auckland dhb

 

CAROL SLIGHT, NURSE PRACTITIONER OPHTHALMOLOGY (PRESCRIBING), AUCKLAND DHB

 

 

Population: Ophthalmic patients (over 15 years of age)

 

Process to establish NP role within the Ophthalmology Service at ADHB

 

Identified Need

Long and growing waiting lists for ophthalmology services at ADHB. Identified greater demand with aging population with no increase to ophthalmologist FTE. 

• Increasing waiting times for first specialist assessment.
• Tripled over a one year period to a two and a half year waiting list.
• Increasing numbers and waiting time for follow-up appointments
• Long waits for acute ophthalmic assessment within the acute eye clinic leading to non-compliance to triage guidelines
• Up to 6-hours.

It was identified that by expanding the skills and scope of the already established CNS role into a Nurse Practitioner role which could manage specific presentations autonomously that there was great potential for decreasing waiting times and waiting lists.  It was also envisaged that the NP could move across DHB boundaries to deliver services in the wider Auckland area, thereby reducing access barriers.

 

Service delivered

 

Referral and assessment process restructured within the ophthalmology service with allocation of patients to either ophthalmologist or NP – based on presenting ophthalmic condition.

• NP autonomously and in collaboration manages:
• Patients with common but uncomplicated ophthalmic conditions, eg uncomplicated glaucoma, cataracts
• Patients with less complex acute ophthalmic conditions who can be assessed, diagnosed, managed and discharged autonomously.
• Co-ordination of care for patients with more complicated ophthalmic conditions.

 

Implementation/ funding of NP Position 

• Previous Clinical Nurse Specialist role prior to NP registration.
• Business case development and presentation to ADHB on benefits of NP role to service provision within the ophthalmic service.  Awaiting budget approval in the 08/09 budget, which includes backfilling the CNS role.
• Funding will be within the nursing budget
  

Outcomes

• Decreased waiting times for first specialist assessment in ophthalmology – from 2 ½ years to 8 months for FSA in glaucoma
• Decreased waiting times for follow-up appointments which are now falling within the optimal follow-up time frame
• Decreased waiting times in acute service for assessment when NP is working within the service
• Decreased follow up waiting times within the acute service from 6 hours to 1 hour for anterior uveitis follow up
• Improved patient satisfaction
• Health education with improved compliance to guidelines and recommendations
  

Currently working towards the establishment of clinics in the wider Auckland area (Waitemata and Counties- Manukau DHBs) so that patients can be seen in their home area.