Success for nurse practitioner-delivered intravitreal injection service for wAMD

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By Shreeya Nanda, Senior medwireNews Reporter

Well-trained nurse practitioners can successfully provide an injection service for the treatment of wet age-related macular degeneration (wAMD) with ranibizumab, an audit shows.

Ranibizumab, an intravitreal vascular endothelial growth factor (VEGF) inhibitor, has a good safety profile when administered by ophthalmologists and has recently been recommended by the UK’s National Institute for Health and Care Excellence for the treatment of wAMD.

Recognising that existing resources at the West of England Eye Unit were insufficient to cope with the anticipated demand for treatments, two nurse practitioners with previous experience in minor surgical procedures were trained to deliver ranibizumab injections. An ophthalmologist was required to be available in the unit when the nurse practitioners were treating patients with ranibizumab.

The service was reviewed regularly, at least every 6 months, to quantify complication rates and a prospective safety audit was conducted for the initial 5.5 years, the results of which are reported in Eye.

The nurse practitioners delivered 10,006 (84.1%) of the 11,893 ranibizumab injections during the audit period.

Moreover, Peter Simcock (Royal Devon & Exeter NHS Foundation Trust, UK) and colleagues note that “the proportion of injections given by the [nurse practitioners] has continued to increase with almost an entirely [nurse practitioner]-delivered service in recent months.”

Four incidences of presumed infectious endophthalmitis were observed, giving an incidence of 0.04% per injection, which is an improvement over the rates reported in previous randomised controlled trials and similar to that observed by the British Ophthalmological Surveillance Unit in their 15-month prospective study, say the authors.

They did not find any evidence of lens touch, retinal detachment or systemic thromboembolic events, but an ophthalmologist was summoned to attend a patient who developed elevated intraocular pressure on administration of the injection.

“This episode demonstrated the robustness of the service-delivery model in its ability to manage potential ophthalmic emergencies”, say Simcock et al.

They conclude: “An injection service provided by a carefully selected and rigorously trained [nurse practitioner] adhering to the necessary clinical governance safeguards has the potential to help eye units throughout the UK to meet the rising demands for wAMD treatment in an ageing population.”

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