2017Winners and commendations

This supplement has been produced on behalf of Bayer and showcases the winning entries from the 2017 Ophthalmology Honours in order to share best practice in the ophthalmology community. The results were announced at the awards ceremony on the 6th December 2017.

The Ophthalmology Honours is an educational initiative fully funded by Bayer. The awards recognise and celebrate the outstanding work being carried out by multi-disciplinary teams in ophthalmology throughout the UK.

The Ophthalmology Honours reflects the mission of Bayer, a leader in medical retina, to support science for better lives by improving patient outcomes and showcasing the very best ophthalmology care in the UK. Supported by the Royal National Institute of Blind People (RNIB) and Visionary, this awards programme demonstrates the commitment of Bayer to support the implementation of good practice in the NHS; resulting in tangible benefits for patients and

advancements in ophthalmology care in terms of multi-disciplinary and innovative working.

Although funded and facilitated by Bayer, the awards were judged by a multi-disciplinary panel of experts in ophthalmology care and the decision-making process was wholly independent of Bayer.

In order to help share best practice in the ophthalmology community, details of the winning and highly commended entries are included for select categories as follows; Best ophthalmology team, Best ophthalmology service improvement, Best patient support or education initiative and Judges’ special award.

Ophthalmology Honours

Don’t miss out on your chance to be part of next year’s awards programme. The 2018 awards programme will be open for entry on Monday 23rd April 2018.

Further information on the judging panel and each of the finalists can be found at:

www.ophthalmologyhonours.bayer.co.uk

Ophthalmology Honours is an educational initiative fully funded by Bayer and supported by the Royal National Institute of Blind People (RNIB) and Visionary

The judging process is carried out by a panel of independent judges and is wholly independent of Bayer. UKEYL01170014bz Date of preparation: February 2018

Ophthalmology Honours 2017

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Vision: Reducing patient cancellations and improving theatre utilisation through the development/implementation of:

• blood pressure (BP) policy. With no clinical evidence that high BP had any adverse effect on local anaesthetic (LA) cataract surgery, the team worked with the clinical and anaesthetic leads to develop a policy

• diabetic policy with detailed guidance of diabetes for cataract surgery patients

• inpatient report to highlight any patient currently admitted elsewhere, but due to have ophthalmology surgery shortly

• e-theatre lists

• cataract video. It is available on DVD or YouTube, and is sent out in advance of the appointment and returned after surgery. It provides a helpful explanation of the process in a fun way that reassures patients.

The team has also:

• addressed complex patients to reduce associated on-day cancellations

• introduced reminder calls to all ophthalmology elective day case patients

• implemented vitreoretinal (VR) list changes to separately identify elective/non-elective lists

• implemented Alturos minutes across the directorate.

Action: The dedicated Ophthalmology Theatre & Seamless Surgery team consists of staff from within the admin, nursing, clinical and management team within ophthalmology, plus theatre staff and service improvement support. One of their key aims from the start has been to undertake detailed analysis of all on-day elective patient cancellations to ascertain the reasons why surgery is cancelled and develop plans to address them.

Learning is taken from any investigations through this meeting, and is shared with relevant staff, with an aim to improve practice and reduce errors.

To motivate and boost team morale, the team have featured in the Trust’s newsletter, reporting on some of the successful work streams undertaken. In addition, a key morale booster to the team recently was winning awards in the Trust’s own ‘Seamless Surgery Awards’, and attending an evening

awards ceremony. The Ophthalmology Theatre & Seamless Surgery team were the winners for the ‘Overall Seamless Surgery Team’, and ‘Theatre Flow’ categories. The team was also highly commended for ‘Best Elective Patient Experience’, and ‘Reducing Cancellations’.

The team continue to go from strength to strength. In 2017/18 they are aiming to reduce cancellations further by looking at issues such as information provided to patients regarding eating/drinking before surgery, the introduction of all day lists in VR to enable better planning, text reminders and the completion of the rollout of e-theatre lists.

Results: The Ophthalmology Theatre & Seamless Surgery team have been meeting every Tuesday since June 2015 with a vision of improving theatre utilisation and reducing cancellations.

Overall, the team’s actions have seen on-day elective cancellations reduce significantly from over 6% for Q1—Q3 in 2016/17 to 4.9% for Q4 and 3.9% for the first 6 weeks of 2017/18.

Development and implementation of:

• blood pressure policy – saw associated cancellations reduce to nil when it was introduced in May 2016

• diabetic policy – saw associated cancellations reduce to nil when it was introduced in September 2016

• inpatient report – allows the team to contact the ward where the patient has been admitted to ensure they are able to attend surgery, or arrange an alternative date. Report is received 5 days ahead of ophthalmology surgery date

• e-theatre lists: a move from paper theatre list planning to electronic to reduce admin cancellation reasons. Since January 2017, they are already leading to reduced cancellations due to admin issues

• cataract video: its purpose is to help avoid on-day anxiety and potential cancellations, and it is hoped it will lead to a reduction in the overall time taken in pre-assessment in future. This is being audited.

In addition:

• complex patients – on-day cancellations generated by differences in surgeon opinion have been addressed by ensuring all complex patients are operated on by the listing surgeon only

• implementation of Alturos minutes has enabled improved planning and reduced cancellations from lack of theatre time introduction of reminder calls: calls introduced in January 2017, and since then on-day cancellations for avoidable reasons such as patient unfit, did not attend (DNA) etc. have reduced from 4/5 patients per week, to 2/3, with further reductions anticipated

• implementation of VR list changes has managed to improve utilisation and prevent on-day elective cancellations for emergencies.

JUDGES COMMENTS:

“Overall, this was a strong entry that demonstrated enthusiasm and efficiency across the board, and was very replicable with lots of good points for other centres to consider moving forwards. The judges really liked this entry as they felt it highlighted a solution to a real problem for eye centres across the UK, demonstrating that there is a need for the team to work together to solve it. The entry really encompassed the idea of teamworking, and the judges were impressed by how the team works together at all levels.”

For further information on this initiative please contact:Samantha Hardman Deputy Operations Director – ENT & Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust samantha.hardman@sth.nhs.uk

Ophthalmology Honours 2017

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Best Ophthalmology Team

Situation: Owing to the size, complexity and pace of the directorate, there is a need for an effective and efficient team dynamic and functionality.

The dynamic required includes a multi-disciplinary team with different strengths, all working toward the shared goal of improving theatre utilisation and reducing cancellations. Regular input from the Service Improvement department is integral. It is important that any demotivating/unproductive behaviour is dealt with promptly. The team are dependent on each other, with each person required to complete actions to ensure progress and momentum. There is a need for shared ownership and responsibility, reflected very simply in the shared weekly taking and timely dissemination of the meeting notes.

With team functionality, there is a requirement for good organisation and transparent working to achieve outcomes. The team need to have access to the tools/information required, plus a willingness to work alongside their team to trial, monitor and review new ideas.

WINNER

Sheffield Teaching Hospitals NHS Foundation Trust

The Ophthalmology Theatre & Seamless Surgery Team

Roshini Sanders (Ophthalmology Honours judge) Laura Hudson, Zanna Currie, Rob Fowler, Gemma Rhodes, Clare Wilson, Claire Hopkins, Alison Calverley, Lisa Taylor-Canter, Ed Coats (Host)

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Ophthalmology Honours 2017

WINNING TEAM:

“It was nice to feel appreciated for the work carried out at St Paul’s. Going into work at St Paul’s every day and dealing with the volume of patients we see, sometimes it’s easy to forget the impact our roles have had on patients’ lives. This award has helped us to remember.”

The St Paul’s Eye Unit team

Vision: The objectives were to:

• provide a coherent, supportive, end-to-end treatment service for people attending the keratoconus service

• successfully expand the service to treat more people while maintaining current standards of service and communications with patients

• introduce more nurse-led pre- and post-operative clinics, giving medical staff opportunity to create keratoconus clinics in parallel

• delay or prevent the need for corneal grafts by providing a viable alternative that does not rely on donation or long-term care

• meet the particular needs of all patients, e.g. those with Downs Syndrome require specialist care and general anaesthesia; patients from outside Liverpool, e.g. those on the Isle of Man need extra help with transport and accommodation; families with a genetic predisposition benefit from joint appointments; young people may need to work around exams and university; others may need to work around religious beliefs.

Action: The team comprises medics, nurses, optometrists, technicians and clerical staff. Good communication is essential and the team works well together.

The nursing team meets every morning to review the previous and current day. This is essential in dealing with patients’ needs, enquiries and problems. These are communicated to the rest of the team and dealt with every day. All members are invited to the medical team weekly clinical meetings; discussing and critiquing current medical research.

The team strongly believes in training to motivate staff, boost morale and enhance skills. The corneal nurse specialist who leads the nursing staff, Claire Britten, is a strong and committed mentor, providing on-the-job training and arranging shadowing at other clinics and theatre. She has encouraged and helped the assistant practitioners to achieve foundation degrees; as band 4 they now have the option to train as nurses or develop into practitioners. Training is used to change perspectives and aspirations. The medical staff have regular training days to which other staff are invited, for example Pentacam in Manchester and a tour of the Eye & Vision Science labs at University of Liverpool.

Research and audit are essential to all staff. Papers have been published, with one due for publication in the Journal of Refractive Surgery. All team members actively work together to collate data for audit, and work to improve their practices based on the audit findings.

Officially, standards are laid down as a series of internal competencies which are regularly assessed. Informally, there is an excellent rapport and mutual appreciation between doctors and nursing staff, creating a strong team ethos. It means staff feel ‘special’ and therefore go the extra mile for patients, which in turn makes them more valued. It’s a virtuous circle which helps ensure standards are maintained.

Results: The main measure is in the number of patients seen and treated, having risen to more than 400 in the past year. This is remarkable given the size of the team – just four staff looking after pre- and post-operative care. We intend to increase this through a carefully planned expansion and more nurse-led clinics.

Patient complaints are very rare, and the few that were informally received were about waiting times and these have been rectified. This success is largely due to consistency of care and excellent patient communications which we intend to continue. In contrast, the positive verbal and written feedback from patients grows. We even have instances where patients ask to be referred to us because of friends’ recommendations.

The team has successfully made the business case for expansion twice in two years. The fact that both requests were granted — the team is in the process or expanding its service now — and that so many trusts across the country are increasing their referrals to St Paul’s for CXL, suggests the quality and impact of the service is excellent.

The impact can also be seen in external relations. Staff from Crewe, Bolton and Manchester trusts have all visited the team recently to learn from our set-up, while doctors who have left to take up consultancies elsewhere have enquired about replicating the service. Also, Claire has given several presentations about the service at conference, and the feedback and requests for further information she received are universally enthusiastic.

For further information on this initiative please contact:Karen Miller Marketing & Communications Officer, St Paul’s Eye Unit, Royal Liverpool University Hospital kmiller@liverpool.ac.uk

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Ophthalmology Honours 2017

Situation: Corneal crosslinking (CXL) is the treatment administered to young people with keratoconus. The CXL team is a multi-disciplinary group of ophthalmic doctors, nurse specialists, assistant practitioners, clerical staff and optometrists.

The nursing and medical team is at the heart of the service, developing and providing a patient-centred service. That runs from initial assessment – including arranging flexible treatment dates with the patients and families — through to treatment and then patients’ post-operative care. As patients see the same staff throughout their pathway, strong bonds of trust develop. Direct contact is available at all times via mobile phone or email.

Demands on the service have increased substantially, from 227 procedures in 2015 to 360 in 2016, mainly due to increased referrals from other NHS trusts. This has resulted in the team successfully making the business case for expansion twice in recent years, and becoming a centre of excellence.

Best Ophthalmology Team

HIGHLY COMMENDED

The Royal Liverpool and Broadgreen University Hospitals

Corneal Crosslinking at St Paul’s Eye Unit

Roshini Sanders (Ophthalmology Honours judge), Natalie Mclean, Claire Britten & Fay Watts, Ed Coats (Ceremony Host)

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Ophthalmology Honours 2017

Vision: The goals were to:

• ensure full utilisation of ophthalmic staffing resources within the injection pathway virtual clinics to allow the service to expand rapidly in the absence of trained ophthalmologists

• ensure that new staff entering the service (hospital optometrists/nurse practitioners) were robustly trained and develop a reproducible training package

• ensure that once trained, these staff had ongoing QA of at least 10% of their work with continuous feedback (analogous to diabetic retinopathy screening (DRS) standards)

• provide consultant led governance via secondary/tertiary grading and facilitate this with rapid feedback using a group email mechanism

• ensure that the injection pathway is notes free so that all data can be reviewed electronically by any team member

• ensure the injection clinic pathway is proactive (i.e. fixed dosing or treat and extend dosing) so that each treatment decision can be made at least 4 weeks in advance of the next therapy allowing QA of that decision if necessary

Action: A training package was designed where staff:

• receive OCT analysis training from medical retina (MR) consultants

• receive injection pathway training from MR consultants

• receive a relevant reading list

• shadow current senior assessors (optometrists/MR ophthalmologists).

A log book was created for trainers and staff to sign off completion of these tasks.

Subsequently staff begin assessing virtual clinic patients working alongside trainers (MR ophthalmologists/senior optometrists) with instantaneous trainer feedback on 100% of cases in the first instance, followed by a formal feedback session then further review of 100% of cases for 1—2 more clinics.

Staff then begin independent reviews with all cases logged onto a central spreadsheet. 20% of all reviews are re-graded by a senior assessor and the results fed back.

Finally sign-off occurs from MR consultant before independent reviews are allowed, followed by 10% ongoing QA.

As the workforce expanded a QA email was developed (2016) to allow trained staff to group email all 5 MR consultants to query challenging cases/the need to stop or switch therapies.

The development of a notes-free injection pathway utilising Medisoft in 2015, allowed all data to be easily accessible for QA reviews and removed the problem of needing to retrieve notes to secondarily review primary decisions.

The development of a proactive injection pathway (Jan 2016) using fixed loading doses followed by a treat and extend protocol, ensures that there is usually at least 4 weeks to decide subsequent management permitting senior opinions via QA email review — this overcame the problem of having to rapidly try to obtain senior review for difficult cases within the original pro-re-nata (prn) pathway.

The virtual clinic review system works with remote assessment of patients in general. A parallel slit lamp clinic pathway for injection patients is also available, that allows injection patients to be seen at least every 12 months within a traditional clinic setting.

Results: Using this training system, seven hospital optometrists have been trained/certified as competent. One nurse practitioner has been fully trained whilst two more are within the training pathway.

This team reviews 15,000 virtual assessments per year, generated by intravitreal anti-VEGF injections. The team, on average, reviews data within 1 week of an injection. Within our treat and extend pathway, this allows 3 weeks minimum for the response by the QA email team to a query.

In year one, the QA email generated 450 queries with an exponential increase as staffing numbers/injection numbers increased. Responses to these queries were on average generated within two weeks. Two medical retina consultant PAs currently support this work.

Queries fall into several categories relating to:

1. confirmation that an interval extension is reasonable

2. confirmation that a patient with extended intervals who has now re-activated should return to a 4-week interval or should reduce to an interval shorter than previously — depending on the reactivation severity

3. whether a patient should switch injection agent

4. whether a patient needs further investigation i.e. repeat angiography

5. whether a patient has end-stage disease so needs face-to-face counselling about treatment cessation.

No clinical incidents have occurred within this service related to inappropriate treatment or delayed treatment due to an assessment decision error. Detailed audit for wet AMD reveals outcomes matching real-world treat and extend (T+E) data. Audit for T+E DMO and RVO is pending.

As a by-product of the existence of the QA email our specialised admin team use the function to query:

1. correct pathway decisions re clinic bookings requested

2. action for a patient repeatedly not attending appointments

3. medical queries generated by patients ringing admin, for example with co-morbidities.

As a consequence, we now have more robust service decisions about ending treatment and discharge policies.

JUDGES COMMENT:

“This was an absolutely superb and fantastic entry that highlighted the added value brought to patient care for the centre with superb metrics. The whole panel felt that this initiative could be (and should be) replicated in other centres across the UK.”

For further information on this initiative please contact:Louise Downey Consultant Ophthalmologist, Hull and East Yorkshire NHS Trust louise.downey@hey.nhs.uk

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Ophthalmology Honours 2017

Situation: Since 2010 the multi-disciplinary team at Hull and East Yorkshire Hospitals NHS Trust has undertaken virtual clinic assessments for patients undergoing intravitreal treatments. Within virtual clinics the patient attends for electronic Medisoft/Optical coherence tomography (OCT) data collection then leaves the clinic. Later their data is reviewed and their next appointment scheduled. As the intravitreal service has grown, the team has welcomed hospital optometrists and nurse practitioners into the medical retina team, reviewing virtual clinic data. They developed a local training package guaranteeing the staff have the skills to perform these virtual assessments then created a quality assurance system, to continuously assess the work undertaken and provide feedback/training. The team has retained medical retina consultant governance of these clinics via secondary and tertiary grading of the data and a Quality Assurance email for queries on complex cases.

Best Ophthalmology Service Improvement

WINNER

Hull and East Yorkshire Hospitals NHS Trust

Quality assurance of a multi-disciplinary team reviewing retinal virtual clinic assessments

Roshini Sanders (Ophthalmology Honours judge), Louise Downey, Ellen Beddows, Brian Melia, Ed Coats (Host)

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Ophthalmology Honours 2017

Vision: Clear aims and objectives were identified by the local team when designing and implementing the mobile unit. These were underpinned by the service delivery pressures experienced by the local team and reported by patients and their carers.

These were to:

• reduce time spent at appointments when attending the mobile unit. Target set was 95% of patients spending less than 60 minutes at an appointment

• maintain follow up time in line with Royal College of Ophthalmology guidance. Target set was 100% being seen within guidelines

• eliminate all evening and weekend clinics

• achieve a set number of clinic slots available in the mobile unit. Target was to provide 230 slots per month in the mobile unit

• improve patient satisfaction by reducing appointment times and treating closer to home. Target was 80% of patients rating the service either “good” or “excellent”.

Action: The impetus for the introduction of the mobile macular unit was clinical and patient feedback and the need to increase capacity. A stakeholder group was set up to consider improvement ideas. Included within this group were a consultant lead, operational manager, nurse and healthcare assistants. A demand and capacity analysis was undertaken to help identify the extent of the current and future capacity issues, providing clarity and understanding of the healthcare challenge that needed to be addressed. The cost of, and risks of, the improvement ideas were established and an options appraisal was undertaken. The options appraisal formed the basis of the business case for the mobile unit. From the outset, the project team had clear aims and objectives and were able to identify the outcome measures that would be a meaningful indicator of success both for the healthcare provider and the patient group who would be using the facility.

The stakeholder consultation period, design and implementation took a total of 18 months. In the months preceding this, the clinical team contributed their ideas to the unit design and spent time walking through the patient pathway to ensure a seamless service.

Stakeholder insight and collaboration have been key to the design and delivery of this service. Patient feedback contributed to the instigation of the innovation and FHFT supported the mobile unit by ensuring that staff were available to deliver the service.

Financial constraints of the NHS were an issue which was dealt with by a joint working agreement initially with an external stakeholder to lease the vehicle and subsequently FHFT bought the mobile unit.

Another problem identified was the improvements needed in the IT infrastructure. Through collaborative working within the Trust, 4G wireless access ensured that patients’ images are linked between the hospital and mobile unit.

Results: From the outset of the project, measures of success were integral to all aspects of mobile service delivery. The stakeholder project team developed a clear understanding of the healthcare challenge and was able to identify key outcome measures that would need to be assessed post implementation. Measures of success were collected 6, 12, 18 & 24 months post implementation.

Eighteen months post implementation of the mobile unit, results showed:

• mean appointment time was reduced from 81 minutes in the main hospital to 56 minutes in the mobile unit. Approximately, 50% of patients experienced time savings of greater than 30 minutes by attending the mobile unit

• evening clinics and weekend clinics at the main hospital were eliminated

• more than 98% of patients rated their experience of the mobile unit as “excellent” and more than 95% said it was more convenient than the main hospital

• follow up time was maintained as per the Royal College of Ophthalmology guidelines for 99.8% of patients

• among the patients surveyed, 100% said that they were likely to recommend the service to friends and family if they needed similar care.

For further information on this initiative please contact:Professor Geeta Menon Consultant Ophthalmic Surgeon, Frimley Health NHS Foundation Trust geeta.menon@fhft.nhs.uk

A key change has been the delivery of the service within the community, providing a service which is convenient and closer to home for many of our patients. The patient satisfaction outcome measures show that the unit is a service welcomed by patients and their carers reducing time taken attending appointments.

At the opening, the Secretary of State Jeremy Hunt MP said, “This is a really innovative service putting patients in the centre of care.” The mobile unit service was rated outstanding by the Care Quality Commission and won the coveted ‘Clinical Service of the Year’ award from the Macular Society. The practice has been disseminated widely with Manchester, Bristol and Southampton macular services all having mobile units based upon the Frimley model.

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Ophthalmology Honours 2017

Situation: The Macular service provided by the Ophthalmology team at Frimley Park Hospital (Frimley Health NHS Foundation Trust (FHFT)) was identified as a service delivery area that required improvement in response to clinical and patient feedback and an increase in capacity. Macular diseases including macular degeneration, retinal vascular disease and diabetic macular oedema are a leading cause of sight loss in the UK. Advances in treatment have led to improved outcomes and coupled with an ageing population, there has been a marked increase in demand on services. The Ophthalmology Department at FHFT is a modern unit with up to date diagnostic and treatment facilities, however, growing demand increasingly led to overbooked appointments, waiting room delays and suboptimal patient satisfaction.

Approximately 50% of patients treated were travelling from outside the Trust’s immediate catchment area and the travel burden was often significant with journey times of more than 2 hours.

HIGHLY COMMENDED

Frimley Health NHS Foundation Trust

Improving macular service patient experience through community based mobile services

Roshini Sanders (Ophthalmology Honours judge), Geeta Menon, Lorraine North, Elizabeth Howells, Manju Chandran, Ed Coats (Host)

Best Ophthalmology Service Improvement

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Ophthalmology Honours 2017

Vision: The aim was to introduce a staff training programme and a patient information service to address these issues, and to raise awareness about the support Corinna herself could give to staff and patients in her role as ECLO.

The specific goals were to:

• ensure that patients across the Trust have their sight needs met, from basic things like finding toilets and reaching for drinks to taking medication

• give patients the opportunity to explain their condition to staff and so contribute to their own care

• eradicate complaints about sight-related issues from patients with visual impairments

• create and then roll-out a visual awareness training programme for both new and existing staff. This would give staff an awareness and appreciation of the difficulties and fears experienced by patients with vision problems, and give staff the tools and confidence to meet patients’ needs

• make this training mandatory across the Trust

Action: Following agreement from Learning Development staff, Corinna audited patients’ experiences and existing staff training, and drew on her personal experience as a visual impaired patient.

Autumn 2014 saw Corinna’s first training programme, developed and delivered for new and existing staff at St Paul’s. This took a hands-on approach, incorporating:

• videos and practical exercises on how to guide people with sight loss

• videos on living with sight loss

• simulation spectacles which attempt to replicate the experience of different eye conditions plus specially designed activities.

Voluntary attendees on the programme increased session on session, so much so that in 2016 the sessions were extended to all Trust staff. Corinna also creates bespoke sessions for different staff, e.g. consultants and nurses.

Corinna also proposed a Sight Loss Information Pack for use on wards. As funding and permission were required for its creation and distribution, Corinna took her proposal to the Senior Management Team (SMT) who approved her initiative, as did the Core Brief and Learning Development Committee. The pack created features:

• sight loss information booklet

• ‘Me and My Sight Loss’ booklet – for completion by the patient. It describes their condition, how they ommunicate, what upsets/reassures them, how they take medication and what help they need, food preferences/needs etc. This goes in the patient’s ward file and ‘describes’ the patient to staff

• guidance notes on completing the booklet

• stickers for the patient’s file and wrist band to indicate their needs, and a matching magnet for the nurses’ station board – less intrusive and more dignified than the ‘Blind’ sign previously used

• a support service directory

• Corinna’s contact details – as well as visiting each sight-impaired patient on ward or in clinic, patients and staff can contact her at any time.

We understand that Royal Liverpool & Broadgreen University Hospital Trust is the only trust in the UK using such a resource.

Results: Patient complaints are virtually zero. A&E very occasionally produces one, but this is tied to the stresses of the situation, and staff know to call Corinna as soon as there is an issue

• the Sight Loss pack is distributed and used by all wards in the Trust

• every quarter, patients who have used the service are asked to complete and return an anonymous feedback form. Return rates are 41% which is considered very good, with all providing glowing feedback (see below for some comments)

• many more patients are aware of, and making use, of Corinna’s support, guidance and signposting service:

o July — December 2014: 400 patients

o 2015: 900 patients

o 2016: 1,200 patients

o Jan — July 2017: 900 patients

• corinna also receives lots of ‘thank you’ cards/letters from grateful patients

• anecdotally, staff — including doctors — have reported that they now find it easier to identify people with visual impairments, and know how to help with their practical and emotional needs. This makes their job more productive and satisfying

• staff across the Trust are now offered the training, with 150 having voluntarily attended so far

• corinna is now also training the Trust’s 300 occupational therapists who themselves are promoting the pack’s use on wards

• there has been excellent feedback from the senior management team

• she has not yet managed to make training mandatory but is working on it!

JUDGES COMMENT:

“Overall, great feedback from the judging panel who all agreed that this initiative is improving the experience for patients across the whole trust. The judges felt that it was a remarkable achievement to persuade the trust to implement training across the board. The regular quarterly audit is also a fantastic way of continually monitoring results, ensuring its success.”

For further information on this initiative please contact:Karen Miller Marketing & Communications Officer, St Paul’s Eye Unit, Royal Liverpool University Hospital kmiller@liverpool.ac.uk

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Ophthalmology Honours 2017

Situation: Corinna Swift – St Paul’s Eye Clinic Liaison Officer (ECLO) – came into post in July 2014 and immediately noticed gaps across the Trust in the support provided for patients with sight loss and associated staff training.

These issues mainly centred on patients attending the hospital for treatment for one condition, but who also have sight loss (often a hidden disability), and also involved people attending eye clinics. Entering a new environment is confusing and disorienting for these patients, and Corinna realised that while their medical needs were addressed, their practical and emotional needs were not being met by staff who had not been appropriately trained. This resulted in distressed, vulnerable patients, some of whom made formal complaints.

Corinna herself is severely sight impaired, and is a low vision therapist and a trained rehabilitation worker for the blind and partially sighted, so was ideally placed to notice and address problems.

Best Patient Support or Education Initiative

WINNER

St Paul’s Eye Unit, Royal Liverpool University Hospital

St Paul’s Eye Unit’s ECLO: helping staff to help patients

Abigail Irons (Ophthalmology Honours judge), Corinna Swift, Ed Coats (Host)

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Ophthalmology Honours 2017

Vision: Depression and anxiety, the aims were to:

• improve the early diagnosis of mental health conditions

• identify patients who may otherwise be missed

• enable our patients to access mental health services in a timely manner

• educate patients in the services available to them

• streamline mental health referrals

• develop a bespoke referral—treatment pathway

• educate and empower staff in the identification of mental health issues

• prevent mental health disease progression

• collaborate with the Integrating Mental & Physical healthcare: Research, Training & Services (IMPARTS) team to develop bespoke self-help materials

• utilise the data collected via IMPARTS to examine the prevalence of mental health conditions in this population.

Smoking, the aims were to:

• support patients to stop smoking as this exacerbates many eye conditions

• reduce cancer risk and long-term cost.

Quality of life, the aims were to:

• measure quality of life using the World Health Organisation Disability Assessment Scale (WHODAS)

• inform and enhance patient care from outcomes.

Ultimately the aim is to improve quality of life for patients, reducing social isolation.

Action: ECLO, Adrian Iuga, successfully applied for support from the IMPARTS team, a King’s Health Partners initiative aimed at integrating mental and physical healthcare.

Using an outcome assessment tool (on an iPad) via the IMPARTS initiative, Adrian has collected patient-reported outcomes since March 2017, and holistically supports patients for problems associated with their emotional, mental and physical wellbeing. Patients who are referred to Adrian, and who are aged 18 or over, are asked to complete screening surveys for:

• Depression (PHQ-9) (nationally validated survey)

• Anxiety (GAD-7) (nationally validated survey)

• Quality of life (WHODAS) (nationally validated survey)

• Smoking (developed locally).

The results are uploaded to the electronic patient record (EPR) in real-time and can be viewed by any clinician accessing the system. The outcomes are used to guide the consultation and appropriately refer patients via a bespoke referral pathway for ophthalmology. The depression and anxiety surveys have a standardised scoring system. If the patient scores above a threshold then an alert will appear on EPR in red to prompt the clinician to act and refer to the appropriate service.

The team has set up four specific referral pathways:

1. refer to RNIB counselling services

2. refer to Macular Society counselling services

3. refer to A&E (actively suicidal)

4. refer to Improving Access to Psychological Therapies (IAPT), a national NHS mental health service available to anyone with anxiety or depression. Patients accessing this service are provided with evidence-based psychological interventions either in the form of guided self-help, group interventions or face-to-face psychotherapy.

Smoking — current smokers are asked if they would like help to stop. If they would, the patient can enter their details to receive either a text or email with a link to the NHS online smoking cessation service.

Results:45 patients have been screened since March 2017.

Depression & anxiety:

• 13 patients (29%) screened positive for probable major depression and prompted a referral according to the teams pathways

• of these, 11 were newly identified and 2 were already diagnosed with depression and were under treatment

• a further 7 patients screened positive for some depressive symptoms. These were offered referral to and information about an emotional support service

• 7 patients screened positive for generalised anxiety disorder of which only one presented without depression. This resulted in an additional referral to IAPT for treatment.

In conclusion, a total of 12 (26%) patients have been identified with a mental health condition for the first time and the team were able to connect them with adequate mental health support.

Smoking:

• 5 patients were current smokers

• of these 1 (20%) accepted a referral to smoking cessation services and 4 were provided with general advice and information about the effects of smoking on eyesight.

Anxiety and depression surveys are repeated at 6 months. Quality of life and smoking questionnaires are repeated yearly. Results are audited to look for improvement in scores.

The team are in the process of developing a feedback survey for service users.

Plans for the future include:

• making the screening available to all patients attending an eye clinic outpatient appointment

• a specific question for the symptoms of Charles Bonnet syndrome (CBS). We have a local psychiatrist expert in CBS and they plan to improve the referrals to this service and set up a patient support group.

The King’s team are also currently working on a mental health audio self-help guide specifically for people with a sight impairment. When finished, this will be made available to other NHS trusts and the wider eye health sector.

WINNING TEAM:

“The Honours were an excellent opportunity to learn about best practice in ophthalmology. I hope our initiative inspires others to integrate mental health into their routine practice.” “As an ECLO I feel very proud to contribute to improving the service for our patients with sight loss and I am humbled by the recognition the project has received.”

Adrian Iuga ECLO, King’s College Hospital

For further information on this initiative please contact:Adrian Iuga Eye Clinic Liaison Officer, King’s College Hospital adrian.iuga@nhs.net

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Ophthalmology Honours 2017

Best Patient Support or Education Initiative

Situation: It is known that patients with visual impairment and chronic conditions have a higher rate of mental health issues. Patients are up to three times more likely to experience problems such as depression and/or anxiety than the general population and they experience poorer quality of life and social functioning. The prevalence of depression in patients attending low vision rehabilitation clinics is even higher at around 43% (Margrain et al 2016). However, they are often not asked about these symptoms as part of their eye clinic appointment and too often the diagnosis of mental health conditions is delayed.

It was noticed by the Eye Clinic Liaison Officer (ECLO) that visually impaired patients at King’s College hospital were not accessing mental health services and were often not aware of the help and support available to them. Treating patients holistically has been shown to be effective in improving overall patient outcomes.

Abigail Iron (Ophthalmology Honours judge), Adrian Iuga, Ed Coats (Host)

HIGHLY COMMENDED

King’s College Hospital

The King’s Vision for mental health

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Ophthalmology Honours 2017

Vision: The team’s vision was to make SEI a place for excellence in delivering high quality clinical research and embedding this as an integral part of routine clinical care as per NHS constitution.

The objectives were:

• to increase the number of trials conducted at SEI with a balanced portfolio of commercial and non-commercial research studies

• to increase the number of patients recruited in clinical trials and achieve 100% recruitment to time and target (RTT)

• uptake of complex CTIMP research trials

• dedicated research slots in routine clinics

• facilitate the establishment of an ophthalmic trainee research network

• to increase the number of consultants active in research and extend role of trainees and non-medical allied health professionals (NMAHP) as Principal Investigator (PI)

• engagement with community optometrists.

To achieve this, collaboration and partnership between stakeholders including North East & North Cumbria clinical research network (NENC CRN), Trust R&D, SEI staff (including specialist trainees), community optometrists and patients was essential.

Action: Infrastructure development and staff recruitment:

• appointment of ophthalmic trained research nurses (2.1 WTE), optometrist, photography staff and data coordinator (18 hours/week) from commercial income

• sharing the participation and PI status amongst consultant colleagues interested in research has ensured ‘round the clock’ research cover including sickness and planned leave

• industry grant (£110,000) obtained towards imaging equipment to increase our suitability as a site.

Raising patient awareness:

• promotion of patient awareness through posters in clinical areas and discussion during clinic appointments regarding prospective research trials

• the team worked towards improving patient and public involvement by organising an ‘OK to ask campaign’ ophthalmology research day as a celebration of the national clinical trials day in 2015, that was attended by 70 patients and carers and involved both eye charities and industry.

Achieving recruitment to time and target (RTT):

• maintenance of pre-screening logs has ensured short ‘study sign off to accrual’ time and RTT

• trust R&D has systems in place to provide support towards prompt ‘study sign off’ timelines achieving Site Specific Information (SSI) to study sign off’ and ‘sign off to first accrual’ within 30 days

• monthly research newsletter and meetings both at departmental level and Trust R&D has promoted reflection and development of targets for efficient and safe research

• creating links with local clinical research network staff and resources has facilitated uptake of studies as well as pre-empt and address local and national challenges.

Training:

• GCP (good clinical practice) training organised annually for staff and training towards data entry and retinal imaging

• organisation of trainee timetables and creation of a new clinical research fellow post has generated opportunities to trainee doctors to participate in research

• regionally we mentored trainees on research skills and development of North East Trainee Research in Ophthalmology Network (NETRiON)

• we have supported community optometrists towards establishment of a primary care network promoting close links between primary and secondary care.

Results:• Over the last 5 years, 10 out of 20 SEI

clinicians participated as PI in over 30 global & national commercial & non-commercial clinical trials on National Institute for Health Research portfolio; Chief Investigator for >5 studies

o RETAIN, LAEVO, INJECT, MEMO, IRISS: top recruiters in the UK

o RETAIN success showcased in CRN ‘News from Network’

o LUMINOUS, POLARIS recruited twice their RTT

o POLARIS & ASH: completed RTT within 30 days of study sign off

• ophthalmology contributed to 14.44% (27 of 187 studies) of all CHS recruitment

• regionally SEI contributed to 54.49% of all specialty recruitment in 2016—17, making us the highest recruiters for ophthalmology in the North East of England

• there has been a progressive increase in the number of closed studies from 8 in 2012—13, 9 in 2013—14 and 15 in 2014—15 (~1,000 patients over last 5

years in ~30 studies). SEI achieved 100% RTT for all studies conducted between 2012—16. SEI recruited 348 patients among open studies and 189 among closed studies for 2015—16

• the research nurse is one of first few nurse PI (FASBAT Study) in the UK. Our trainee PI for EDNA study

• two clinicians received the ‘NIHR National Leading commercial PI Award 2015’, from Prof. Dame S. Davies, CMO, NHS England

• SEI research team was awarded ‘Commercial Team award 2015’, by J. Sheffield, CEO NIHR and ‘Bright Ideas in Health award 2015’, by NHS Innovations North

• monthly research newsletter and meetings are instrumental in monitoring progress and identify struggling studies as well as sharing best practice

• SEI is an active contributor to the ‘Making research better’ NENC CRN website

• feedback from clinical research organisations, study sponsors and ‘Friends and family test’ is excellent

• our RTT track record has attracted several sponsors and we have over 7 ongoing, 5 to be initiated industry trials

• SEI is nationally recognised as a centre for research excellence.

WINNING TEAM:

“It’s great to see the hard work and dedication from ophthalmology teams across the UK in meeting these challenges recognised and rewarded, as well as ideas exchanged and best practice shared. The evening was both great fun and inspiring and I would encourage other units to put themselves forward for next year.”

David Steel Consultant Ophthalmologist, and Vitreoretinal surgeon at Sunderland Eye Infirmary

For further information on this initiative please contact:Mrs Deepali Varma Consultant Ophthalmologist, Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust & Speciality Group Lead Ophthalmology, North East & North CumbriaDeepali.Varma@chsft.nhs.uk

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Ophthalmology Honours 2017

Judges’ Special Award

Situation: Sunderland Eye Infirmary (SEI) is a dedicated eye hospital and part of City Hospitals Sunderland (CHS) NHS Trust that provides eye service to a population of approximately 800,000 from Sunderland and surrounding areas.

Over the last 8 years, the SEI research team has faced several challenges towards expansion of clinical research, including:

• wide geographical coverage• exponential rise in service users• lack of dedicated research staff• reduction in consultant programmed activities supporting research activity• multiple outreach sites• restructuring of local clinical research networks• reduction in tariffs and increased complexity of clinical trial of an investigational

medicinal product (CTIMP) studies.

Until 2008—9 we had two consultants active in research; 0.5 whole time equivalent (WTE) research nurse time, one photographer, one optometrist and <5 clinical trials were conducted at SEI.

WINNER

Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust

High quality clinical research using a collaborative team approach at Sunderland Eye Infirmary

Stevie Johnson (Ophthalmology Honours judge) Steve Dodds, Jane Swithenbank, Caspar Geenen, Deepali Varma, David Steel, Tina Morrell and Santy Nocon, Ed Coats (Host)

Ophthalmology Honours 2017

Congratulations to the winners and those who have been highly commended and commended in the 2017 Ophthalmology Honours

Best Ophthalmology TeamWinner: The Ophthalmology Theatre & Seamless Surgery Team, Sheffield Teaching Hospitals NHS Foundation Trust

Highly Commended: Corneal Crosslinking at St Paul’s Eye Unit, St Paul’s Eye Unit, Royal Liverpool University Hospital

Commended: Southampton Medical Retina Team, University Hospital Southampton NHS Foundation Trust

Best Ophthalmology Service ImprovementWinner: Quality assurance of a multi-disciplinary team reviewing retinal virtual clinic assessments, Hull and East Yorkshire Hospitals NHS Trust

Highly Commended: Improving macular service patient experience through community based mobile services, Frimley Health NHS Foundation Trust

Best Patient Support or Education InitiativeWinner: St Paul’s Eye Unit’s ECLO: helping staff to help patients, St Paul’s Eye Unit, Royal Liverpool University Hospital

Highly Commended: The King’s Vision for mental health, King’s College Hospital NHS Foundation Trust

Commended: Glaucoma Support Edinburgh — International Glaucoma Association Scotland, Princess Alexandra Eye Pavilion, NHS Lothian

Judges’ Special AwardWinner: High quality clinical research using a collaborative team approach, Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust

Outstanding Ophthalmology Nurse or Allied Health ProfessionalWinner: Outstanding Ophthalmology Allied Health Professional: Rasmeet Chadha, Optometrist and Lead for Childhood Low Vision, Chair of Low Vision Group for Oxfordshire, Optometry Lead for Age Related Macular Degeneration, Oxford University Hospitals NHS Foundation Trust

Winner: Outstanding Ophthalmology Nurse: Adam Mapani, Medical Retina Nurse Consultant, Moorfields Eye Hospital NHS Foundation Trust

Highly Commended: Carole Dallimore, Specialist Nurse, Salisbury District Hospital, Salisbury NHS Foundation Trust

Steve Dodds, Research Nurse, Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust

Laura Grant, Head Orthoptist, Whipps Cross Hospital, Barts Health NHS Trust

Kieran Loft, Specialist Optometrist, Royal Devon and Exeter NHS Foundation Trust

Anna Sanders, Registered General Nurse, Hull and East Yorkshire Hospitals NHS Trust

Ophthalmology Unsung Heroes:Winner – individual: Marina Jones, Senior Medical Retina Secretary, Stanley Eye Unit, Abergele Hospital

Winner – team: Ophthalmology Administration Co-ordinator Team, NHS Greater Glasgow and Clyde

The 2017 awards programme received a significant number of high quality entries. After much deliberation, the judges identified the finalists listed below for their exceptional initiatives and hard work.

Don’t miss out on your chance to be part of next year’s awards programme. The 2018 awards programme will be open for entry on Monday 23rd April 2018.

For more details please visit: www.ophthalmologyhonours.bayer.co.uk

The 2018 deadline will be Friday 17th August 2018.

We look forward to receiving your entry! For further information on the Ophthalmology Honours please visit our website www.ophthalmologyhonours.bayer.co.uk

Bayer is committed to delivering the Ophthalmology Honours programme in order to continue to recognise the outstanding work being carried out by multi-disciplinary teams in ophthalmology across the UK.

Bayer may be contacted via Bayer Medical Information at: Bayer plc, 400 South Oak Way, Green Park, Reading, Berkshire, RG2 6AD

Tel: 0118 206 3116 Email: medical.information@bayer.co.uk

© Bayer plc February 2018 ® Registered trademark of Bayer AG, Germany.

UKEYL01170014bz Date of preparation: February 2018