quarterly meeting · professor matthew cripps national director, nhs rightcare remember to delete...
TRANSCRIPT
Quarterly MeetingWednesday 1st March 2018
Introduction & Agenda
• Introduction 10:30
• UKOA Update
• GIRFT Update
• Right Care overview
Lunch Break 12:45
• Procurement Workshop
• Glaucoma Patient Standards
• Summary & Close 15:45
UKOA UpdateAllison Beal, Melanie Hingorani & Gill Salter
UKOA Progress Update
Since our last meeting we have….• Secured funding for the Alliance for 2018/19 • Invited 24 more trusts including scan for safety units to join the Alliance • Set up a coding workshop - 9th May (London)• Arranged two UKOA management training sessions for members
7th March (Manchester) & 4th April (London)• Confirmed with the College to support the IOL standard• Developed our first newsletter about the Alliance for internal and external sharing • Developed new UKOA website • Continued to work with the RNIB on the patient standard Started to develop quality
standard based on the giant cell arteritis work from Norfolk and Norwich
UKOA Progress Update RNIB• RNIB identified core access issues for patients - taking into account your contributions on 6
December
• Patient feedback received to date by RNIB indicates these do represent the key factors
• Awaiting further feedback from IGA and Macular Society before proceeding
• RNIB plans to provide UKOA members with a draft standard and a patient survey in April
• You will be asked to provide feedback on those documents for the June meeting
• We anticipate that individual Trusts will want to run the survey, at a time of their choosing.
• The survey will help you see any areas for improvement and inform improvement actions.
• RNIB will continue to support UKOA members with this process.
• The patient issues we identified are documented for circulation. To develop comms re hospital
eye services should ensure is provided or happens during the patient visit.
UKOA Progress continued..
Since our last meeting we have….• Developed an overview/case study to share on the intravitreal presentation (with RH
to finalise)
• Developed a brief overview/case study to share on the Sunderland processes (to flesh out with visit in May)
• Continued work on procurement best practice
• Started recruitment of clinicians to help further define best practice surgery packs
• Developed draft “fools guides” for IOLs and phaco machines
• Started working on Catarapp – a time and motion / carbon waste phone app
• Moorfields Vanguard Programme publications
• Claims work
• Started looking at glaucoma standards and good practice
UKOA Update: Website
GIRFT UpdateCarrie MacEwen & Alison Davis: GIRFT Ophthalmology Clinical Leads &
Lydia Chang : GIRFT Ophthalmology Clinical Advisor
From pilot to national programme…..
24 1000Clinical work streams are already underway
Clinical Lead visits already completed
Wave Start Date Workstreams Total
1 2012 Orthopaedics 1
2 Jan 2015 General surgery, Spinal, Vascular, Neurosurgery 5
3 Jan 2016Urology, Cardiothoracic, Paediatric surgery, Ophthalmology, ENT, Oral & Maxillofacial, Obstetrics &
Gynaecology12
4 Apr 2017 Emergency medicine, Cardiology, Dentistry 15
5 May 2017 Breast surgery, Diabetes, Endocrinology, Imaging/ Radiology 19
6 Jul 2017 Anaesthetics/Perioperative, Intensive & Critical Care, Renal 22
7 Sep 2017 Acute & General medicine, Neurology 24
8 Nov 2017 Geriatrics, Respiratory, Dermatology 27
9 Jan 2018 Rheumatology, Pathology, Outpatients, Trauma, Stroke, 32
10 Mar 2018 Gastroenterology, Mental Health, Plastic surgery 35
Implementation until March 2021 with more specialties e.g. oncology, paediatric medicine TBC
Clinical Leads Carrie MacEwen & Alison Davis Clinical AdvisorLydia Chang
GIRFT Ophthalmology Work Stream
Phase 1 - Preparation (June 2016 to Nov 2016)
Decided on priorities & parametersDATA PACK (HES data)
&QUESTIONNAIRE development
(bespoke to ophthalmology)
Phase 2 - Pilot Deep Dive Visits (Dec 2016)
Hinchingbrooke, Sunderland, York and LeedsAdjusted data pack & questionnaire
GIRFT Ophthalmology Work Stream
Phase 3 - Deep Dives / Visits (Feb 2017 to April 2018)
2 HOURS
Arrange visit dateData packs & questionnaires sent out
AS MANY STAFF AS POSSIBLERepresentation ALL staff groups
AFTER visitTrust Observation minutes; Recommendations &/or Actions
LOCAL IMPLEMENTATION Implement Actions supported GIRFT Implementation Team
GIRFT Ophthalmology Building Implementation Plans
Phase 4 - Implementation
Trust adds visit recommendations to Implementation plansAssisted by GIRFT Regional Hub &Continue to deliver improvement
Phase 5 – National Report
Clinical Leads and GIRFT National Team publish national reportTrust adds visit recommendations to Implementation plans
Assisted by GIRFT Regional Hub &Continue to deliver improvement
GIRFT OphthalmologyRe-Visits and Transition to BAU
Phase 6 - Review
GIRFT data team refresh & reissue Trust data packClinical leads & GIRFT review team revisit Trusts
Trusts update implementation planAssisted by GIRFT regional hub
& continue to deliver improvements
Phase 7 – Complete implementation & transition to business as usual
GIRFT regional hubs assist Trusts to complete actions in implementation plans
& transition improvement into business as usual
GIRFT Local Support• GIRFT Regional Hubs set up by Nov 2017
• Led by hub directors, a team of clinical and project delivery leads to support trusts & local partners to build and deliver implementation plans reflecting:
Variations highlighted in Trusts’ data packs
Improvement priorities from Clinical Lead visits
Recommendations from each National Report
• Also produce good practice manuals full of case studies & best practice guidance that trusts can use to implement change locally
• Hubs support mentoring networks across Trusts
• Level of support & frequency of visits will be determined by need, including whether existing support arrangements are already working well
Prioritising GIRFT Support
Difficulty
En
ga
ge
me
nt
PRIORITY FOR ENGAGEMENT
Trusts with smaller opportunities and lower difficulty of solutions, low engagement and least progress made
HIGHEST PRIORITY FOR SUPPORT
Trusts with larger opportunities and difficult solutions, with low engagement and least progress made
Pro
gre
ss
MONITORING ONLY
Trusts will smaller opportunities and lower difficulty of solutions, high engagement and most progress made
MONITORING AND LIGHT TOUCH SUPPORT
Trusts with larger opportunities and difficult solutions, with higher engagement and most progress made
Opportunity
No. Type Criterion
1 Opportunity Size of GIRFT opportunity: quality improvements and financial savings (as captured in data pack & opportunities database)
2 Difficulty Difficulty of delivering change (e.g. volume of specialties, complexity of solutions, barriers to change, wider trust issues)
3 Engagement Level of GIRFT engagement at trust (e.g. MD as GIRFT champion, level of meeting attendees, implementation plan drafted)
4 Engagement Level of external support/ agreement on solutions (from CCGs, STP, NHSI, ACCs and other local actors)
5 Progress Rate and quality of change at that trust (as captured in GIRFT Implementation Plan)
6 Progress Commitment to improving data quality (e.g. data quality improving, sharing protocols in place, input into national data sets)
Hubs will use a GIRFT Support Index to establish the urgency and intensity of support.
Progress since Feb 2017
Number visited 97
Total 120
Ophthalmology Update And Emerging ThemesHow far have we got?
• 97/120 visits completed
• Complete all visits by end of March / start April 2018
• National Report “Summer 2018”
Data pack• Reliant on HES data, but for next dataset working with RCO to use NOD• Questionnaire and visits crucial (Thank you)
• Working with the procurement team
• Very complex arrangements
Procurement
Discussion Around Recommendations
• Aim to support these via implementation hubs
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NHS RightCare - The Power of Variation
Professor Matthew CrippsNational Director, NHS RightCare
Remember to delete this text from your final presentation.
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First Do No Harm
The first Atlas of Variation (2009) – destabilised complacency by highlighting huge and unwarranted variation in:
• Access
• Quality
• Outcome
• Value
Also revealed two other problems:
Overuse – leading to
• Waste
• Patient harm (even when the quality of care is high)
Underuse – leading to
• Failure to prevent disease
• Inequity
Evolution of NHS RightCare
• Atlases of Variation & Health Improvement Packs
• Clinical Engagement
• Improvement processing
• Clinical leadership
• Evidential and Indicative data - Triangulation of variation – Where to Look
• Intelligence packs
• Knowledge transfer and shared learning
• National mandate and industrialisation
NHS RightCare’s essentials of population healthcare
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Impact on Programmes of Care • As a programme with its
roots in improving patient care and population health management, NHS RightCare’s activity can also be expressed by the impact it’s had on programmes of care
• All CCGs looking at any pathway under the programme are required to work up a logic model, clearly showing how activity will impact services and to act as a basis for evaluation
• CCGs have produced 804 delivery plans that are used to measure progress locally and to share best practiceby the national team
• The graph above shows how many of which programmes of care are being supported through transformational change under the programme
• In addition to a focus on expensive pathways such as MSK and Respiratory, previously neglected specialities such as Neurology are also well represented
% of diabetes patients having retinal screening in the previous 12 months Over 88,000 patients would be screened if each CCG improved to
level of their best 5 CCGs of their similar 10 demographic peers.
Source: Quality and Outcomes Framework (QOF), NHS Digital, 2013/14
Average waiting time for cataract surgery
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NHS Bradford City CCG
Heart disease pathway of a page – Why Bradford chose CVD
= 95% confidence intervals
Initial contact to end of treatment
Optimal design - NHS RightCare Pathways• CVD disease prevention
• Diabetes
• Stroke
• Falls & Fragility Fractures
• COPD
• Coming soon/ in development:
CVD for people with SMI,
Progressive neurology,
Headache and Migraine,
Frailty, MH, MSK, Vision,
Rehabilitation…
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Product range
• Where to Look packs
• Focus packs
• GP Practice packs
• LTC packs
• RightCare Optimal Pathways
• RightCare High Impact Interventions
• RightCare Casebooks
• RightCare LTC Case Scenarios
• RightCare Combined Pathways (prototype in development)
• Quick Impacts for RightCare (new)
31 Source: RightCare Long Term Conditions Focus Pack
Opportunity in the top right hand corner is how many additional people with COPD would be diagnosed if the CCG achieved the average of highest 5 of the 10 most similar CCGs
32 Source: RightCare Long Term Conditions Focus Pack
Opportunity in the top right hand corner is how many fewer days (nights) spent in emergency admissions people with respiratory disease would have in last year of life if the CCG achieved the average of lowest 5 of the 10 most similar CCGs
• GIRFT• Academia
• Warwick Business School & health faculty (behavioural science)
• Salford University (population healthcare improvement)• Oxford University (primary care, value)• LSE (STAR tool)• Manchester Met Business School (improvement processing)
• Clinical Colleges and national charities (best practice)• Manchester Airport• McLaren F1• CIPFA, CIMA, HFMA (financial sustainability)• Euler Hermes• Pfizer
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Knowledge Transfer
What can the ancient Greeks and the medieval English teach NHS improvement?
• System Vs Pathway - do people design complexity or simplicity?
• Thales’ principle of reductionism and Ockham’s Razor
o Components (steps in pathways) are simpler to understand than whole systems (FE, UC)
o Break down to simple components, design optimal
and build back up into complex systems
• Mild heart conditions treatment – change lifestyle first, before prescribed drugs. Learnt this via reductionist research on body chemistry and physiology.
• Step 1 – Awareness is the first step to improvement
• Step 2 – Find a champion
• Step 3 – Engage the right people to design optimal
• Step 4 – Understand the problem (use data)
• Step 5 – Convert data into knowledge and design optimal
• Step 6 – Use delivery levers to implement
• So, when did it all begin? Knowledge transfer from the ancient world….
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Generics of optimal improvement processing
• 355 days in a year• 10 months (most years)• Added an extra month every so often to catch up with
the lunar cycle• Extra months were determined by the College of
Pontiffs (a set of priests with a focus on astronomy)
• Current situation – the system sort of worked and they muddled through year to year (sound familiar?)
• Problems – e.g. harvest would often officially occur weeks before or after the crops actually needed to be harvested
36
Roman calendar c. 250BC - 49BC
37
Egypt 48BC – Gaius Julius Caesar
• Step 1 – Awareness is the first step to improvement• Senators had begun to notice lower corn supply in years prior to extra months
and wondered whether the current system was fit for purpose (= unwarranted variation)
• Step 2 – Find a champion• Step forward Gaius Julius Caesar, enjoying a prolonged visit to
Egypt, in the arms of Cleopatra (= strong change leader)
• Step 3 – Engage the right people • World’s leading academics• Mathematicians, Astronomers (lunar cycle)• Epicureans (pre-cursor to modern scientists)• Senators and other land owners (farmers)
(= expert and stakeholder engagement)
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What happened?
• Step 4 - Collect and analyse data - understand the problem
• Trawled back through all the calendar and seasonal records, star charts, religious festivals (= produced RC focus pack)
• Step 5 – Convert data into knowledge and use to design optimal
• Met with all the engaged experts in Alexandria Library until had the answer (= optimal design event)
39
What happened?
• Step 6 – Use delivery levers to implement• Took over the republic of Rome, made himself Dictator, enforced the change
(= slightly tenuous link to – isolate the reasons for non-delivery)
40
What happened?
• Optimal design –• 365 day year• 12 months (even named one of the new ones after himself)• Extra day every fourth year to re-align with lunar cycle
• In time, led to increased corn supply to Rome which was used as a form of welfare benefit (population healthcare improvement)
• 2,066 years later, we’re still benefitting
• Knowledge transfer:• The process itself
• Moral of the story:• If you do change properly you create a sustainable solution
41
What happened?
For further information -• Email RightCare
• Twitter:
• @nhsrightcare
• @matthew_cripps1
• Visit RightCare:
• http://www.england.nhs.uk/rightcare/
Procurement Workshop Kath Ibbotson & Melanie Hingorani
FOM Refresh
239 TrustsAcute, Mental Health, Community and
Ambulance
£5.7bnSpent annually on goods by Trusts
£2.2bn (40%)Spent through NHS Supply Chain
£616m (10.8%)Saving annually by 2020
The FOM targets increase from 40% spend throughNHS Supply Chain
to 80% by 2020
• Reduced variation and range rationalisation• Leveraging national purchasing power• Evidence based clinical evaluation and assurance
Procurement Workshop – CTSP Providers
Category Tower Provider Model
© NHS Collaborative Partnership 2018
Award of up to 3
Towers
46
NHS Owned Limited Liability Partnership
CPP Background
• Owner of nationwide framework agreements including:
© NHS Collaborative Partnership 201847
Total Orthopaedic Solutions
Clinical Consumables
Total Cardiology Solutions
Theatre Surgery Consumables
Complete Ophthalmology Solutions
• Category specific expertise and knowledge
• Clinical engagement
• Business Analytics
Complete Ophthalmology Solutions
• Lot 1 Intraocular Lenses• Lot 2 Surgical Instruments
• 2.1 Single Use• 2.2 Re-usable
• Lot 3 Procedure Packs• Lot 4 Solutions & Gases• Lot 5 General accessories &
consumables
• Lot 6 Ophthalmic Equipment• 6.1 phacoemulsification• 6.2 vitreoretinal machines• 6.3 ophthalmic microscopes• 6.4 diagnostic equipment• 6.5 ophthalmic lenses• 6.6 additional ophthalmic equipment
• Lot 7 Combination specific lots
• Lot 8 Managed Service
CPP CTSP Update since award
• DH Implementation stage @ month 4
• Numerous work streams preparing for “go live” – IT, systems, estates, TUPE,
Novation
• Working alongside NHS Supply Chain team to share information, taking best
from both
• Analysing all data looking for opportunities to offer nationally
• Continuing to develop National Category Strategy @”Mature Draft”, Trusted
Customer/CaPA
• E.mail all Heads of Procurement for Supplier Spend
CPP Strategy
• Recommending 3 key areas of focus in year 1 based on collaboration
with UK OA• Rationalisation of packs
• Monofocal lenses
• Instrument rationalisation
• Working together to deliver FOM (Carter/GIRFT principles)
• Consistent best practice,
• Reduced unwarranted variation,
• Better productivity
• Reduced risk
• Reduced costs, ability to aggregate, deliver savings
• NHS recommended national product, clinically driven and accepted
ProcurementMelanie Hingorani
Procurement Work stream• Working with
• NHSI
• Procurement Hubs
• NHS Supply Chain
• National ophthalmology category tower service provider
• GIRFT leads
• Interested Alliance members: procurement, clinical, theatre leads, managers
• Cleaning up inaccurate national data sets on theatre and procedure purchasing
• Creating consistent supplier codes, comprehensive national brochure, greater accuracy trust data input
• Ideal consistent procedure packs and instrument sets
• Clinical/safety/cost analysis to identifying best IOLs and devices
• Modelling to identify best and most cost effective purchasing
• Benefits: consistent practice, reduced unwarranted variation, better productivity, reduced costs
Procurement Why?
• National data is inaccurate and poorly understood by national analysts
• More accurate data will allow better analysis of efficiency: costs, productivity
• More understanding via clinical input will allow better understanding quality, safety, ease of use,
appropriateness
• Put together:
• Advise providers how their costs and productivity benchmark against others
• Advise providers what are the most cost effective models and suppliers
• Make supplies more consistent for productivity, safety and costs
• Assess supplies vs outcomes
• Drive down costs via bulk purchase or discounts
Last time: IVT packs
• A LOT of IVT packs available to buy nationally
• We went through all of them in detail
• Problems:
• Duplication e.g. two pairs of scissors, two callipers, two speculae, two forceps
• Waste: needles and syringes even for preloaded injections
• Or opening extras for every case
• Massive variability even in same units
• Make costings difficult to compare between units
• Confusing and inefficient for staff
• Sometimes quite limited input from clinicians into contents
• If it’s like this for simple IVT, imagine what it’s like for other procedures!
Last time: IVT packs
Wash Hand towel
Prep Gauze swabs, swab forceps
Pack Crepe
Drape
Drape minimum 40 x 40cm with pre-
perforated clear film aperture 6 x 8cm
with Adhesive
Tray Intrsinsic 2 pot tray
Speculum Barraquer type wire speculum closed
blades
Calliper/mar
kerBraunstein pointed calliper 3.5/4mm
Buds/spears Cotton Buds x 3-5
With drape
Prep Gauze swabs, swab forceps
Pack Crepe Paper 60 x 60cm (to be used as wrap)
Scissors Straight scissors
Drape Drape 40 x 40cm Aperture 6 x 8cm with Adhesive clear film
Tray Polypropylene Tray 23 x 13.5 x 2cm
Tray Galipot 60ml x 2
Speculum Kratz Barraquer Wire Speculum 13.5mm Open Blades 52mm Long
needle Needle Hypodermic 25g x 1"
needle Needle Hypodermic 25g x 5/8”
Syringes Syringe 2ml Luer Lock x 2
mark Braunstein Fixed Calliper 3.5/4mm
buds Cotton Buds x 6
buds Cellulose spears x 6
14 items12 buds/spearsOpen hand towel always
9 items 3-5 budsOpen needles & syringe if need
Last time: IVT packs
Wash Hand towel
Prep Gauze swabs, swab forceps
Pack Crepe
Drape
Drape minimum 40 x 40cm with pre-
perforated clear film aperture 6 x 8cm
with Adhesive
Tray Intrsinsic 2 pot tray
Speculum Barraquer type wire speculum closed
blades
Calliper/mar
kerBraunstein pointed calliper 3.5/4mm
Buds/spears Cotton Buds x 3-5
With drape
9 items 3-5 budsOpen needles & syringe if need
Wash Hand towel
Prep Gauze swabs Rampleys Sponge Holder 11/14 x1-2
Pack Crepe
Tray Intrsinsic 2 pot tray
Invitrea
Buds/spears Cotton Buds x 3-5
With Intravitrea 7 items
Current Moorfields IVT pack
Pack paper cover
Paper wrap 50x50cm
Tray Tray with 2 integrated gallipots
Drape Mini precut incise drape
SpeculumBarraquer speculum flat blade
Calliper/markerPointed IVT marker 3.5/4.5mm blue
Buds/spearsSwab stick small x 3
Swabs or similar (for prep)
10x10cm Non woven gauze 4 ply x 5
Labels Tracer labels
Rubbish bag Orange rubbish bag
Towel Hand towel 1/4 fold
7 items
Procurement project at Moorfields• Tender for VR and phaco packs
• Also looking at instrument sets to see if can rationalise
• Aiming to make any savings or benefits available to others
• Bring small representative sensible group together and discuss – then test with others
• Phaco packs:
• 5 different packs including Bedford
• Much of the contents never been challenged – why have a betnesol label in every pack?
• List of the contents sometimes wrong or no one understands what it means!
• 30 different items all differing a bit from the next one
• Why cystotome and insulin syringe and bender and rhexis forceps always available?
• Often opened more than one pack for different surgeons just because they wanted a different instrument
• Told agreement on one set and pack could “never be done”
• VR: more consistent because surgeons had taken an interest
• Surprisingly easy to rationalise as long as get everyone together and make it simple
• From 30 all different to 26 identical contents
Procurement methodology• How many packs for same procedure
• Make a list of headings
• Make a list of everything that falls into that heading and see if need all/need some/need all; question all
duplication
• Ask again because knee jerk is to keep everything in
• Aim to have everything you use every time in the pack
• Aim to open separately everything you use ?<100% ?<50 % of the time? But have enough of them in every
theatre
• See whether items are better on instrument set or pack
• Are somethings better quality disposable or reusable
• Don’t include things just to please certain individuals
Headings IVT pack• Wrap of pack• Tray• Gallipots• Patient drape• Prep forceps• Prep gauze/swabs• Scissors• Speculum• Forceps• Calliper• Syringe• Needle drawing up• Needles injecting• Buds/spears• Eyepad, shield• Labels • Towel• Rubbish bag• anything else?
Headings phaco pack
• Tipless pack• Tip • Machine drape• Table drape• Patient drape• Receiving basin• Tray• Gallipots/cups• Prep forceps• Prep gauze/swabs• Scissors• Speculum• Section blade• Side blade• Forceps• Corneal irrigation cannula• AC cannula (Rycroft)
• Hydrodissection cannula• I/A• Syringes (drawing up, corneal wash, AC BSS, AC
lignocaine, ic or sc antibiotic, wound hydration )• Rhexis insulin syringe/cystotome/forceps• Prep gauze/swabs• Needle drawing up• Needles injecting• Buds/spears• Eyepad, shield• Labels• Towel• Rubbish bag• anything else?
Procurement Workstream
• Pros:
• Consistency for efficiency and safety
• Drive down costs as fewer items
• Drive down costs by bulk purchasing
• Can make consistent without initially limiting but clarifies variability
• Barriers:
• Consultant individuality
• Clinical preferences
• Local trust systems
• Restriction to choice worries people
MEH best practice IVT pack
Pack paper cover
Paper wrap 50x50cm
Tray Tray with 2 integrated gallipots
Drape Mini precut incise drape
SpeculumBarraquer speculum flat blade
Calliper/marker
Pointed IVT marker 3.5/4.5mm blue
Buds/spearsSwab stick small x 3
Swabs or similar (for prep)
10x10cm Non woven gauze 4 ply x 5
Labels Tracer labels
Rubbish bag Orange rubbish bag
Towel Hand towel 1/4 fold
MEH phacopack
Machine supplier dependent
Best practice pack Extras to be available single packed in all theatres
Phaco tip supplier dependent 45 degree mini-flared Kelman 0.9mm suitable for all phaco devices used if possible
Tipless pack (casette, sleeves, tubing, wrench, test chamber, machine drapes)
supplier dependent Tipless casette/sleeve , machine drape etc pack
I&A supplier dependent Bimanual
Table drape can be supplier dependent
2 table drapes minimum size 44"x44" Lint free woven
Knife section supplier dependent Phaco incision blade single bevel 2.4mm
Patient drape Half body drape with incise area minimum 5x7cm with minimum 500ml integral bag with wick
Basin for receiving syringes and sharps Basin emesis 700cc
Plastic tray for iodine & used prep forceps Plastic tray minimum 8 x 5" with small insert section
Prep forceps Plastic sponge forceps minimum 14cm x 3Prep guauze Gauze swabs 4ply 10 x 10cm x 10Fluid holders Cup, solution, graduated 120ml x 1Knife side port MVR and feather blade
Corneal irrigation cannula Rycroft 0.80 x 22mm 21GAC cannula Rycroft 30G 7/8"Hydrodissection cannula Hydrodissection cannula Pearce style 35° angled 8mm flat,blunt tip,
overall length 22mm 25 or 27GI&A Simcoe Syringe Syringe hypodermic luer lock 5ml x 2 (drawing up antibiotic,
irrigating cornea)Syringe luer lock 3ml x 2 (for AC BSS, for lidocaine)
1ml syringe (for AC/wound)Insulin syringe integral needle 1ml (for rhexis)
Needle Needle 19G 38 RB (drawing up antibiotic)Spears Spears eye surgical sponge with light blue handle 6 in pack
Labels Label white BBS+Adrenaline 0.1MG/MLLabel white 38X11MM, BSSLabel white Aprokam 10MG/MLLabel white HPMC 2% + BSS
MEH best practice VR pack
23g VR pack 25g VR pack 27g VR packMachine pack -supplier dependent
Constellation Pack 5000cpm, Valved, 0.6mm (23g)
Constellation Pack 7500cpm, Valved, 0.5mm (25+)
Constellation Pack 7500cpm Valved, Str. Endoill.0.4mm (27+)
Cannula aspiration 23g Aspiration Cannula (0.6mm) 25g Aspiration Cannula (0.5mm) 27g Aspiration Cannula (0.5mm)Tray Arm cover -supplier dependent Constellation Tray Arm Cover Constellation Tray Arm Cover
Constellation Tray Arm Cover
Table covers -could be supplier dependent
Cover back table, W/ADH (140x140cm) Soft Fold
Cover back table, W/ADH (140x140cm) Soft Fold
Cover back table, W/ADH (140x140cm) Soft Fold
Rubbish Bag drawstring Bag drawstring Bag drawstring
Chair cover Armchair Cover x 2 Armchair Cover x 2 Armchair Cover x 2
Patient drape
Drape, Incise, Non-Woven, (125x140cm)
Drape, Incise, Non-Woven, (125x140cm) Drape, Incise, Non-Woven, (125x140cm)
Prep 4ply Gauze (10x10cm) x 10 4ply Gauze (10x10cm) x 10 4ply Gauze (10x10cm) x 10Plastic Forceps (19cm) x 3 Plastic Forceps (19cm) x 3 Plastic Forceps (19cm) x 3
Plastic bowls/tray 700ml bowl 700ml bowl 700ml bowl120ml Graduated Cup x 2 120ml Graduated Cup x 2 120ml Graduated Cup x 2
3Part Tray (25x24x5cm) 3Part Tray (25x24x5cm) 3Part Tray (25x24x5cm)
Buds
Cotton tip applicator 3” (7.6cm) x 10
Cotton tip applicator 3” (7.6cm) x 10
Cotton tip applicator 3” (7.6cm) x 10
Cannula AC
20g Anterior Chamber Cannula (0.9x22mm)
20g Anterior Chamber Cannula (0.9x22mm)
20g Anterior Chamber Cannula (0.9x22mm)
Syringes 3ml Luer Lock Syringe x 2 3ml Luer Lock Syringe x 2 3ml Luer Lock Syringe x 2
Needles 25g Needle (0.5x16mm) 25g Needle (0.5x16mm) 25g Needle (0.4x16mm)19g x 1.5” Needle, ( 1.1x40mm) 19g x 1.5” Needle, ( 1.1x40mm) 19g x 1.5” Needle, ( 1.1x40mm)
Dressing
Melolin Dressing, Low ADH,( 5x5cm)
Melolin Dressing, Low ADH,( 5x5cm)
Melolin Dressing, Low ADH,( 5x5cm)
Eye Pad Eye Pad Eye PadEye shield Eye shield Eye shield
Labels Marcain Label x 2 Marcain Label x 2 Marcain Label x 2Betnesol Label x 2 Betnesol Label x 2 Betnesol Label x 2Zinacef Label x 2 Zinacef Label x 2 Zinacef Label x 2
MEH best practice phaco setIn set Extras in every theatre Alternative
Instrument Tray Instrument tray
Artery forceps (lift lid to drape) Artery forceps
Scissors Drape scissors blunt Sharp straight scissors
Speculum Phaco speculum
Small forceps Titanium corneal forceps grooved
Titanium corneal tying forceps
Second instrument Phaco chopper Mushroom and simskey hook
Needle holder Castroviejo for bending insulin needle (disposable)
Corneal needle holder Could be omitted from set and opened as extra for certain cases
Rhexis forceps 2.2mm cross over rhexis forceps (disposable)
Could be omitted from set and opened as extra for certain cases
IOL forceps Kelman-Macpherson forceps
Other Iris repositor
MHE best practice VR set
Vitrectomy Set InstrumentsDetachment extras
Barraquer speculum x1Fison Retractor 0107092 J Weiss
Spencer Wells – Curved x 4Bulldog Clip (Small)
Scissors – Straight / Blunt x1Bulldog Clip (Small)
Scissors – Straight / Sharp x1Bulldog Clip (Small)
Westcotts Spring Scissors x1Bulldog Clip (Small)
Moorfields Forceps x2Curved artery clip x3
St. Martin Forceps x1
Grooved (Hoskins) Forceps x1 - DK 2-100 (Notched forceps)
Cross-Action Plug Forceps x1
Castro. Needleholder x2
Barraquer Needleholder x1
Squint Hook – Flat x2
Glaucoma Patient Standards Provided by Karen Osborne – IGA
What the IGA does
• Funds research
• Campaigns to increase glaucoma awareness and reduce needless sight loss
• Helps people to live well with glaucomao Free advice and information o Websiteo Online forumo Telephone helpline, Mon – Fri 09.30-17.00
Most common reasons for calling the IGA helpline
1. Surgery and laser questions, worries about treatment choices
2. Eye drops – side effects & problems instilling
3. Lifestyle queries – how to live well with glaucoma
4. Driving
5. Appointment delays and cancellations
IGA information publications• Booklets
• Glaucoma - a guide Trabeculectomy
• Aqueous shunt implantation Babies and Children
• Dry eye – a guide Eye drops and aids
• Secondary glaucomas MIGS (coming soon)
• Ocular hypertension – a guide
• Leaflets
• Driving and glaucoma Blepharitis
• Laser treatment for glaucoma Pigmentary glaucoma
• Glaucoma and your relatives Glaucoma & how we help
• Syndromes and Anomalies Primary angle closure glaucoma
• Primary open angle glaucoma Delays and cancellations
• What to expect at a first appointment (coming soon)
www.glaucoma-association.com
Moorfields #KnowYourDropsto Improve Patient Compliance and QoLSarah ThomasLead Pharmacist for Satellite Services and ContractsandFiona ChiuAssociate Chief PharmacistStrategy, Procurement & Satellite Services
UK Ophthalmology Alliance
1.3.18
Moorfields #KnowYourDrops
What guidance is available on how to provide this information and best support to patients
Moorfields #KnowYourDrops
So – there is a gap in the quality of care
Moorfields #KnowYourDrops
Poor compliance
Support recommended
Lack of concrete guidance from
professional bodies
Lack of awareness
culture that eye drop
compliance is important
No standardised effective
support being given
Poor Compliance with Ophthalmic Treatments
Moorfields #KnowYourDrops
Poor compliance
Support recommended
Lack of concrete guidance from
professional bodies
Lack of awareness
culture that eye drop compliance
is important
No standardised effective
support being given
•Poor compliance could result in:• poor clinical outcomes and vision loss
• lower Quality of Life for patient and their carers - stress, difficulties with day-to-day living, difficulties at work, driving, lack of dignity, poor performance
• Polypharmacy
• More medical appointments, surgery
• Financial burden for patients paying for medicines
• Financial burden for NHS
50% patients non-compliant
Preventable sight loss estimated to cost the UK economy > £28bn
What are we at Moorfields doing to provide the necessary support
to patients?
Moorfields #KnowYourDrops
Moorfields #KnowYourDrops
#KnowYourDrops Campaign - Background
Patient Feedback
Stakeholder Engagement
Pilot clinic
Site by Site Trustwide
National & International
Moorfields #KnowYourDrops
Successfully Improving Outcomes and QoL
report improved confidence
putting in their drops
report improved ability
putting in their drops
Moorfields #KnowYourDrops
Benefits to Care• Improved patient/carer confidence in putting in eye drops
• 100% (n=95) report improved confidence• Improved patient/carer ability to administer drops
• 100% (n=95) report that the personalised session helped improve their technique
• Improved patent satisfaction and experience
• Improved treatment outcomes such as improved IOPs
• Prevention of surgery and preventable degradation in conditions
• Improved quality of life for patients and carers
• Improved social care in communities for adults and children
• Improvement management of medicines in different settings
• Tailored patient-centered support for high quality of care
• Improved waiting times and patient pathway as role removed from clinical staff
• Likely reduction in repeat prescribing and GP/hospital review appointments
Moorfields #KnowYourDrops
Q – Quality I – Improvement P – Productivity P - Prevention
How we can work together to bridge the gap
Moorfields #KnowYourDrops
Research for QoL and effects on outcomes for
patients with compliance
supportRaise
awareness of eye drop
compliance aids
Defined compliance
support guidance
Develop standardised model of care for ophthalmic
pathway
Embed ophthalmic
MUR
Improve availability of compliance
aidsChange in culture to no long overlook eye drops as
important
The status quo needs to change direction
Moorfields #KnowYourDrops
Thank you and Questions