References
Pilot study of a nurse-led adult lacrimal clinic at a tertiary ophthalmic centre
Abstract
This article provides the reader with an outline of the anatomy and physiology of the lacrimal system and illustrates how a variety of pathologies within this system can result in the development of a watery eye. It describes the role of the nurse consultant in the diagnosis and management of patients with watery eye in the lacrimal clinic, and how the training programme for the development of such skills was implemented. Following training, within the realms of an established pilot study, the nurse consultant began to implement her skills in a newly established nurse-led lacrimal clinic. Patients seen in the lacrimal clinic would previously have been assessed and managed by a doctor. To confirm the accuracy of this approach, an audit was undertaken comparing the nurse-led diagnosis and management plans with that of an oculoplastic doctor. In addition, patient waiting times in the clinic and patient satisfaction were assessed, as important indicators of quality of care.
Nurse-led clinics in the UK were first endorsed by the Government in the 1990s in a variety of documents including Making a Difference (Department of Health, 1999) and the Chief Nursing Officer's 10 key roles for nurses set out in The NHS Plan(2000), which also required hospital management to make changes and respond to the Government's strategy for nursing and midwifery by introducing new ways of working to improve service delivery by providing more quality care and treatment.
The field of ophthalmology has seen the development of several nurse-led services in recent years (Dunlop, 2010; Sandinha et al, 2012; Shum et al, 2017; Mohamed et al, 2018) including, for example, in the areas of oculoplastic surgery, cataract surgery, ocular oncology and intravitreal injections for medical retina disease. The authors' hospital, a tertiary ophthalmic centre within the subspecialty of oculoplastics, offers an outpatient lacrimal clinic service dealing specifically with the diagnosis and management of patients presenting with a watery eye, known as ‘epiphora’. The causes of watery eye are multifactorial, some of which require management with surgery, but others can be managed either conservatively or with the use of topical medications. The assessment of such patients requires a systematic approach, including the application of a few specialised clinical tests.
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