Indemnity for orthoptist-delivered intravitreal injections.

Abstract

Sir, We thank Mall et al1 for their interest in our article relating to nurse-delivered intravitreal injections at Moorfields Eye Hospital (MEH).2 We appreciate the fact that the increasing demands for intravitreal injection therapy necessitate novel methods of service delivery. Nurses, as part of their practical professional training, are familiar with aseptic technique, administration of injections, and safe disposal of sharps. For this reason, it was decided to proceed with nurse training for intravitreal injections at MEH. Other allied health professional (AHP) groups within ophthalmology such as optometrists and orthoptists are not usually practically trained in these procedures as they are not generally required as part of their regular professional practice. We note that professional approval from the British and Irish Orthoptic Society (BIOS) has been sought for orthoptist-delivered intravitreal injections and also Trust approval. However, in the letter from Mall et al,1 there appeared to be no reference to medico-legal consultation on this new scope of professional practice for orthoptists. At MEH, we obtained medico-legal clarification on the potential risk of clinical negligence related to nurse-delivered intravitreal injections as this was a novel method of drug delivery that did not have a standard published body of evidence to prove safety before we commenced the initiative. We obtained written confirmation of indemnity cover from the National Health Service Litigation Authority (NHSLA) for nurse-delivered intravitreal injections. We welcome the expansion of training in practical procedures for AHPs including orthoptists. However, it is important that medico-legal issues are clarified in writing for Trust indemnity purposes with the NHSLA, and robust training with appropriate high level supervision and regular audit and competency reviews are implemented for patient safety purposes.