Implementation of a nurse-delivered intravitreal injection service

Abstract

Purpose The purpose of this study was to introduce nurse-delivered intravitreal injections to increase medical retina treatment capacity. Methods Indemnity, clinical governance, training, planning, and implementation issues were addressed. The outcome measures were patient safety, patient experience, and clinic capacity.Results No serious vision-threatening complications were recorded in a consecutive series of 4000 nurse-delivered intravitreal injections. A Mann-Whitney test showed a significant increase in intravitreal injections (P ¼ 0.003) in the medical retina service after introduction of nurse-delivered intravitreal injections. The majority of patients accepted and were satisfied with a nurse-delivered intravitreal injection. Discussion Nurse-delivered intravitreal injections appear safe, acceptable to patients, and are an effective means to increase intravitreal injection capacity in medical retina clinics.

Translational public health care perspective: Intravitreal treatment of neovascular age‐related macular degeneration has revolutionized clinical ophthalmology

“…The results are confirmed by an independent study, which is also reported in this issue (Asten et al 2014), and the new studies lend support to two previously published studies from the United Kingdom (Dacosta et al 2014;Michelotti et al 2014). The verdict is clear: the safety of intravitreal injection of vascular endothelial growth factor inhibitor by nurses or physicians in the early stage of ophthalmology training is as safe as injection by fully trained ophthalmology specialists.…”

Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery

“…We found no significant association between zonular dialysis during cataract surgery and the 1 to 9 prior intravitreal injections group (OR, 1.02; 95% CI, Of interest, particularly in the United Kingdom, intravitreal therapy increasingly is being administered by health care professionals other than doctors to help meet clinical demand, and nurse-delivered intravitreal injections are reported to be safe and acceptable to patients. 16 For patients who underwent multiple intravitreal injections, it was apparent that these had been administered by practitioners in various roles and training positions. Although our analyses did not identify a significantly higher likelihood of PCR after intravitreal injections administered by junior trainee surgeons, the OR for PCR with previous intravitreal therapy ever administered by a nurse practitioner was 2.05 (95% CI, 0.72e4.51, P ¼ 0.12).…”

Indemnity for orthoptist-delivered intravitreal injections

“…A previous study also reported a significant difference in the mean macular thickness of the fellow eye treated with unilateral intravitreal bevacizumab for diabetic macular oedema, but no difference in the fellow eye of those receiving unilateral ranibizumab. 2 We report a case of a significant improvement in macular thickness of the non-injected eye of a patient receiving unilateral ranibizumab for diabetic macular oedema. To our knowledge, this effect has not previously been reported.…”

“…2 We appreciate the fact that the increasing demands for intravitreal injection therapy necessitate novel methods of service delivery. Nurses, as part of their practical professional training, are familiar with aseptic technique, administration of injections, and safe disposal of sharps.…”