Introducing a nurse-led FFA: trials, tribulations and evaluation

Abstract

Introduction: This paper describes the implementation and evaluation of a nurse-led fundus fluorescein angiography (FFA) service following the development of an evidence-based protocol. A national survey was carried out resulting in evidence-based guidance to support implementation. Literature review: Research-based evidence is scarce however nurse-led FFA has been shown to be safe, improve efficiency, decrease clinic over booking and improve patient satisfaction. However, a clearly defined protocol remained elusive. Method: A national survey was carried out and 87 completed questionnaires were analyzed. Data analysis: 61 units ran a nurse-led FFA service. The majority had implemented their services using in-house training including intravenous (IV) cannulation, IV administration, intermediate life support and consent training. Discussion: Nurses with recognized ophthalmic training and experience were undertaking nurse-led FFA. The issue of informed consent, consistency of information given by nurses and doctors and using patient group direction to administer IV fluorescein raised interesting contradictions when compared with national guidance. This was addressed during implementation of the nurse-led FFA service within the author's unit. Implementation: A training workbook was formulated including nurse-led informed consent. Evaluation: The nursing service has been in place for 5 years and has undertaken investigations on 1313 patients. A prospective audit of adverse events has taken place since inception with only 99 patients, approximately 7.5%, being identified as having incomplete FFA performed because of adverse events. Only two patients showed signs consistent with cardiac and respiratory problems. Conclusion: The lack of robust national guidance limited the ability of the organization to develop practice efficiently, but the survey showed that nurses safely enhance their practice to run FFA clinics and adverse events remain consistently low over 5 years.