PEARS/MECS ANNUAL UPDATE 6/7/16

CET Admin information PEARS/MECS Cataract Safeguarding anyone? Overview

Cornea clinics -feedback form VR Project-learning objectives IOP Initiative Leaflets available, Spears available CET

 To prove our service  To care for Px  To drive up standards We Are On A Mission

 Using March & May figures  Looking carefully at practices that stood out last time  Or are doing large numbers  Or have become outliers Mini-CG Review

 We do not seek to pick on anyone  If you are an outlier we have to act  We expect some behaviours to change following this exercise Mini-CG Review

 Letters sent  Practice visits planned Mini-CG Review

Our Services – over Halfway!

Activity By Practice

Discharged (avg 63%)

Follow Ups (avg 14%)

24 Hour ARC Referral (avg 6%)

72 Hour ARC Referral (avg 5%)

IOPRM & Cataract

 The ‘ugly sisters’  Minor increases in users  If you benefit from PEARS/MECS we expect you to join, support and use the other services as well IOPRM & Cataract

PEARS/MECS…Doing Things Better

Use the Guidance

Use the Rules

Quality of Record Keeping  Clear  Contemporaneous  Concise  Relevant  Reason for referral  Completion PEARS/MECS Data

 Unprecedented level of accuracy  Use specific cases as examples  Show the level of data we can accumulate  Confused symptoms, notes referrals.  Signs & clinical findings in appropriate box  Discussion not lecture Follow ups …..another ugly sister? Of 1153 follow ups to date, 89% have not been recorded Using the software

PEARS…MECS; CG

Quality of Clinical Notes

 Reason for Referral (Triage) FnF Eye Examination Notes (Consultation) FnF Comments (Consultation) “ _” Comments (Outcome) “_”“_” 24Hr Referral

 Reason for Referral (Triage) Other Eye Examination Notes (Consultation) flashes in both eyes LR. When px moves eyes Comments (Consultation) “ _” Comments (Outcome) “_”“_” 72 Hour Referral

 Reason for Referral (Triage) Painful eye Eye Examination Notes (Consultation) Painful red eye Comments (Consultation) “Painful red eye emergency referral” Comments (Outcome) “Painful red eye” 24Hr Referral

 Reason for Referral (Triage) Other Eye Examination Notes (Consultation) drop in vision Comments (Consultation) “drop in vision” Comments (Outcome) “_”“_” 24Hr Referral

 Reason for Referral (Triage) Other Eye Examination Notes (Consultation) Flashes and Shadow in RE Comments (Consultation) “Flashes and Shadow in RE” Comments (Outcome) Vitreous haemorrhage 24Hr Referral

 Reason for Referral (Triage) Red eye Eye Examination Notes (Consultation) Px has reported a Red swollen eye Comments (Consultation) “RE - Redness / swollen and watery discharge” Comments (Outcome) “_”“_” 24Hr Referral

Quality of Decisions

 Reason for Referral (Triage) Painful eye Eye Examination Notes (Consultation) fb from strimmer yesterday Comments (Consultation) “central corneal abrasion” Comments (Outcome) “corneal abrasion yesterday. px feels the ey is worse today. stains readily. No evidence of foreign body remaining.” Action 24 hr referral

 Reason for Referral (Triage)  F&F Eye Examination Notes (Consultation)  RE Shadow and pain Comments (Consultation) RE Shadow and pain Comments (Outcome) “_”“_” Referral Urgent 72 hour for Seen next day A&E; grade 3+ AC cells; treated for iritis, referred to ARC

 Reason for Referral (Triage) sore eyes Eye Examination Notes (Consultation) Swollen, itchy, watery and sore red eyes Comments (Consultation) Diagnosis Allergy Outcome Urgent 24 hr referral

 Reason for Referral (Triage) red eye Eye Examination Notes (Consultation) Px reports she has a stye LE 2/7 ago, eyes were stuck together this morning becoming more painful as the day goes on. Px pregnant due soon. Comments (Consultation) Diagnosis Stye Outcome Urgent 24 hr referral

 Reason for Referral (Triage)  red eye Eye Examination Notes (Consultation) LE outer corner of lid inflamed and sore itchy patches. Comments (Consultation) Diagnosis other Outcome Urgent 72 hr referral

 Reason for Referral (Triage)  red eye Eye Examination Notes (Consultation) Increase in itching, red, watery, sticky eye Diagnosis Bacterial conjunctivitis Outcome Urgent 72 hr referral

 Triage  Loss of Vision Consultation Notes macular haemorrhage Diagnosis wet AMD Referral ARC 72 hrs Mrs W

 Triage Loss of Vision Consultation Notes Pain inside and back of LE. Last month dry eye drops Diagnosis unknown pain Referral ARC 24 hrs Mrs LM

VR Audit

 Reason for Referral (Triage)  F&F Eye Examination Notes (Consultation)  F&F 3 days Temporal RD with macula off, VA 6/36 Referral ARC 72 hrs Outcome attended A&E, surgery next day, VA 6/9- Mr G

 Triage F&F Consultation Notes 26/1/16 – F&F, RD Referral ARC 24 hrs Outcome operated 1/2/16, now has cataract Mr TG

 Triage F&F Consultation Notes bilateral disc swelling Comments Papilloedema Referral ARC 72 hrs Mrs FF

 or print & walk in?  Phoning ARC?  Triage in ARC?  Referral replies Does the referral system work?

 Patients already under HES for that condition PEARS…MECS

 Pharmacies  3 day limit on Rxs Pharmacies

FOOOD

Cataract

PoLCV

Success rate of Cataract Referrals at WEI 12 th April 2016 PRAB BOPARAI BSc (Hons) MCOptom Hospital and Community Optometrist Co-Chair (Wolverhampton Local Optometric Committee)

 Designed to eliminate un-necessary referrals to HES  Every px dilated to exclude co-pathology  Cataract must be significant and main reason for reduced VA  BCVA must be 6/12 or worse  5 page questionnaire for Px  Px must agree to sx before referral to hospital New Cataract Pathway in community

 Evaluate success rate of cataract referrals at WEI  Evaluate which mode of referral successfully results in conversion to cataract surgery at WEI Aim of study

 New cataract pathway (started Sept 2014)  GOS 18  Old cataract pathways (Old Cat 1 & outer areas)  GP  Others (DESP + OPD) Modes of referral

Results - Mode of referrals Mode of Referral Referrals (98) GOS 1834 New Cataract Pathway 23 Old Cataract pathways 21 GP12 Others8

Success rate of total referrals OutcomeReferrals (98) Successful71 Unsuccessful27

Success rate distribution Mode of referralSuccessful (71) GOS 1821 Old Cataract Pathway 18 New Cataract Pathway 17 Others8 GP7

Success of modes of referral

OutcomeTotal referred (111) GOS 18 (38) New Cataract Pathway (26) Old Cataract Pathway (25) GP (12) Other (OPD & DESP) (10) Successful DNA Incorrect referrals Other Pathology Px Declined Other Total referred and their outcomes

 72% of all referrals to cataract clinic resulted in listing for surgery  74% of referrals from new cataract pathway and  86% of referrals from “old” cataract pathway listed for surgery  58% from GP and  62% from GOS 18 resulted in surgery  Reasons for patients not being listed for surgery:  DNA (13/111……….>10%)  Incorrect referral  Wrongly booked patient /other pathology Conclusion

 Encourage increased uptake of cataract pathway referrals  Reduce GOS18 referrals  Encourage GPs to use Optometrists for cataract referrals using pathway  Encourage feedback to referring Optometrist Recommendations

 23 referrals came via GOS18 from practices on cataract pathway - why? Unclear referral?  14 (61%) successful for surgery  9 (39%) unsuccessful for surgery  7/98 Optom / practice details illegible Food for thought

 VA >6/12  VA good- Px managing well (CAT1+2);  VA 6/6 (GP) ;  VA 6/9 (Gos18) ;  VA 6/7.5 (Gos18) ;  VA 6/9, R>B (Gos18) ;  Min. cat, VA 6/9 (Gos18);  Insignificant cat (GP)  Insignificant cat to justify VA -> refraction (Cat1&2)  Insignificant cat, unexplained poor VA, ->refraction (CP) Reasons for no surgery

 Other pathology:  Pale discs – EVTs MRI (CP)  DMO (VA 6/9) -> Bhatnagar(G18)  Corneal dystrophy (VA 6/9)-> Gandhewar (G18)  Corneal dystrophy -> Gandhewar (CP)  FED (VA 6/9)-> Ilango (G18)  Moderate ARMD (Gos18)  High IOP, ERM -> VF (CP – out of area)  UTI – Wait until clear (G18)  PED > refer to Macular ( VA down both eyes) (Gos18) Reasons for no surgery

 Inappropriate patient?  Dementia, unlikely to benefit sx + dryAMD(G18)  Poor understanding of R&B – refer to speak to family (CP)  Px opted out as only eye (GP/DESP)  Px declined surgery to think (Gos18)  Px managing well (CP)  Dementia, Px declined managing well (GP) Reasons for surgery

 Get £35 for a dilated exam  Patient completes questionnaire  Easy to enter onto Optomanager  Refined referral  Gain respect from patient AND Hospital  Referral ed so can’t get lost  ed direct to hospital so quicker for patient  WHY SAY NO !!! Enrol onto cataract Pathway

Mr Manoj