The RoyalCollege of Ophthalmologists
Quality Standards Development Group
Quality standards for diabetic retinopathy services in NHS Scotland
Introduction
There are a number of reasons for wanting to know how well a clinical service is working. A commissioning organisation or a regulatory body may want evidence of quality to inform a commissioning decision or as part of an inspection. A department may wish to know how well it is doing in comparison with another department or whether it is improving, standing still, or deteriorating over a period of time. There are many possible ways of measuring quality ranging from opinions of service users and staff to hard measures of outcome such as mortality. However, good measures of quality may be defined as ones which ask questions which discriminate accurately between a service which is serving its patients well and one which is failing its patients.
The College's Quality Standards Group has produced a suite of simple self-assessment tools in draft form for the following clinical services: cataract, glaucoma, diabetic retinopathy, children and young adults, oculoplastics, age-related macular degeneration (AMD) and vitreoretinal surgery. The tools do not attempt to assess every aspect of each service, but focus on areas where problems are likely to show if the service is under stress. Very few clinical services will achieve a perfect score, so the questionnaires can be used as quality improvement tools as well as snapshot audit tools.
In order to improve and develop the self assessment questionnaires, we will be very grateful if you could complete the attached feedback form after you have completed the questionnaire.
Please send feedback to Beth Barnes, Head of Professional Standards.
(Effectiveness 54%, Safety 31%, Patient experience 15%)
1.The DR service has a clinical lead with the role defined on the job plan, with a job description to include liaison with NHS Board coordinator, Lead Clinician and Service Manager of diabetic retinopathy screening programme and responsibility for DR audit and failsafe within the eye unit. Safety
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
2.All patients with a diabetic retinopathy grade of R4, R3 or M2 are assessed and treated by appropriately trained staff inclinics with urgent access to retinal imaging and laser treatment facilities. Effectiveness
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
3. The service hasa mechanism formonitoring the accuracy of grading of DR and the appropriateness of treatment decisions made by staff who assess and treat patients with DR.Effectiveness
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
- There is a reliable protocol for logging new referrals of patients with DR and allocating appointments that comply with timing standards of the relevant National Screening Programme? Safety 50% Effectiveness 50%
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
5. There is a robust system for ensuring that patients with active proliferative DR and sight-threatening diabetic maculopathyhave access to treatment within the time frame stipulated by the relevant national screening programme Safety 50% Effectiveness 50%
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
6.There is regular audit to ensure that follow up and treatment appointments occur within 15% of the planned interval, including following including following hospital initiated cancellations Safety 50%, Patient experience 50%
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
7.The hospital DR service has a mechanism for ensuring the screening programme, GP and patient are notified regularly and reliably of the visual acuity, retinopathy grade and pathway status of each patient within the DR service
Effectiveness 50%, Safety 50%
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
8.The service has an agreed DNA policy for patients with DR that complies with the relevant National Screening Programme, including a mechanism for informing the GP, patient and local screening programme when a patient who persistently fails to attend is discharged from the service Safety
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
9.The DR service conducts a continuous audit of patients who qualify for certification of sight impairment due to diabetic retinopathy which includes an analysis of whether the visual loss could have been prevented and whether the patient had been registered with a screening programme. Effectiveness 50%, Patient experience 50%
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
10.There is regular audit of patients undergoing vitrectomy for diabetic retinopathy to identify treatment or screening failures or/and other modifiable risk factors
Effectiveness
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
11.It is standard practice to incorporate into consultations an assessment of diabetic control and risk factors for major complications of diabetes and to share relevant information with the patient’s diabetologist and GP. Effectiveness
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
12. The DR service routinely has access to photographic images taken at community DR screening encounters Effectiveness
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
13.The service solicits regular feedback from patients and uses this information to improve the service Patient experience
YES(Score 0.75)NO (Score 0)UNABLE TO ANSWER (Score 0)
Total score:
1
July 2013 Review: July 2015
Document Ref: Authors: Mr Robert Johnston FRCOphth, Dr John Olson FRCOphth,Mr Richard Smith FRCOphth
2013/PROF/143