Prema

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first assessment for this recently registered service. This key question has been rated good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient notes were comprehensive, and all staff could access them easily. Staff completed registration details by hand and then added them to a digital cloud-based record. Consultants and relevant staff could access clinic letters, imagery, optometry data, and diagnostics securely and remotely. This meant patients received efficient care and referrals were handled promptly.

Staff used strict patient suitability criteria to identify which patients could safely receive care and treatment at this service. If patients were temporarily unsuitable for treatment, for example due to being unwell, staff undertook a 90 day follow up review to ensure patients were optimised for surgery. When prospective patients were deemed unsuitable for treatment, the clinical reasoning for this was documented in patient records.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider had developed an ethos based on delivering a high standard of care, led by advanced specialists, to meet complex needs. This included complications of cataracts, vitreoretinal surgery, and high-risk medical retinal treatment amongst patients living with diabetes.

The provider had systems in place to ensure care and treatment followed the most up to date national and international best practice guidelines issued by appropriate professional and industry bodies. These included the Royal College of Ophthalmologists (RCOphth), the World Health Organisation (WHO), and the National Institute for Health and Care Excellence (NICE).

The provider maintained policies, treatment pathways, and standard operating procedures (SOPs) and ensured these were readily available to staff delivering care. All policies were centrally uploaded onto a database which alerted staff to new policies for them to read. This supported staff to access policies easily and be aware of any changes made to them.

Staff considered the psychological and emotional needs of patients at preoperative consultations and were trained to recognise the challenges of eye problems amongst older people. This helped them coordinate appropriate individualised care.

Staff used the RCOphth/WHO combined surgical safety checklist for surgery during procedures. This facilitated the safest, most effective standards of evidence-based care within the patient’s aims of refractive treatment. For example, the checklist removed the risk of using the incorrect intraocular lens during a surgical procedure.

The service had clear protocols to enable timely surgery to take place in line with RCOphth guidance. Where patients presented with an urgent need and the service did not have surgical capacity, staff used service level agreements to refer patients to other regional providers.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Teams collaborated well with each other, ensuring information about patients’ needs were communicated seamlessly at each stage of handover. Staff had access to all the information they needed to appropriately assess, plan and deliver people’s care treatment and support.

When patients were referred outside of the service for further care or treatment, staff recorded all correspondence to the electronic patient record. The service followed up on whether patients received the care and treatment they needed. Clinic staff would, where appropriate, contact a patients’ General Practitioner to check whether patients with additional needs were safe for surgery or required any reasonable adjustments.

Staff held effective multidisciplinary meetings to discuss patients and improve their care. They worked across health care disciplines and with other agencies when required to care for patients. Ophthalmologists reflected a range of different subspecialties and were affiliated with other registered providers, which meant patients had access to multidisciplinary specialists to coordinate complex care.

We support people to manage their health and wellbeing.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing.

Summarise your findings here using the example topic below:

Staff provided relevant information promoting healthy lifestyles and support to patients on an individual basis where this could improve eye health. Surgical teams provided each patient with individualised postoperative advice to promote a rapid recovery, including in relation to their work, hobbies, and sports.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Outcomes for patients were positive, consistent, and met expectations, such as national standards. Patients spent time in the recovery room until clinical staff were satisfied it was safe for them to leave and the patient felt comfortable doing so. Staff provided individual post-operative instructions to each patient to make sure they recovered quickly and safely. They spent time with each patient in recovery to answer questions about how to look after themselves at home and what to do if they had unexpected side effects.

Staff carried out comprehensive pre-discharge checks before patients left the service. This included eye pressures, pain or discomfort, and a review of medicines. They provided each patient with printed guidance on how to manage post-operative concerns, including for complications, during normal working hours and out of hours.

Patients reported on the outcomes of their surgery. The service always collected patient feedback through a patient experience questionnaire on the day following surgery. The service had been developing a digital solution to enable to effectively collect patient recorded outcome measures (PROMs). This would also include monitoring quality of life (QoL). The service reported it was too early in the development cycle to produce definitive data but they were confident that its development would enhance their service offer.

However, the service monitored individual consultant ophthalmologist performance for different procedures, incidence of complications, type and number of complications both during and after surgery.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. They completed consent documentation during the preoperative stage and this was recorded in the patient’s notes. Surgeons checked patient consent on the day of surgery to ensure the patient still understood the potential risks and benefits and wished to proceed.

The service used a routine 14 day cooling off period. When patients wished to expedite this due to time constraints, or if the condition required urgent treatment, there were documented discussions before agreement to bypass the 14 day cooling off period. This was in line with the Royal College of Ophthalmologists Recommendations for Professional Standards for Refractive Surgery.

Staff made sure patients consented to treatment based on all the information available. They discussed planned benefits, potential risks and side effects, and recovery times, before surgery commenced. Patients received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. All patients were given both written and verbal information about their treatment, in advance, to support making decisions and informed consent.

Staff said that if there were communication needs identified at the first assessment with the optometrist, they would organise a translator to provide accurate interpretation at the virtual consent discussion with the consultant ophthalmologist and on the day of surgery. This meant staff could be confident patients understood the risks and benefits of their treatment and had made an informed decision based on this

Patients who required an off-label medication like Mitomycin C, to support their treatment, were given the right information to make an informed decision about their care and treatment. This was recorded on their consent form, separately to the informed consent decision for their surgical procedure.