A safety audit of the first 10 000 intravitreal ranibizumab injections performed by nurse practitioners

Simcock, Peter; Kingett, B.; Mann, Nirmal S.; Reddy, Venkat Sandeep; Park, J.

doi:10.1038/eye.2014.153

Cited by 34 publications

(30 citation statements)

References 11 publications

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“…Under a system where nurses only injected favourable cases, they achieved safety rates comparable to those of physicians in training. Simcock et al (2014) reported recently similar findings in their study.…”

Section: Discussionsupporting

confidence: 79%

Safety study of 38 503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting

Hasler

Bloch

Villumsen

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate and to compare the safety of intravitreal ranibizumab injections performed by physicians and nurses at a single large hospital clinic in Denmark during 5 years. Design: Retrospective, interventional, non-comparative study. Methods: Setting: All eyes that underwent a protocolized ranibizumab injection procedure performed in an operating room mainly by nurses and physicians in their first year of ophthalmology training. Study population: A total of 4623 eyes in 3679 patients with subretinal neovascularization secondary to a variety of retinal diseases, mainly neovascular AMD treated with intravitreal therapy (IVT) at the Glostrup Hospital

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Section: Discussionsupporting

confidence: 79%

Safety study of 38 503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting

Hasler

Bloch

Villumsen

et al. 2014

Acta Ophthalmologica

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“…Since complications would have to be very severe if they were to be reflected on a mean best-corrected visual acuity change, we studied the relative distribution of ocular adverse events such as lens damage, retinal detachment and endophthalmitis. The incidence of endophthalmitis (0.5& per injection) was similar to the incidence in the Comparison of Age-related Macular Degeneration Treatments Trial (Martin et al 2011) where all injections were physician-administered and also to observational studies from Denmark and the UK with 12 000 nurse-administered intraocular injections each (Simcock et al 2014;Hasler et al 2015). No lens damage or retinal detachments were observed during the study.…”

Section: Discussionsupporting

confidence: 70%

“…The rising number of intraocular injections, expected to continue according to projections of the increase in the elderly population, (United Nations 2017) has become a challenge for ophthalmology departments worldwide. Task shifting to nurse-administered injections may alleviate this burden (Browning 2018), and observational studies indicate this might be safe and acceptable to patients (Varma et al 2013;DaCosta et al 2014;Michelotti et al 2014;Simcock et al 2014;Hasler et al 2015). However, no randomized controlled trial (RCT) has earlier investigated whether such a task shift can be performed without increased risk to visual function.…”

Section: Introductionmentioning

confidence: 99%

Task shifting of intraocular injections from physicians to nurses: a randomized single‐masked noninferiority study

Bolme

Morken

Follestad

et al. 2019

Acta Ophthalmologica

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Purpose To test if task shifting of intraocular injections to nurses in a real‐world setting can result in similar visual function outcome with equal safety profile. Method All patients with either age‐related macular degeneration, retinal vein occlusion or diabetic macular oedema remitted to intraocular injections at a tertiary ophthalmology department in Norway between March 2015 and May 2017, were asked to participate. The participants were randomized to either nurse‐ or physician‐administered intraocular injections of anti‐vascular endothelial growth factor. The primary outcome measure was change in best‐corrected visual acuity from baseline to 1‐year follow‐up. The mean difference in the primary outcome between the groups was analysed by a noninferiority test with a margin of three letters in disfavour of the nurse group. Adverse events were recorded. Results Three hundred and forty‐two patients entered the study. Two hundred and fifty‐nine completed the 1‐year follow‐up and were included in the study sample for the analysis of the primary outcome. Nurse‐administered intraocular injections were noninferior to physician‐administered injections with 0.7 and 1.6 letters gained, respectively (95% CI of the mean difference, −2.9 to 1.0; p = 0.019, one‐sided t‐test). Two thousand and seventy‐seven injections and three ocular adverse events were recorded. Conclusion Task shifting of intraocular injections to nurses can be performed without increased risk to visual function. Such a task shift can alleviate the burden of performing intraocular injections in ophthalmology departments. To our knowledge, this is the first RCT on task shifting of a surgical procedure from physicians to nurses in a high‐income country.

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“…Nurse injectors have been demonstrated to be able to provide a safe and effective injection service that is well received by patients. 9,19 Costs to the NHS and drug label status were of the least importance to patients and this has potential important consequences to the way off-label drugs are used. There is much in the recent literature debating the use of off-label anti-VEGF agents due to their significant cost saving.…”

Section: Discussionmentioning

confidence: 99%

“…8 In addition to the issue of cost, there is the issue of workload with an increasing number of units turning to the use of nursing staff to perform the intraocular injections 9 and issues as to whether it is appropriate to inject patients on the same day as their assessment clinic.…”

Section: Introductionmentioning

confidence: 99%

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

Baxter

Fotheringham

Foss

2016

Eye

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Purpose To determine the opinions from a patient perspective on relevant variables in the delivery of treatment for neovascular age-related macular degeneration (nAMD). Methods Pilot interviews with patients and doctors were conducted to identify what variables in the provision of a nAMD service were important. This led to the generation of two sets of scenario options. Subsequently 100 patients undergoing active treatment for nAMD in the National Health Service University Hospital, United Kingdom underwent interview assessment. They were asked to rank their preferences for provision of their care with reference to these two sets of scenario options. Using conjoint analysis, percentage preferences, and utility scores for each variable in each scenario design were calculated. Results Ninety-five patients completed the preference ranking for both scenarios. Eight patients ranked worse vision as preferable to better vision and were excluded on the basis that they had not understood the task. The results of the remaining 87 patients are presented. The most important factor to patients was having good vision, followed by a one-stop service and less frequent follow up. The least important factors were label status of the drug, cost to the health service, and grade of the injector. Conclusion Patients regard good vision and minimal visits to the hospital above the status of injector, label status of drug, or cost to the NHS.

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A safety audit of the first 10 000 intravitreal ranibizumab injections performed by nurse practitioners

Abstract: Purpose To evaluate the safety of a nurse practitioner (NP)-delivered injection service for the treatment of wet age-related macular degeneration (wAMD) with ranibizumab.

Cited by 34 publications

References 11 publications

Safety study of 38 503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting

Safety study of 38 503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting

Task shifting of intraocular injections from physicians to nurses: a randomized single‐masked noninferiority study

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

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