
Retain that information long enough to make a decision. ^[2]
Weigh the information (benefits, risks, and alternatives). ^[2]
Communicate a decision (verbally or otherwise). ^[2]
Record the answers and any adjustments made to support decision‑making. ^[1]^[3]
If capacity is present, respect the patient's decision (even if it seems unwise). ^[1]^[2]
If capacity is absent and dilation is necessary for safety or diagnosis, act in the patient's best interests: document the lawful justification, use the least restrictive option, arrange an escort and sunglasses post‑dilation, and advise caution about driving. Record the rationale, who was consulted, and the steps taken. ^[2]^[3]^[5]^[1]

Scenario 4: Refusal of Care with Fluctuating Capacity

Scenario

An adult attends with markedly raised intraocular pressure and suspicious optic discs. They are distressed and intermittently confused; when you suggest urgent hospital referral the patient dismisses it, saying, "I'll be fine," and refuses to go. Their capacity appears to fluctuate with their distress.

How do you balance autonomy and protection?

Differentiate an unwise choice from true incapacity before overriding autonomy. ^[1]^[2]
Recheck and clarify understanding of the risks and likely consequences; address practical barriers (transport, fear) and consider a short, time‑limited review later the same day if capacity appears impaired by distress. ^[1]^[6]
If capacity is present, respect the refusal but provide clear written safety‑netting, arrange a short review, and with consent involve a trusted supporter. ^[1]^[3]
If capacity is absent and there is a high risk of serious harm, act in the patient's best interests to arrange urgent assessment or referral; document the lawful basis and all communications with carers or services. ^[2]^[1]

References (numbered in text)

Decision making and consent, General Medical Council (came into effect 9 November 2020; updated 13 December 2024). Find (opens in a new tab)
Mental Capacity Act Code of Practice, Office of the Public Guardian (GOV.UK), 2013. Find (opens in a new tab)
Instilling eye drops, College of Optometrists. Find (opens in a new tab)
Utilizing the “teach‑back” method to improve surgical informed consent and shared decision‑making: a review — Kevin D. Seely; Jordan A. Higgs; Andrew Nigh; Patient Safety in Surgery (2022). Find (opens in a new tab)
Advice after receiving your dilation eye drops, Guy's and St Thomas' NHS Foundation Trust. Find (opens in a new tab)
Mental Capacity Act 2005 at a glance, Social Care Institute for Excellence (SCIE). Find (opens in a new tab)

Key Points

Please take a moment to review these points, reflect on their significance and consider how they apply to your own experiences.

Tick to confirm (optional):

Support decision‑making before assessing capacity (adjust information, use teach‑back).
Assess capacity using the functional test: understand, retain, weigh, communicate.
Record capacity checks, adjustments made, verbatim responses and rationale.
Respect capacitated decisions; distinguish unwise choices from incapacity.
If capacity is lacking and risk is high, act in the person's best interests and document least‑restrictive measures.
Use time‑limited reviews for fluctuating capacity and provide written safety‑netting when refusal is respected.
Involve trusted supporters with consent and escalate urgently when necessary (record lawful basis).

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Mental Capacity Act 2005 Raising a Concern

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Course Snapshot

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Length: 60 minutes CPD (1.00 CE Credits)
Appropriate for: Optometrists, dispensing opticians, optical assistants, practice managers and other optical team members in the UK.
Course Price: Free
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Harvard

Mecourse Lifelong Learning (2025) ‘Scenario Page 2: Capacity and Consent’. Mecourse Lifelong Learning [Online]. Available at: https://www.mecourse.com/scenario-page-2-capacity-and-consent [Accessed 12 May 2026].

Vancouver

Mecourse Lifelong Learning. Scenario Page 2: Capacity and Consent [Internet]. Mecourse Lifelong Learning; 2025 Aug 22 [cited 2026 May 12]. Available from: https://www.mecourse.com/scenario-page-2-capacity-and-consent.

Chicago

Mecourse Lifelong Learning. “Scenario Page 2: Capacity and Consent.” 2025. https://www.mecourse.com/scenario-page-2-capacity-and-consent. Accessed May 12, 2026.

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Mecourse Lifelong Learning. (2025, August 22). Scenario Page 2: Capacity and Consent. https://www.mecourse.com/scenario-page-2-capacity-and-consent

IEEE

Mecourse Lifelong Learning, “Scenario Page 2: Capacity and Consent.” Mecourse Lifelong Learning. https://www.mecourse.com/scenario-page-2-capacity-and-consent (Accessed: May 12, 2026).

AMA

Mecourse Lifelong Learning. Scenario Page 2: Capacity and Consent. Mecourse Lifelong Learning. Published August 22, 2025. Accessed May 12, 2026. https://www.mecourse.com/scenario-page-2-capacity-and-consent.

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GOC Standard 11: Safeguarding Adults at Risk in Optical Practice (Level 2)

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Scenarios: Capacity and Consent

Scenario 3: Patient with Dementia (Dilation Decision)

Scenario 4: Refusal of Care with Fluctuating Capacity

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