Implementation and evaluation of a nurse-delivered intravitreal injection service

Abstract

Purpose: A major development within the medical retina service has been the introduction of intravitreal Anti-VEGF agents. As a consequence, outpatient attendances within the medical retina service have significantly risen causing a tremendous burden on service provision. The purpose of this project was to explore the utilization of nurse-delivered intravitreal injections to increase service capacity. We carried out a retrospective case series of 1000 intravitreal injections, performed independently by nurses, to assess safety and patient satisfaction.

Methods: In preparation for an independent nurse-led injection service careful planning was undertaken to ensure a formalized training framework. This included wet lab training and supervised competency based assessments. All nurses performed 100 intravitreal injections under direct doctor supervision before independent practice was approved. Appropriate indemnity and standard operating procedures were put in place.<br /> <br /> We identified 1000 intravitreal injection procedures, performed independently by specialist ophthalmic nurses. The case notes were retrospectively reviewed for post-intravitreal injection complications. Patient satisfaction questionnaires were completed to assess patient experience. The primary outcome measure was safety profile and secondary outcome measure was patient experience.

Results: No serious or sight-threatening complications were recorded in a consecutive series of 1000 nurse-delivered intravitreal injections. There was little variation in patient experience when compared to a doctor-led service.

Conclusions: Nurse-delivered intravitreal injections are safe and acceptable to patients. This is an effective measure to increase service provision capacity in medical retina clinics.