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N:d YAG Laser Capsulotomy by Nurses and Optometrists
Policy and Procedure
Policy Summary This policy will outline the procedure for non-medical staff performing Nd:YAG Laser Capsulotomy
Version: 3.0
Status: FINAL Approved: 22 May 2018 Ratified: 26 April 2016
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Version History
Version Date Issued Brief Summary of Change Author
1.0 December 2009 Helen Gibbons
2.0 4th May 2013 Amend comorbidity of patients Helen Gibbons
Carmel King
Yvonne Kana
Eilis Kennedy
2.1 22nd April 2016 revised Yvonne Kana
3.0 April 2018 Review Yvonne Kana
For more information on the status of this document, please contact:
Yvonne Kana
Carmel King
Policy Author Helen Gibbons
Carmel King
Yvonne Kana
Eilis Kennedy
Policy Owner Tracy Luckett
Department Corporate Nursing
Accountable Director Tracy Luckett
Date of issue May 2018
Review due April 2021
Responsible Committee/ Group for approval
Clinical Governance Committee
Ratified by The Management Board
Audience All staff involved in advance practice role
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Contents
Section Page
Executive Summary 4
1.0 Introduction 5
2.0 Scope 5
3.0 Purpose 5
3.1 Benefits to patient 5
3.2 Outcome measures 6
3.3 Frequency of Practice 6
3.4 Professional accountability 6
3.5 Qualifications & Training 7
4.0 Policy 7
4.1 Scope of policy 7
4.2 Consent, prescribing and documentation 7
4.3 Exemptions to treatment by the practitioner 8
4.4 Equipment required to perform YAG Laser Capsulotomy 8
4.5 Prior to YAG Capsulotomy session commencing 9
4.6 Preparation of the Patient 9
4.7 Procedure 11
4.8 Record Keeping & Documentation 11
5.0 Drugs used for the procedure 11
6.0 Potential risks 12
6.1 Risks to the patient 12
6.2 Risks to staff 12
7.0 Explanation to terms used 12
8.0 Duties 13
8.1 Nurses/Optometrists responsibilities 13
8.2 Consultant Ophthalmologists responsibilities 13
8.3 Employers Responsibilities 13
8.4 Trust Managements Responsibility 14
9.0 Stakeholder Engagement and Communication 14
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Section Page
10 Approval and Ratification 14
11 Dissemination and implementation 14
12 Review and Revision 14
13 Documentation Control and Archiving 14
14 Monitoring and Compliance 15
15 Supporting References 16
16 Supporting Documents 16
Appendices
Appendix 1 Yag Competency training checklist 17
Appendix 2 Observed practice record
Supervised Practice Record
Independent supervised practice
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Appendix 3 Equality impact Assessment Tool 21
Appendix 4 Policy applicable to trust sites 23
Appendix 5 Checklist for the review and approval of policies 25
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Executive Summary
This policy sets out the process by which designated nursing staff and optometrists will train to deliver YAG Laser Capsulotomies as independent practitioners.
This policy outlines the training and duties involved for those staff designated to deliver the service.
The policy also provides guidance for the management of patients who will have Nd:YAG Laser Capsulotomy performed by either an ophthalmic trained nurse or an optometrist.
In addition this policy sets out the process to be used for monitoring compliance and outcomes.
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1. Introduction
Posterior capsular opacification (PCO) remains one of the most common post-operative complications of cataract surgery (Spalton 1999). In 1998, a meta-analysis by Schaumberg et al showed that 11.8% of patients who had routine cataract surgery would require a YAG laser capsulotomy within one to five years following their surgery. Nd. YAG laser is performed on patients who have undergone cataract surgery, most commonly performed by phacoemulsification, and whose vision has deteriorated due to posterior capsule thickening. The laser procedure causes photodisruption of the tissues and is used to cut a hole in the posterior capsule (Coakes et al 1995). Its purpose is to create a gap in the membrane behind the patient’s intraocular lens in order to restore the patient’s visual acuity to its best post-operative level (Gibbons et al 2001). In 1997, nurses in the United Kingdom started to undertake training in YAG capsulotomy in response to the Department of Health’s report by Calman (1991), which recommended that appropriately trained nurses could expand their roles to undertake some roles previously undertaken by trained medical practitioners. The Department of Health’s NHS plan continued with this theme. Enabling nurses and optometrists to be trained to perform Nd:YAG laser capsulotomy will contribute to the efficient delivery of the ophthalmology clinic services within Moorfields Eye Hospital NHS Foundation Trust. This will enhance and develop patient-centred care through a process of enabling nurses and optometrists to perform functions previously only performed by medical staff.
2. Scope
This guidance is relevant to:
Ophthalmic nurses (band 7 and above)
Optometrists 3. Purpose
Enabling nurses & Optometrists to be trained to perform YAG Laser Capsulotomies will contribute to the efficient delivery of the ophthalmology clinic services within Moorfields Eye Hospital NHS Foundation Trust. This will enhance and develop patient-centred care through a process of enabling nurses and optometrists to perform functions previously only performed by medical staff. This will ensure that service provision will be more flexible and less reliant on the availability of doctors with the potential for increased capacity for treatment.
It will also enable national guidelines and service delivery targets to be met.
3.1. Benefits to patients
Enhanced patient-centred care, patients will be able to build a rapport with the nurse or optometrist treating them as the patient will be treated by the same health care professional at each visit.
Greater efficiency in terms of waiting times for treatment and ensuring patient choice – the nurses and optometrists will have regular sessions in clinic, which will ensure that patients can agree on a convenient date for their procedure to be carried out
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3.2. Outcome measures
• Safe treatment for patients requiring Nd YAG laser capsulotomy, (patient safety will be monitored by regular audit).
Positive experience of care by patients and their relatives/carers, leading to greater patient satisfaction This will be measured via an annual audit looking at the patients’ experience and comfort during the procedure, and overall satisfaction levels.
A record is kept of all patients treated by the nurse or optometrist; These records are audited on an annual basis to identify any patients who have had to re-attend as an emergency patient. (During training period records are kept and reviewed on every patient, once competent for independent practice annual audits will take place)
3.3. Frequency of practice This practice will be carried out on a regular basis as required by the service. Each nurse / optometrists has a planned list but also has the option to treat the patient from the clinical area as required. Professional accountability From the point of registration, each practitioner must adhere to their code of professional conduct (Nursing and Midwifery Council, 2008 & General Optical Council 2009) and is accountable for his / her practice. The Nurse’s code of conduct provides firm guidance on which decisions about expansions to the scope of practice can be based. The code of professional conduct for nurses states: “As a professional, you are personally accountable for your actions and Omissions in your practice and must always be able to justify your actions”
Treat people as individuals
Ensure you gain consent
Respect people’s confidentiality
Work effectively as part of a team
Manage risk
Use the best available evidence Keep your knowledge and skills up to date. Keep clear and accurate records in patients hospital notes
Nurses and Optometrists working within Moorfields Eye Hospital NHS Foundation Trust must be aware that:
Additional education and training are necessary for all practice not covered in previous training and education;
They assume full accountability for their actions/omissions;
They should maintain and improve professional knowledge;
They should acknowledge limitations in knowledge and competency and decline any duties or responsibilities unless able to perform them in a safe competent manner;
They must adhere to current policies and guidelines for practice;
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Delegation of work to other staff must be within their level of competence and to a degree appropriate to their role
Where appropriate, patients and informal carers must have sufficient knowledge and understanding to participate safely in the patients care;
Any proposed expansion of practice must not compromise policies and procedures ratified by the trust.
3.4. Qualifications and training This procedure must be performed by a registered nurse (RN) level 1, who must hold an ophthalmic nursing qualification or an optometrist. The optometrist (OO) must be fully registered and have completed 3 years post graduate experience. Both nurses and optometrists must have completed the YAG laser training and be assessed as competent by their supervising consultant. This must include a series of formal lectures on YAG Caspulotomy, consenting, complications and personal study into risks and complications from YAG laser treatment. •The nurse/optometrist must be trained in consenting. •The nurse/optometrist must be satisfied with his/her own level of competence in accordance with the Nursing and Midwifery Council’s guidelines (2008) and The General Optical Council (2009) •The nurse/optometrist must have attended the local laser safety training study day prior to undertaking any practice. •The nurse/optometrist must undertake a period of observation of the procedure before practical training commences
4. Policy
4.1. Scope of the policy
This policy covers the treatment of adult patients undergoing an YAG capsulotomy by a member of nursing or optometry staff.
This policy should be read in conjunction with the current version of:
o Standard Operational Procedures YAG laser Capsulotomy o Patient Direction Groups, o Consent policy, o Tonometry SOP o VA Snellen SOP o Trust Infection Control manual – Hand Hygiene Policy
This policy provides details of minimum qualifications and training in order to carrying out this procedure.
This policy outlines: Consent, prescribing and documentation required. The required procedural steps, including equipment required and the
management of complications. Contraindications to nurses and optometrists carrying out this treatment.
This policy applies to all sites within the Moorfields Eye Hospital NHS Foundation Trust where Nurse led / Optometry led YAG Laser Clinics are carried out are carried out.
It is essential that this policy is followed, as failure could result in the loss of the trust’s indemnity and could result in investigation and management action being taken as considered appropriate. This could include formal action in line with the trust’s disciplinary
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procedures for trust employees and/or other action in relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary contract
4.2. Consent, prescribing and documentation
The RN OO undertaking the YAG laser procedure must have completed the consent policy training course
The RN / OO must obtain written consent for the procedure in line with the trust’s consent policy to ensure that the patient is aware of the rationale for the procedure and of all potential complications.- see section 5 of policy
The patient must have been given a copy of the relevant patient information leaflet prior to signing the consent form.
Exemptions to treatment by the Nurse/Optometrist The laser should not be performed by the nurse/optometrist if: Informed consent is not obtained The patient refuses treatment by the RN /OO The referring consultant / senior clinician decide that the patient is not suitable for the nurse/optometrist to perform due to any underlying comorbidity or other underlying medical condition. The patient has an underlying condition which will make it difficult for them to keep still – e.g., Parkinson’s disease – or if there are any concerns that the patient will be unable to fixate; for example, patients with nystagmus should be referred on to the supervising consultant.
4.3. Equipment required to perform YAG laser
• All eye drops must have their expiry dates checked before use:
• Proxymethacaine and fluorescein eye drops
• Tropicamide 1% eye drops
• Iopidine 1% eye drops
• Oxybuprocaine hydrochloride eye drops
• Viscotears gel (for capsulotomy lens)
• Capsulotomy lens
• Cleansing wipes to clean lens and laser slit lamp in between patients, as per infection control policy
• Tissues
• Capsulotomy lens
• Slit lamp
• Disposable tonometer heads
• YAG laser
4.4. Prior to YAG Laser session commencing Review the patient’s notes and ensure the patient has been referred for treatment by an Ophthalmologist Confirm that a fundus examination has taken place by a doctor or professional who is deemed competent in fundus examination and details of the examination are recorded in the patient’s notes. If not, a fundus review must be obtained prior to any laser treatment taking place.
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1. Check that there is a doctor available in clinic. 2. Turn the laser machine on, ensure power setting is at the lowest (machine
dependant but ideally 1MJ) and that the focusing switch is set to posterior mode, (some machines will need to be manually offset, please observe local manual) and on single shot burst only. Turn off again until ready to use.
3. Clean YAG capsulotomy lens with approved wipes as per infection control policy.
4.5 Preparation of the patient
Introduce yourself to the patient and ask the patient to confirm their identity in line with trust policy, to ensure that the patient is treated with dignity and respect and to prevent errors of misidentification
Confirm patient allergy status and past medical history to prevent any untoward side effects from medications used for this procedure.
Ask patient if there have been any changes to their ophthalmic history since last seen – e.g., increased flashes and floaters; if yes, the patient will need to be reviewed by a doctor. This is to ensure that there are no untoward complications from laser treatment.
Explain the procedure, giving the patient time to ask questions and gain written consent, using the guidelines outlined for nurse/ OO consent in the trust consent policy, available on the intranet, to ensure the patient understands the procedure and gives valid consent.
Perform a visual acuity test as outlined in VA Snellen SOP April 2008 to ensure a baseline visual acuity measurement
Measure intraocular eye pressure using Goldmann tonometry as outlined in Tonometry SOP 2008 to ensure baseline intraocular pressure measurement is recorded in case of a post-procedure pressure spike.
Instil one drop of Tropicamide 1% eye drops (following professional standards for administration of eye drops) to the eye being treated and wait 20 to 30 minutes to take effect. If adequate mydrasis is not achieved after this time, add one further drop of Tropicamide 1%. If adequate mydriasis is still not achieved, contact the supporting doctor for advice. The drops are necessary to dilate the pupil to ensure that capsule opacification is visible.
4.6. Procedure
Sit patient at the YAG laser machine and ensure their position is comfortable
Turn laser machine on using code if required and switch to standby mode
Insert x1 drop of oxybuprocaine hydrochloride eye drops -following professional standards for administration of eye drops
Rinse capsulotomy lens in sterile water and dry
Put 1cm of viscotears gel onto contact lens
Insert contact lens by asking patient to look up; once inserted, ask the patient to look straight ahead
Start with minimum power to break capsule (usually 1MJ dependant on machine being used and thickness of capsule)
Apply initial shots away from the visual axis
Aim the beam just behind the posterior capsule
Perform capsulotomy with a complete circular technique to avoid pitting the lens (As per Moorfields protocol for optometrists 2006)
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Check the visual axis is clear
Remove contact lens, by asking the patient to squeeze their eyes shut; it will lift off the eye)
Remove contact lens and clean with alcohol wipe
Instil one drop of Iopidine 1% to the treated eye as per PGD to prevent post-procedure pressure rise
Give patient written after care advice and a contact telephone number in case they have any cause for concern, such as severe pain, dramatic drop in visual acuity. Inform patient they can return to A&E at Moorfields if they experience any problems.
Ask patient to attend their own optometrist within two weeks to see if their glasses prescription requires adjustment, unless the patient has a history of glaucoma or other co-morbidity where they need referral back to clinic
4.7 Record keeping and Documentation
Record treatment clearly in the patient’s health records – details of the procedure, eye drops instilled signature and designation should all be clearly recorded.
Complete GP letter on OpenEyes filing a copy in the paper health records.
Complete proforma for notes (see appendix E)
If an unexpected event occurs, document and complete and report the incident as necessary.
This procedure is necessary to facilitate communication within the team, meet legal requirements of practice and enable monitoring over a time period.
Inform patient of treatment outcomes and discuss further appointments if required in order to facilitate good communication and a partnership approach to care.
5.0. Drugs Used for Procedure Tropicamide 1% Eye drops Legal status: Prescription only medicine. Dose: Once only Method and route of administration: Standard eye drop instillation procedure. Instil ONE drop to the outer aspect of the lower fornix of the eye to be treated. For supply of treatment: see medicines from policy on patient group directions.
Advice to patients
Drop may sting Patient should not drive for 1-2 hours following dilatation of pupils Patient should not operate machinery unless vision is clear Patient should advise the hospital of any untoward effects.
Adverse drug reactions
Transient stinging, local irritation Hyperaemia Oedema Conjunctivitis
Record keeping
The administration of Tropicamide 1% eye drops will be recorded in the patient’s case notes, recording date, time and signature of nurse. 5.1. Oxybuprocaine hydrochloride 0.4% eye drops (benoxiate) minims.
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Legal status: Prescription only medicine. Dose: Once only Method and route of administration: Standard eye drop instillation procedure. Instil ONE drop to the outer aspect of the lower fornix of the affected eye. For supply of treatment: see medicines from policy on patient group directions.
Advice to patients
Drop may sting Patients should refrain from touching or rubbing their eyes due to loss of corneal
sensation Advise the hospital of any unwanted effects.
Adverse drug reactions
Transient stinging, local irritation Hyperaemia Oedema
Supporting facilities
Medical staff
Record keeping
The administration of oxybuprocaine hydrochloride 0.4% eye drops will be recorded in the patient’s case notes, recording date, time and signature of nurse. Information to be documented: Name, form and strength of medicine to be documented in full Date, time and dosage administered Signature of registered nurse 5.1. Apraclonidine (Iopidine 1%) Legal status: Prescription only medicine. Dose: Once pre-laser treatment and once immediately post-laser Method and route of administration: Standard eye drop instillation procedure: Instil ONE drop to the outer aspect of the lower fornix of the affected eye.
Advice to patients
Drop may sting Patient should not drive for 1-2 hours following dilatation of pupils Patient should not operate machinery unless vision is clear Patient should advise the hospital of any unwanted effects.
Adverse drug reactions
Dry mouth / taste disturbance Discomfort and lacrimation Headache Dry nose Conjunctival blanching Cautions In patients with angina Recent MIs
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Heart failure Chronic renal failure Vasovagal attack Pregnancy and breast feeding
Record keeping
The administration of Apraclonidine 1% eye drops will be recorded in the patient’s case notes. 6.0. Potential risks 6.1To the patient The Risks of Nd: YAG Laser Capsulotomy are:
Retinal tear / detachment
Cystoid Macular Odema
Loss of vision (from any of above)
Raised intra ocular eye pressure
Risk of damage to the intra ocular lens
Floaters 6.2 To staff
Electrocution
Laser burn if reflective surfaces present 7.0. Explanation of Terms Used
Term Definition
Cataract Opacity of the lens
Retinal detachment Separation of the neurosensory retina from the pigment epithelium
Capsule Opacification Residual lens epithelial cells grow across this posterior capsule, resulting in capsule opacification.
Cystoid Macular odema An accumulation of fluid within the retina at the macular area
Intra ocular eye pressure
The fluid pressure inside the eye
Nd:YAG Laser YAG = Yttrium Aluminium garnet is the laser used to perform a capsulotomy
Posterior Capsulotomy Capsule thickening in the back of the capsule bag
Anterior Capsulotomy Capsule thickening in the front of the capsule bag
8.0. Duties Nurses/ Optometrists responsibilities
Nurse/Optometrist undertaking the training are responsible for keeping up to date, accurate training records as required by this policy. They are also required to audit their patient records on an annual basis (once signed off as competent to
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practice independently) reporting on outcomes to the supervising consultant or designated deputy.
Nurse/Optometrist have a duty of care to ensure that the patient that is being treated is fully informed of the risks and benefits of the YAG laser treatment.
Patients will be given a written information leaflet informing them that the treatment will be performed by a nurse or optometrist ensuring the patient is aware of the benefits of these clinics. The leaflet will also explain the potential risks of the treatment. Patients will be informed that they can refuse their treatment by the nurse / OO if they have any concerns.
8.1. Consultant ophthalmologist’s responsibilities to the Nurse and Optometrist
• To ensure the nurse/optometrist has achieved a satisfactory knowledge base from which to perform this enhanced role – the consultant will formally examine the nurse/ optometrist to ensure she/he has the knowledge base required.
• To provide adequate time for the nurse to observe Nd: YAG laser procedure and to subsequently supervise and assess the nurse’s procedural skills.
• To be available to support the nurse during an N:d YAG laser clinic
8.2. Employer’s responsibilities
To provide sufficient time and support for the nurse/optometrist to achieve the requirements of the individualised learning programme prior to them expanding their sphere of practice. This means that the trainee will have a dedicated training role and staff in training will be in addition to normal staffing levels and will not be expected to carry out additional roles during training
To provide the medical personnel to train the designated nurse/optometrist ensuring that training lists are not oversubscribed.
To provide trust indemnity for the nurse/optometrist providing they adhere to the policy and procedure document.
The training manual and protocol must be accessible at all times and updated as required and published to the intranet.
The Trust must ensure documented evidence is maintained to ensure evidence is available of competency of practice through audit for the nurse/optometrist performing the procedure.
8.3. Trust Management’s responsibility
To provide sufficient time and support for the nurse/ optometrist to achieve the requirements of the individualised learning programme prior to them expanding their sphere of practice.
To provide the medical personnel to train the designated nurse / optometrist 8.4. Nursing/ optometry management’s responsibility
Advising and overseeing the implementation and evaluation of the service delivery. 9.0. Stakeholder Engagement and Communication This policy was developed by the Cataract nurses, Vitreo Retinal nurses, Medical Retinal Nurses, Helen Gibbons & management.
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Stakeholder engagement with consultants and other relevant staff via appropriate meetings and email communication. 10. Approval and Ratification This policy has the approval of the Clinical Governance committee and has been ratified by the Management Executive Board.
11. Dissemination and Implementation
This policy will be implemented and disseminated immediately following ratification to all staff involved with the Nd:YAG Laser capsulotomy procedure, and will be communicated to key stakeholders and policy users via email, and highlighted at Medical Retina service meetings.
This policy will be published on the Moorfields intranet site 12. Review and Revision Arrangements
This document will initially be reviewed after one year then every three years (maximum) thereafter.
Changes to the legislation of the administration of intravitreal injections by non-medical personal will trigger a review of this policy.
13. Document Control and Archiving
The current and approved version of this document can be found on the Trust’s intranet site. Should this not be the case, please contact the Quality and Compliance team.
Previously approved versions of this document will be removed from the intranet by the Quality and Compliance team and archived on the corporate governance shared drive. Any requests for retrieval of archived documents must be directed to the Quality and Compliance team.
14. Monitoring compliance with this Policy The Trust will use a variety of methods to monitor compliance with the processes in this document, including the following methods:
Measurable Policy Objective
Monitoring/ Audit method
Frequency of monitoring
Responsibility for performing the monitoring
Monitoring reported to which groups/ committees, inc responsibility for reviewing action plans
This policy will be reviewed by the authors every 2 years to
History Every 2 years
Director of Corporate Governance
Management Executive
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ensure that its content remains valid and in date
Complications to be recorded
Incident forms on-going Risk and safety team
Non-medical personnel performing YAG Laser
Clinical Governance
Any patient who is dissatisfied with the treatment delivered by Non-medical personnel
Complaints Incident forms
On-going PALS
Patient experience committee
Medical retinal Service
Clinical Governance
In addition to the monitoring arrangements described above the Trust may undertake additional monitoring of this policy as a response to the identification of any gaps, or as a result of the identification of risks arising from the policy prompted by incident review, external reviews or other sources of information and advice.
This monitoring may include commissioned audits and reviews, detailed data analysis or another focussed study, for example. Results of this monitoring will be reported to the committee and/or individual responsible for the review of the process and/or the risks identified.
Monitoring at any point may trigger a policy review if there is evidence that the policy is unable to meet its stated objectives. 14.1. The current and approved version of this document can be found on the Trust’s intranet site. Should this not be the case, please contact the Risk and Safety team.
14.2 Previously approved versions of this document will be removed from the intranet by the Risk and Safety team and archived in the policy repository. Any requests for retrieval of archived documents must be directed to the Risk and Safety team. 15. Supporting References / Evidence Base
References:
British Medical Association (2001) British National Formulary, British Medical Association
and the Royal Pharmaceutical Society of Great Britain.
Coakes R, Sellors P (1993) Outline of Ophthalmology 2nd edition Oxford. Butterworth
Heinemann
Gibbons H, Frossell S. (2001) The role of the nurse performing YAG laser capsulotomy,
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Ophthalmic Nursing 2001 5 (1):12-15
Hinchingbrooke Health care (2002) NHS Trust, policy for patient group directions
Nursing and Midwifery Council (2008) code of professional conduct, NMC London.
Schaumberg DA, Raza D, Christen W, Glynn RJ, (1998) A Systematic overview of the
incidence of posterior capsule opacification, Ophthalmology 105 1213 -1221
http://www.optical.org/en/about_us/People/code_of_conduct_for_members.cfm accessed
21/12/2012
15. Supporting Document
Supporting Documents/References Owner
College of Ophthalmogists website External website
VA Snellen SOP
Nursing
Patient Group Direction Policy, Pharmacy
Consent policy Risk
Tonometry SOP
Nursing
Trust Infection Control manual Infection Control
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Appendix 1 Yag Capsulotomy Competency training
The nurse / optometrist must achieve these competencies with each patient to decide when nurse is competent to practise independently. In addition they must have an annual review by lead consultant. Nurse’s / optometrist name Patient number
COMPETENCY STATEMNENT YES NO COMMENT
Carries out patient ID check
Measures visual acuity accurately
Obtains accurate Goldmann IOP
Reviews notes to check appropriate treatment
Explains procedure
Obtains informed consent
Instils pre-op drops according to protocol
Safely prepares YAG laser, and room safety
Prepares sterile contact lens
Identifies position for capsulotomy
Instils local anaesthetic
Safely performs YAG laser capsulotomy
Give post-op medication as per protocol
Safe discharge of patient (including post-op prescription and OPA if required)
Documentation correctly completed Notes sent to correct destination
Nurse’s/ optometrist signature _________________________ Date_______________ Consultant’s Signature ________________________ Date______________
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Record of training for YAG laser Capsulotomy Appendix 2
Date Patient record Number
Observed Procedure Total energy used Comments Signature of practitioner
Signature of Supervisor
1
2
3
4
5
6
7
8
9
10
Observation of Procedure
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Record of training for YAG Laser Capsulotomy
Date Patient record Number
Supervised Practice procedure
Total energy used Comments Signature of practitioner
Signature of Supervisor
1
2
3
4
5
6
7
8
9
10
(Insert further sheet if more supervised practice required)
Supervised Practice
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Record of training for YAG laser Capsulotomy
Date Patient record Number
Independent Observed Practice
Total energy used Comments Signature of practitioner
Signature of Supervisor
1
2
3
4
5
6
7
8
9
10
Independent observed Practice
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Appendix 3
Equality Impact Assessment
The equality impact assessment is used to ensure we do not inadvertently discriminate as a service provider or as an employer. To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.
Comments / Evidence
1 Which groups is the policy/guidance intended for? Who will benefit from the policy/guidance? (refer to appropriate data)
All patients who require YAG PC
Race No discrimination
Gender (or sex) No
Gender Reassignment No
Pregnancy and maternity No
Marriage and civil partnership
No
Religion or belief No
Sexual orientation including lesbian, gay and bisexual people
No
Age No
Disability (e.g., physical, sensory or learning)
No
2 What issues need to be considered to ensure these groups are not disadvantaged by your proposal/guidance?
N/A
3 What evidence exists already that suggests that some groups are affected differently? (identify the evidence you refer to)
None
4 How will you avoid or mitigate against the difference or disadvantage.
N/A
5 What is your justification for the difference or disadvantage if you cannot avoid or mitigate against it, and you cannot stop the proposal or guidance?
N/A
If you have identified a potential discriminatory impact of this procedural document, please refer it to the director of quality and safety, or the human resources department, together with any suggestions as to the action required to avoid/reduce this impact.
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For advice in respect of answering the above questions, please contact the director of quality and safety (ext. 6564) Please ensure that the completed EIA is appended to the final version of the document, so that it is available for consultation when the document is being approved and ratified, and subsequently published.
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Appendix 4
Policy Applicability to Trust sites
This document applies to all premises occupied by Trust staff/activities, unless explicitly stated otherwise. List all excluded sites: Moorfields Pharmaceuticals Provost Street RDCEC Upper Wimpole Street
Where the list indicates that the policy does not apply, this implies that the Trust will adhere to the policy of the host. Where a query exists then this must be referred, in the first instance, to either the:
Divisional Manager /Head of nursing
Policy owner
Accountable director
Service director Moorfields Dubai will adhere to their own local policies and procedures and Trust-wide documents will not apply, unless explicitly stated otherwise.
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Appendix 5
Checklist for the Review and Approval of Documents
To be completed (electronically) and attached to any document which guides practice when submitted to the appropriate committee for approval or ratification.
Title of the document: N:d YAG laser Capsulotomy by nurses and optometrists
Policy (document) Author: Helen Gibbons, Carmel King, Yvonne Kana, Eilis Kennedy,Tracy Luckett
Policy (document) Owner: Tracy Luckett
Yes/No/
Unsure/NA
Comments
1. Title
Is the title clear and unambiguous? Yes
Is it clear whether the document is a guideline, policy, protocol or standard?
Yes
2. Scope/Purpose
Is the target population clear and unambiguous?
Yes
Is the purpose of the document clear? Yes
Are the intended outcomes described? Yes
Are the statements clear and unambiguous?
Yes
3. Development Process
Is there evidence of engagement with stakeholders and users?
Yes
Who was engaged in a review of the document (list committees/ individuals)?
Helen Gibbons
Carmel King
Yvonne Kana
Eilis Kennedy
Has the policy template been followed (i.e. is the format correct)?
Yes
4. Evidence Base
Is the type of evidence to support the document identified explicitly?
Yes
Are local/organisational supporting documents referenced?
Yes
5. Approval
Does the document identify which Yes
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Yes/No/
Unsure/NA
Comments
committee/group will approve/ratify it?
If appropriate, have the joint human resources/staff side committee (or equivalent) approved the document?
N/A
6. Dissemination and Implementation
Is there an outline/plan to identify how this will be done?
Yes
Does the plan include the necessary training/support to ensure compliance?
Yes
7. Process for Monitoring Compliance
Are there measurable standards or KPIs to support monitoring compliance of the document?
Yes
8. Review Date
Is the review date identified and is this acceptable?
Yes
9. Overall Responsibility for the Document
Is it clear who will be responsible for coordinating the dissemination, implementation and review of the documentation?
Yes
10. Equality Impact Assessment (EIA)
Has a suitable EIA been completed? Yes
Committee Approval (Clinical Governance Meeting)
If the committee is happy to approve this document, please complete the section below, date it and return it to the Policy (document) Owner
Chairman Tracy Luckett
Date 22/05/2018
Ratification by Trust Management Board (if appropriate)
If the Trust Management Board is happy to ratify this document, please complete the date of ratification below and advise the Policy (document) Owner
Date: 26 April 2016
