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Setting up a successful nurse-led intravitreal injections service: pearls from Swindon

12 November 2020
Volume 29 · Issue 20


The demand for performing intravitreal injections has increased in recent years, prompting the need for more nurse training in their administration. The Great Western Hospitals NHS Trust in Swindon has developed a structured nurse training programme and now has 8 independent nurse injectors trained to undertake injections independently; nurse practitioners now contribute upwards of 85% of the total number of injections. The authors have also demonstrated the financial benefits of using injection assistant devices and shown the positive impact such devices have on training. In September 2019, the authors organised the first course to offer nurses and doctors hands-on experience in administering injections, using the Swindon training model to provide participants with a structured approach to learn how to perform intravitreal injections safely. Nurses made up 96% of participants; the remainder were doctors and managers; 6% had never performed an intravitreal injection; of units where they had, disposable drapes and a speculum were used in 71% of these. The number of injections performed per session at participants' units at the time they attended the course was: 17 or more injections=46%, 13–14=39%, and 11–12=15%. The course was rated 8.9/10 overall for content, with 85% very likely to recommend it to colleagues. All participants indicated that using the Swindon model made them feel confident to deliver injections safely. The authors demonstrated that using a structured training protocol and intravitreal assistant device improves the quality of nurse training and increases confidence in administering intravitreal injections.

Age-related macular degeneration (AMD) is a major component of the workload of eye units across the UK. It also has significant physical and psychological effects on patients and places a huge burden on the healthcare system. The prevalence of wet AMD is currently estimated at around 679 000 cases, affecting 4.8% of patients aged 65 years and older and 12.2% of those aged 80 years and over (Owens et al, 2012). Older people need good vision to maintain their independence and quality of life and, with the increase in the UK's ageing population, treatment for AMD is vital.

Intravitreal injections for the treatment of AMD were introduced in 2012 and intravitreal anti-vascular endothelial growth factor (VEGF) medication is currently the only treatment for wet AMD; it is administered directly into the eye in the form of intravitreal injections. Patients treated with anti-VEGF medication for wet AMD may require a significant number of injections. In the experience of the ophthalmic unit at Great Western Hospitals, they require at least 17 injections over a 3-year period with some patients requiring more. Injections are initially given on a monthly basis, with their frequency then reduced thereafter to every 2 months or every 3 months. This was one of the recommendation of a benchmark clinical trial, which involved two studies in which patients were given 2-monthly intravitreal injections of aflibercept after an initial loading dose of monthly injections for 3 months (Heier et al, 2012).

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