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

Bolme, Stine; Morken, Tora Sund; Follestad, Turid; Sørensen, Torben Lykke; Austeng, Dordi

doi:10.1111/aos.14184

Cited by 18 publications

(29 citation statements)

References 16 publications

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“…Conducting interviews came from a desire to learn from the trained nurses because an interview can give in-depth information on participants’ attitudes, thoughts, and actions [ 37 ]. This qualitative study is an important supplement to our previous RCT [ 10 ]. This mixing of methods can act complementarily and provide a richer and deeper understanding of the task shift concept [ 38 ], and it is in line with recommendations for training needs assessment [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Bolme

Austeng

Gjeilo

2021

BMC Health Serv Res

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Background Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task. Methods Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis. Results Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program. Conclusions Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.

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Section: Discussionmentioning

confidence: 99%

“…In 2019, with the first randomized controlled study, we were able to show that nurse-administered injections are just as safe and have the same positive effect as injections given by physicians [ 10 ]. Based on these results, we established a nurse-driven injection clinic at the University Hospital in Trondheim, Norway.…”

Section: Introductionmentioning

confidence: 99%

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Bolme

Austeng

Gjeilo

2021

BMC Health Serv Res

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“…After the first publication of nurse-led IVI by Varma and colleagues in 2013, many similar reports have emerged constantly. Most of them were from European countries, such as UK,[ 8 35 36 40 41 42 43 44 ] Denmark,[ 45 ] Norway,[ 46 47 ] and Spain[ 44 ]; a few were from countries outside Europe, such as New Zealand[ 48 ] and Singapore. [ 49 50 ] Table 2 demonstrates a summary of the literature review of studies related to nurse-led IVI.…”

Section: Capacity Building In Dr Screeningmentioning

confidence: 99%

“…[ 8 45 48 ] In addition, for qualitative evaluation, the majority of patients reported satisfaction with the nurse-led IVI service, based on the positive outcomes from the questionnaire. [ 35 41 43 44 47 49 ] Bolme and colleagues conducted a randomized single-masked noninferiority study of IVI rendered by nurses and ophthalmologists in Norway; they concluded that the task shifting of IVI to nurses can be performed without increased risk to damage to visual function. Sixty percent of patients did not know whether it was a physician or a nurse who performed the injection.…”

Section: Capacity Building In Dr Screeningmentioning

confidence: 99%

Capacity building in screening and treatment of diabetic retinopathy in Asia-Pacific region

Ruamviboonsuk

Silpa-archa

Limwattanayingyong

et al. 2021

Indian Journal of Ophthalmology

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The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists.

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“…The safety profile of nurse practitioners delivering an intravitreal anti-VEGF injection service has been well established [1,2]. In most eye units across the UK, nurses are exclusively providing the intravitreal anti-VEGF injection services [3], whereas others adopt a mixed model consisting of nurses and doctors.…”

Section: Introductionmentioning

confidence: 99%

Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

Raman

Triggol

Cudrnak

et al. 2020

Eye

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Purpose To assess the safety of nurse-led services of intravitreal injection of dexamethasone implant. Methods An audit of intravitreal injection of dexamethasone implant service in our unit revealed a significant delay in the delivery of injection from the time a clinical decision was made. The limiting factors were an inadequate number of injectors and limited capacity. The constraint in capacity was addressed by moving the service from the theatre to the cleanroom in the outpatients setting. Two senior nurse practitioners in the existing pool of injectors, experienced in intravitreal anti-VEGF injection, were trained to deliver the intravitreal dexamethasone implant service. A safety audit was carried out after they had completed 1000 cases. Results The nurse practitioners administered 1006 injections from February 2017 to October 2019. There was no case of endophthalmitis (0%) or other visually significant complications like retinal detachment, vitreous haemorrhage, hypotony or iatrogenic cataract. One patient had incomplete scleral penetration of the implant, but this resolved without any sequelae. The waiting time to inject the implant nearly halved from 29.5 to 15 days in the nurse-led service. A patient satisfaction survey was overwhelmingly positive, with the majority advocating for the continuation of the nurse-led service. Conclusion The current cohort of experienced nurses providing anti-VEGF injections can be trained under supervision to inject the intravitreal dexamethasone implant (Ozurdex). This is safe, additionally effective in streamlining the service and reducing the waiting time for delivery of the steroid implant.

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

Cited by 18 publications

References 16 publications

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Capacity building in screening and treatment of diabetic retinopathy in Asia-Pacific region

Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

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