Standardized care by redesign of an intravitreal injection pathway

Purpose: Intravitreal injection of medication is a rapid rising surgical intervention in modern ophthalmological care. With increasing numbers, the caseload of complications follows and the burden on daily clinical organization increases. This study focuses on developing a standardized treatment protocol to improve care and reduce hazard. Methods: A standardized treatment protocol was designed and educated to the involved medical doctor and registered nurse. An independent observer used this protocol to evaluate the actions performed during the intravitreal injection. Data on the included patients and products injected were collected. Results: In total, 180 injections of 134 patients were observed between 1 December 2011 and 18 October 2012, divided over 16 measurements. From the fifth measurement on, a 100% protocol adherence for the time out procedure was achieved and maintained over time, with a transient insignificant decrease. The performance of actions of the medical doctor and assisting registered nurse followed the same trend with a rapid increase and 100% protocol adherence. No microorganism caused development of endophthalmitis was recorded. Conclusion: The optimization of an intravitreal injection care pathway leads to a more standardized intervention process with no apparent reduction in clinical efficiency and safety.