Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report

Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report

Monica M Michelotti,1 Salwa Abugreen,2 Simon P Kelly,1 Jiten Morarji,1 Debra Myerscough,2 Tina Boddie,2 Ann Haughton,1 Natalie Nixon,2 Brenda Mason,1 Evangelos Sioras11Ophthalmology Department, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; 2Ophthalmology Department, East Lancashire NHS Tr...

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Autores principales: Michelotti MM, Abugreen S, Kelly SP, Morarji J, Myerscough D, Boddie T, Haughton A, Nixon N, Mason B, Sioras E
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2014
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Ophthalmology
RE1-994
Acceso en línea:https://doaj.org/article/2902946be87d4129aa8315aec740971d
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spelling oai:doaj.org-article:2902946be87d4129aa8315aec740971d2021-12-02T06:05:55ZTransformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report1177-5483https://doaj.org/article/2902946be87d4129aa8315aec740971d2014-04-01T00:00:00Zhttp://www.dovepress.com/transformational-change-nurses-substituting-for-ophthalmologists-for-i-a16470https://doaj.org/toc/1177-5483 Monica M Michelotti,1 Salwa Abugreen,2 Simon P Kelly,1 Jiten Morarji,1 Debra Myerscough,2 Tina Boddie,2 Ann Haughton,1 Natalie Nixon,2 Brenda Mason,1 Evangelos Sioras11Ophthalmology Department, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; 2Ophthalmology Department, East Lancashire NHS Trust, Blackburn, UKBackground: The dramatic increase in need for anti-vascular endothelial growth factor (anti-VEGF) intravitreal therapy in the treatment of retinal disease and the absence of an equivalent increase in ophthalmologists to undertake such intravitreal injections created a patient-safety risk. Timing of intravitreal therapy (IVT) is critical to prevent vision loss and local clinics lacked capacity to treat patients appropriately. We aimed to improve capacity for IVT by nurse injections.Materials and methods: A multidisciplinary prospective service-improvement process was undertaken at two adjacent general hospitals in the northwest of England. IVT injections by nurses were a principal component of solution development. After we had obtained appropriate institutional approval, experienced ophthalmic nurses were trained, supervised, and assessed to undertake IVT. Ophthalmologists directly supervised the first 200 injections, and a retina specialist was always on site.Results: Nurses undertook 3,355 intravitreal injections between June 2012 and November 2013, with minor adverse events (0.3% subconjunctival hemorrhage and corneal abrasion). There were no patient complaints at either hospital.Conclusion: Experienced ophthalmic nurses quickly learned how to perform such injections safely. IVT by nurses was well accepted by patients and staff. Hospital A trained three nurses sequentially for improved flexibility in scheduling. Novel use of appropriately trained nonmedical staff can improve efficiency and access in an overburdened service with time-sensitive disease. Retinal assessment was undertaken by ophthalmologists only. Improved access to IVT is important, as treatment with anti-VEGF therapy reduces blindness at population levels.Keywords: ophthalmology, retina, age-related macular degeneration, nurse, transformation, extended rolesMichelotti MMAbugreen SKelly SPMorarji JMyerscough DBoddie THaughton ANixon NMason BSioras EDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 755-761 (2014)
institution DOAJ
collection DOAJ
language EN
topic Ophthalmology
RE1-994
spellingShingle Ophthalmology
RE1-994
Michelotti MM
Abugreen S
Kelly SP
Morarji J
Myerscough D
Boddie T
Haughton A
Nixon N
Mason B
Sioras E
Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
description Monica M Michelotti,1 Salwa Abugreen,2 Simon P Kelly,1 Jiten Morarji,1 Debra Myerscough,2 Tina Boddie,2 Ann Haughton,1 Natalie Nixon,2 Brenda Mason,1 Evangelos Sioras11Ophthalmology Department, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; 2Ophthalmology Department, East Lancashire NHS Trust, Blackburn, UKBackground: The dramatic increase in need for anti-vascular endothelial growth factor (anti-VEGF) intravitreal therapy in the treatment of retinal disease and the absence of an equivalent increase in ophthalmologists to undertake such intravitreal injections created a patient-safety risk. Timing of intravitreal therapy (IVT) is critical to prevent vision loss and local clinics lacked capacity to treat patients appropriately. We aimed to improve capacity for IVT by nurse injections.Materials and methods: A multidisciplinary prospective service-improvement process was undertaken at two adjacent general hospitals in the northwest of England. IVT injections by nurses were a principal component of solution development. After we had obtained appropriate institutional approval, experienced ophthalmic nurses were trained, supervised, and assessed to undertake IVT. Ophthalmologists directly supervised the first 200 injections, and a retina specialist was always on site.Results: Nurses undertook 3,355 intravitreal injections between June 2012 and November 2013, with minor adverse events (0.3% subconjunctival hemorrhage and corneal abrasion). There were no patient complaints at either hospital.Conclusion: Experienced ophthalmic nurses quickly learned how to perform such injections safely. IVT by nurses was well accepted by patients and staff. Hospital A trained three nurses sequentially for improved flexibility in scheduling. Novel use of appropriately trained nonmedical staff can improve efficiency and access in an overburdened service with time-sensitive disease. Retinal assessment was undertaken by ophthalmologists only. Improved access to IVT is important, as treatment with anti-VEGF therapy reduces blindness at population levels.Keywords: ophthalmology, retina, age-related macular degeneration, nurse, transformation, extended roles
format article
author Michelotti MM
Abugreen S
Kelly SP
Morarji J
Myerscough D
Boddie T
Haughton A
Nixon N
Mason B
Sioras E
author_facet Michelotti MM
Abugreen S
Kelly SP
Morarji J
Myerscough D
Boddie T
Haughton A
Nixon N
Mason B
Sioras E
author_sort Michelotti MM
title Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
title_short Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
title_full Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
title_fullStr Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
title_full_unstemmed Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
title_sort transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report
publisher Dove Medical Press
publishDate 2014
url https://doaj.org/article/2902946be87d4129aa8315aec740971d
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