Quarterly MeetingWednesday 1st March 2018

Introduction & Agenda

• Introduction 10:30

• UKOA Update

• GIRFT Update

• Right Care overview

Lunch Break 12:45

• Procurement Workshop

• Glaucoma Patient Standards

• Summary & Close 15:45

UKOA UpdateAllison Beal, Melanie Hingorani & Gill Salter

UKOA Progress Update

Since our last meeting we have….• Secured funding for the Alliance for 2018/19 • Invited 24 more trusts including scan for safety units to join the Alliance • Set up a coding workshop - 9th May (London)• Arranged two UKOA management training sessions for members

7th March (Manchester) & 4th April (London)• Confirmed with the College to support the IOL standard• Developed our first newsletter about the Alliance for internal and external sharing • Developed new UKOA website • Continued to work with the RNIB on the patient standard Started to develop quality

standard based on the giant cell arteritis work from Norfolk and Norwich

UKOA Progress Update RNIB• RNIB identified core access issues for patients - taking into account your contributions on 6

December

• Patient feedback received to date by RNIB indicates these do represent the key factors

• Awaiting further feedback from IGA and Macular Society before proceeding

• RNIB plans to provide UKOA members with a draft standard and a patient survey in April

• You will be asked to provide feedback on those documents for the June meeting

• We anticipate that individual Trusts will want to run the survey, at a time of their choosing.

• The survey will help you see any areas for improvement and inform improvement actions.

• RNIB will continue to support UKOA members with this process.

• The patient issues we identified are documented for circulation. To develop comms re hospital

eye services should ensure is provided or happens during the patient visit.

UKOA Progress continued..

Since our last meeting we have….• Developed an overview/case study to share on the intravitreal presentation (with RH

to finalise)

• Developed a brief overview/case study to share on the Sunderland processes (to flesh out with visit in May)

• Continued work on procurement best practice

• Started recruitment of clinicians to help further define best practice surgery packs

• Developed draft “fools guides” for IOLs and phaco machines

• Started working on Catarapp – a time and motion / carbon waste phone app

• Moorfields Vanguard Programme publications

• Claims work

• Started looking at glaucoma standards and good practice

UKOA Update: Website

GIRFT UpdateCarrie MacEwen & Alison Davis: GIRFT Ophthalmology Clinical Leads &

Lydia Chang : GIRFT Ophthalmology Clinical Advisor

From pilot to national programme…..

24 1000Clinical work streams are already underway

Clinical Lead visits already completed

Wave Start Date Workstreams Total

1 2012 Orthopaedics 1

2 Jan 2015 General surgery, Spinal, Vascular, Neurosurgery 5

3 Jan 2016Urology, Cardiothoracic, Paediatric surgery, Ophthalmology, ENT, Oral & Maxillofacial, Obstetrics &

Gynaecology12

4 Apr 2017 Emergency medicine, Cardiology, Dentistry 15

5 May 2017 Breast surgery, Diabetes, Endocrinology, Imaging/ Radiology 19

6 Jul 2017 Anaesthetics/Perioperative, Intensive & Critical Care, Renal 22

7 Sep 2017 Acute & General medicine, Neurology 24

8 Nov 2017 Geriatrics, Respiratory, Dermatology 27

9 Jan 2018 Rheumatology, Pathology, Outpatients, Trauma, Stroke, 32

10 Mar 2018 Gastroenterology, Mental Health, Plastic surgery 35

Implementation until March 2021 with more specialties e.g. oncology, paediatric medicine TBC

Clinical Leads Carrie MacEwen & Alison Davis Clinical AdvisorLydia Chang

GIRFT Ophthalmology Work Stream

Phase 1 - Preparation (June 2016 to Nov 2016)

Decided on priorities & parametersDATA PACK (HES data)

&QUESTIONNAIRE development

(bespoke to ophthalmology)

Phase 2 - Pilot Deep Dive Visits (Dec 2016)

Hinchingbrooke, Sunderland, York and LeedsAdjusted data pack & questionnaire

GIRFT Ophthalmology Work Stream

Phase 3 - Deep Dives / Visits (Feb 2017 to April 2018)

2 HOURS

Arrange visit dateData packs & questionnaires sent out

AS MANY STAFF AS POSSIBLERepresentation ALL staff groups

AFTER visitTrust Observation minutes; Recommendations &/or Actions

LOCAL IMPLEMENTATION Implement Actions supported GIRFT Implementation Team

GIRFT Ophthalmology Building Implementation Plans

Phase 4 - Implementation

Trust adds visit recommendations to Implementation plansAssisted by GIRFT Regional Hub &Continue to deliver improvement

Phase 5 – National Report

Clinical Leads and GIRFT National Team publish national reportTrust adds visit recommendations to Implementation plans

Assisted by GIRFT Regional Hub &Continue to deliver improvement

GIRFT OphthalmologyRe-Visits and Transition to BAU

Phase 6 - Review

GIRFT data team refresh & reissue Trust data packClinical leads & GIRFT review team revisit Trusts

Trusts update implementation planAssisted by GIRFT regional hub

& continue to deliver improvements

Phase 7 – Complete implementation & transition to business as usual

GIRFT regional hubs assist Trusts to complete actions in implementation plans

& transition improvement into business as usual

GIRFT Local Support• GIRFT Regional Hubs set up by Nov 2017

• Led by hub directors, a team of clinical and project delivery leads to support trusts & local partners to build and deliver implementation plans reflecting:

Variations highlighted in Trusts’ data packs

Improvement priorities from Clinical Lead visits

Recommendations from each National Report

• Also produce good practice manuals full of case studies & best practice guidance that trusts can use to implement change locally

• Hubs support mentoring networks across Trusts

• Level of support & frequency of visits will be determined by need, including whether existing support arrangements are already working well

Prioritising GIRFT Support

Difficulty

En

ga

ge

me

nt

PRIORITY FOR ENGAGEMENT

Trusts with smaller opportunities and lower difficulty of solutions, low engagement and least progress made

HIGHEST PRIORITY FOR SUPPORT

Trusts with larger opportunities and difficult solutions, with low engagement and least progress made

Pro

gre

ss

MONITORING ONLY

Trusts will smaller opportunities and lower difficulty of solutions, high engagement and most progress made

MONITORING AND LIGHT TOUCH SUPPORT

Trusts with larger opportunities and difficult solutions, with higher engagement and most progress made

Opportunity

No. Type Criterion

1 Opportunity Size of GIRFT opportunity: quality improvements and financial savings (as captured in data pack & opportunities database)

2 Difficulty Difficulty of delivering change (e.g. volume of specialties, complexity of solutions, barriers to change, wider trust issues)

3 Engagement Level of GIRFT engagement at trust (e.g. MD as GIRFT champion, level of meeting attendees, implementation plan drafted)

4 Engagement Level of external support/ agreement on solutions (from CCGs, STP, NHSI, ACCs and other local actors)

5 Progress Rate and quality of change at that trust (as captured in GIRFT Implementation Plan)

6 Progress Commitment to improving data quality (e.g. data quality improving, sharing protocols in place, input into national data sets)

Hubs will use a GIRFT Support Index to establish the urgency and intensity of support.

Progress since Feb 2017

Number visited 97

Total 120

Ophthalmology Update And Emerging ThemesHow far have we got?

• 97/120 visits completed

• Complete all visits by end of March / start April 2018

• National Report “Summer 2018”

Data pack• Reliant on HES data, but for next dataset working with RCO to use NOD• Questionnaire and visits crucial (Thank you)

• Working with the procurement team

• Very complex arrangements

Procurement

Discussion Around Recommendations

• Aim to support these via implementation hubs

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NHS RightCare - The Power of Variation

Professor Matthew CrippsNational Director, NHS RightCare

Remember to delete this text from your final presentation.

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First Do No Harm

The first Atlas of Variation (2009) – destabilised complacency by highlighting huge and unwarranted variation in:

• Access

• Quality

• Outcome

• Value

Also revealed two other problems:

Overuse – leading to

• Waste

• Patient harm (even when the quality of care is high)

Underuse – leading to

• Failure to prevent disease

• Inequity

Evolution of NHS RightCare

• Atlases of Variation & Health Improvement Packs

• Clinical Engagement

• Improvement processing

• Clinical leadership

• Evidential and Indicative data - Triangulation of variation – Where to Look

• Intelligence packs

• Knowledge transfer and shared learning

• National mandate and industrialisation

NHS RightCare’s essentials of population healthcare

24

Impact on Programmes of Care • As a programme with its

roots in improving patient care and population health management, NHS RightCare’s activity can also be expressed by the impact it’s had on programmes of care

• All CCGs looking at any pathway under the programme are required to work up a logic model, clearly showing how activity will impact services and to act as a basis for evaluation

• CCGs have produced 804 delivery plans that are used to measure progress locally and to share best practiceby the national team

• The graph above shows how many of which programmes of care are being supported through transformational change under the programme

• In addition to a focus on expensive pathways such as MSK and Respiratory, previously neglected specialities such as Neurology are also well represented

% of diabetes patients having retinal screening in the previous 12 months Over 88,000 patients would be screened if each CCG improved to

level of their best 5 CCGs of their similar 10 demographic peers.

Source: Quality and Outcomes Framework (QOF), NHS Digital, 2013/14

Average waiting time for cataract surgery

26

NHS Bradford City CCG

Heart disease pathway of a page – Why Bradford chose CVD

= 95% confidence intervals

Initial contact to end of treatment

Optimal design - NHS RightCare Pathways• CVD disease prevention

• Diabetes

• Stroke

• Falls & Fragility Fractures

• COPD

• Coming soon/ in development:

CVD for people with SMI,

Progressive neurology,

Headache and Migraine,

Frailty, MH, MSK, Vision,

Rehabilitation…

30

Product range

• Where to Look packs

• Focus packs

• GP Practice packs

• LTC packs

• RightCare Optimal Pathways

• RightCare High Impact Interventions

• RightCare Casebooks

• RightCare LTC Case Scenarios

• RightCare Combined Pathways (prototype in development)

• Quick Impacts for RightCare (new)

31 Source: RightCare Long Term Conditions Focus Pack

Opportunity in the top right hand corner is how many additional people with COPD would be diagnosed if the CCG achieved the average of highest 5 of the 10 most similar CCGs

32 Source: RightCare Long Term Conditions Focus Pack

Opportunity in the top right hand corner is how many fewer days (nights) spent in emergency admissions people with respiratory disease would have in last year of life if the CCG achieved the average of lowest 5 of the 10 most similar CCGs

• GIRFT• Academia

• Warwick Business School & health faculty (behavioural science)

• Salford University (population healthcare improvement)• Oxford University (primary care, value)• LSE (STAR tool)• Manchester Met Business School (improvement processing)

• Clinical Colleges and national charities (best practice)• Manchester Airport• McLaren F1• CIPFA, CIMA, HFMA (financial sustainability)• Euler Hermes• Pfizer

33

Knowledge Transfer

What can the ancient Greeks and the medieval English teach NHS improvement?

• System Vs Pathway - do people design complexity or simplicity?

• Thales’ principle of reductionism and Ockham’s Razor

o Components (steps in pathways) are simpler to understand than whole systems (FE, UC)

o Break down to simple components, design optimal

and build back up into complex systems

• Mild heart conditions treatment – change lifestyle first, before prescribed drugs. Learnt this via reductionist research on body chemistry and physiology.

• Step 1 – Awareness is the first step to improvement

• Step 2 – Find a champion

• Step 3 – Engage the right people to design optimal

• Step 4 – Understand the problem (use data)

• Step 5 – Convert data into knowledge and design optimal

• Step 6 – Use delivery levers to implement

• So, when did it all begin? Knowledge transfer from the ancient world….

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Generics of optimal improvement processing

• 355 days in a year• 10 months (most years)• Added an extra month every so often to catch up with

the lunar cycle• Extra months were determined by the College of

Pontiffs (a set of priests with a focus on astronomy)

• Current situation – the system sort of worked and they muddled through year to year (sound familiar?)

• Problems – e.g. harvest would often officially occur weeks before or after the crops actually needed to be harvested

36

Roman calendar c. 250BC - 49BC

37

Egypt 48BC – Gaius Julius Caesar

• Step 1 – Awareness is the first step to improvement• Senators had begun to notice lower corn supply in years prior to extra months

and wondered whether the current system was fit for purpose (= unwarranted variation)

• Step 2 – Find a champion• Step forward Gaius Julius Caesar, enjoying a prolonged visit to

Egypt, in the arms of Cleopatra (= strong change leader)

• Step 3 – Engage the right people • World’s leading academics• Mathematicians, Astronomers (lunar cycle)• Epicureans (pre-cursor to modern scientists)• Senators and other land owners (farmers)

(= expert and stakeholder engagement)

38

What happened?

• Step 4 - Collect and analyse data - understand the problem

• Trawled back through all the calendar and seasonal records, star charts, religious festivals (= produced RC focus pack)

• Step 5 – Convert data into knowledge and use to design optimal

• Met with all the engaged experts in Alexandria Library until had the answer (= optimal design event)

39

What happened?

• Step 6 – Use delivery levers to implement• Took over the republic of Rome, made himself Dictator, enforced the change

(= slightly tenuous link to – isolate the reasons for non-delivery)

40

What happened?

• Optimal design –• 365 day year• 12 months (even named one of the new ones after himself)• Extra day every fourth year to re-align with lunar cycle

• In time, led to increased corn supply to Rome which was used as a form of welfare benefit (population healthcare improvement)

• 2,066 years later, we’re still benefitting

• Knowledge transfer:• The process itself

• Moral of the story:• If you do change properly you create a sustainable solution

41

What happened?

For further information -• Email RightCare

• rightcare@nhs.net

• Twitter:

• @nhsrightcare

• @matthew_cripps1

• Visit RightCare:

• http://www.england.nhs.uk/rightcare/

Procurement Workshop Kath Ibbotson & Melanie Hingorani

FOM Refresh

239 TrustsAcute, Mental Health, Community and

Ambulance

£5.7bnSpent annually on goods by Trusts

£2.2bn (40%)Spent through NHS Supply Chain

£616m (10.8%)Saving annually by 2020

The FOM targets increase from 40% spend throughNHS Supply Chain

to 80% by 2020

• Reduced variation and range rationalisation• Leveraging national purchasing power• Evidence based clinical evaluation and assurance

Procurement Workshop – CTSP Providers

Category Tower Provider Model

© NHS Collaborative Partnership 2018

Award of up to 3

Towers

46

NHS Owned Limited Liability Partnership

CPP Background

• Owner of nationwide framework agreements including:

© NHS Collaborative Partnership 201847

Total Orthopaedic Solutions

Clinical Consumables

Total Cardiology Solutions

Theatre Surgery Consumables

Complete Ophthalmology Solutions

• Category specific expertise and knowledge

• Clinical engagement

• Business Analytics

Complete Ophthalmology Solutions

• Lot 1 Intraocular Lenses• Lot 2 Surgical Instruments

• 2.1 Single Use• 2.2 Re-usable

• Lot 3 Procedure Packs• Lot 4 Solutions & Gases• Lot 5 General accessories &

consumables

• Lot 6 Ophthalmic Equipment• 6.1 phacoemulsification• 6.2 vitreoretinal machines• 6.3 ophthalmic microscopes• 6.4 diagnostic equipment• 6.5 ophthalmic lenses• 6.6 additional ophthalmic equipment

• Lot 7 Combination specific lots

• Lot 8 Managed Service

CPP CTSP Update since award

• DH Implementation stage @ month 4

• Numerous work streams preparing for “go live” – IT, systems, estates, TUPE,

Novation

• Working alongside NHS Supply Chain team to share information, taking best

from both

• Analysing all data looking for opportunities to offer nationally

• Continuing to develop National Category Strategy @”Mature Draft”, Trusted

Customer/CaPA

• E.mail all Heads of Procurement for Supplier Spend

CPP Strategy

• Recommending 3 key areas of focus in year 1 based on collaboration

with UK OA• Rationalisation of packs

• Monofocal lenses

• Instrument rationalisation

• Working together to deliver FOM (Carter/GIRFT principles)

• Consistent best practice,

• Reduced unwarranted variation,

• Better productivity

• Reduced risk

• Reduced costs, ability to aggregate, deliver savings

• NHS recommended national product, clinically driven and accepted

ProcurementMelanie Hingorani

Procurement Work stream• Working with

• NHSI

• Procurement Hubs

• NHS Supply Chain

• National ophthalmology category tower service provider

• GIRFT leads

• Interested Alliance members: procurement, clinical, theatre leads, managers

• Cleaning up inaccurate national data sets on theatre and procedure purchasing

• Creating consistent supplier codes, comprehensive national brochure, greater accuracy trust data input

• Ideal consistent procedure packs and instrument sets

• Clinical/safety/cost analysis to identifying best IOLs and devices

• Modelling to identify best and most cost effective purchasing

• Benefits: consistent practice, reduced unwarranted variation, better productivity, reduced costs

Procurement Why?

• National data is inaccurate and poorly understood by national analysts

• More accurate data will allow better analysis of efficiency: costs, productivity

• More understanding via clinical input will allow better understanding quality, safety, ease of use,

appropriateness

• Put together:

• Advise providers how their costs and productivity benchmark against others

• Advise providers what are the most cost effective models and suppliers

• Make supplies more consistent for productivity, safety and costs

• Assess supplies vs outcomes

• Drive down costs via bulk purchase or discounts

Last time: IVT packs

• A LOT of IVT packs available to buy nationally

• We went through all of them in detail

• Problems:

• Duplication e.g. two pairs of scissors, two callipers, two speculae, two forceps

• Waste: needles and syringes even for preloaded injections

• Or opening extras for every case

• Massive variability even in same units

• Make costings difficult to compare between units

• Confusing and inefficient for staff

• Sometimes quite limited input from clinicians into contents

• If it’s like this for simple IVT, imagine what it’s like for other procedures!

Last time: IVT packs

Wash Hand towel

Prep Gauze swabs, swab forceps

Pack Crepe

Drape

Drape minimum 40 x 40cm with pre-

perforated clear film aperture 6 x 8cm

with Adhesive

Tray Intrsinsic 2 pot tray

Speculum Barraquer type wire speculum closed

blades

Calliper/mar

kerBraunstein pointed calliper 3.5/4mm

Buds/spears Cotton Buds x 3-5

With drape

Prep Gauze swabs, swab forceps

Pack Crepe Paper 60 x 60cm (to be used as wrap)

Scissors Straight scissors

Drape Drape 40 x 40cm Aperture 6 x 8cm with Adhesive clear film

Tray Polypropylene Tray 23 x 13.5 x 2cm

Tray Galipot 60ml x 2

Speculum Kratz Barraquer Wire Speculum 13.5mm Open Blades 52mm Long

needle Needle Hypodermic 25g x 1"

needle Needle Hypodermic 25g x 5/8”

Syringes Syringe 2ml Luer Lock x 2

mark Braunstein Fixed Calliper 3.5/4mm

buds Cotton Buds x 6

buds Cellulose spears x 6

14 items12 buds/spearsOpen hand towel always

9 items 3-5 budsOpen needles & syringe if need

Last time: IVT packs

Wash Hand towel

Prep Gauze swabs, swab forceps

Pack Crepe

Drape

Drape minimum 40 x 40cm with pre-

perforated clear film aperture 6 x 8cm

with Adhesive

Tray Intrsinsic 2 pot tray

Speculum Barraquer type wire speculum closed

blades

Calliper/mar

kerBraunstein pointed calliper 3.5/4mm

Buds/spears Cotton Buds x 3-5

With drape

9 items 3-5 budsOpen needles & syringe if need

Wash Hand towel

Prep Gauze swabs Rampleys Sponge Holder 11/14 x1-2

Pack Crepe

Tray Intrsinsic 2 pot tray

Invitrea

Buds/spears Cotton Buds x 3-5

With Intravitrea 7 items

Current Moorfields IVT pack

Pack paper cover

Paper wrap 50x50cm

Tray Tray with 2 integrated gallipots

Drape Mini precut incise drape

SpeculumBarraquer speculum flat blade

Calliper/markerPointed IVT marker 3.5/4.5mm blue

Buds/spearsSwab stick small x 3

Swabs or similar (for prep)

10x10cm Non woven gauze 4 ply x 5

Labels Tracer labels

Rubbish bag Orange rubbish bag

Towel Hand towel 1/4 fold

7 items

Procurement project at Moorfields• Tender for VR and phaco packs

• Also looking at instrument sets to see if can rationalise

• Aiming to make any savings or benefits available to others

• Bring small representative sensible group together and discuss – then test with others

• Phaco packs:

• 5 different packs including Bedford

• Much of the contents never been challenged – why have a betnesol label in every pack?

• List of the contents sometimes wrong or no one understands what it means!

• 30 different items all differing a bit from the next one

• Why cystotome and insulin syringe and bender and rhexis forceps always available?

• Often opened more than one pack for different surgeons just because they wanted a different instrument

• Told agreement on one set and pack could “never be done”

• VR: more consistent because surgeons had taken an interest

• Surprisingly easy to rationalise as long as get everyone together and make it simple

• From 30 all different to 26 identical contents

Procurement methodology• How many packs for same procedure

• Make a list of headings

• Make a list of everything that falls into that heading and see if need all/need some/need all; question all

duplication

• Ask again because knee jerk is to keep everything in

• Aim to have everything you use every time in the pack

• Aim to open separately everything you use ?<100% ?<50 % of the time? But have enough of them in every

theatre

• See whether items are better on instrument set or pack

• Are somethings better quality disposable or reusable

• Don’t include things just to please certain individuals

Headings IVT pack• Wrap of pack• Tray• Gallipots• Patient drape• Prep forceps• Prep gauze/swabs• Scissors• Speculum• Forceps• Calliper• Syringe• Needle drawing up• Needles injecting• Buds/spears• Eyepad, shield• Labels • Towel• Rubbish bag• anything else?

Headings phaco pack

• Tipless pack• Tip • Machine drape• Table drape• Patient drape• Receiving basin• Tray• Gallipots/cups• Prep forceps• Prep gauze/swabs• Scissors• Speculum• Section blade• Side blade• Forceps• Corneal irrigation cannula• AC cannula (Rycroft)

• Hydrodissection cannula• I/A• Syringes (drawing up, corneal wash, AC BSS, AC

lignocaine, ic or sc antibiotic, wound hydration )• Rhexis insulin syringe/cystotome/forceps• Prep gauze/swabs• Needle drawing up• Needles injecting• Buds/spears• Eyepad, shield• Labels• Towel• Rubbish bag• anything else?

Procurement Workstream

• Pros:

• Consistency for efficiency and safety

• Drive down costs as fewer items

• Drive down costs by bulk purchasing

• Can make consistent without initially limiting but clarifies variability

• Barriers:

• Consultant individuality

• Clinical preferences

• Local trust systems

• Restriction to choice worries people

MEH best practice IVT pack

Pack paper cover

Paper wrap 50x50cm

Tray Tray with 2 integrated gallipots

Drape Mini precut incise drape

SpeculumBarraquer speculum flat blade

Calliper/marker

Pointed IVT marker 3.5/4.5mm blue

Buds/spearsSwab stick small x 3

Swabs or similar (for prep)

10x10cm Non woven gauze 4 ply x 5

Labels Tracer labels

Rubbish bag Orange rubbish bag

Towel Hand towel 1/4 fold

MEH phacopack

Machine supplier dependent

Best practice pack Extras to be available single packed in all theatres

Phaco tip supplier dependent 45 degree mini-flared Kelman 0.9mm suitable for all phaco devices used if possible

Tipless pack (casette, sleeves, tubing, wrench, test chamber, machine drapes)

supplier dependent Tipless casette/sleeve , machine drape etc pack

I&A supplier dependent Bimanual

Table drape can be supplier dependent

2 table drapes minimum size 44"x44" Lint free woven

Knife section supplier dependent Phaco incision blade single bevel 2.4mm

Patient drape Half body drape with incise area minimum 5x7cm with minimum 500ml integral bag with wick

Basin for receiving syringes and sharps Basin emesis 700cc

Plastic tray for iodine & used prep forceps Plastic tray minimum 8 x 5" with small insert section

Prep forceps Plastic sponge forceps minimum 14cm x 3Prep guauze Gauze swabs 4ply 10 x 10cm x 10Fluid holders Cup, solution, graduated 120ml x 1Knife side port MVR and feather blade

Corneal irrigation cannula Rycroft 0.80 x 22mm 21GAC cannula Rycroft 30G 7/8"Hydrodissection cannula Hydrodissection cannula Pearce style 35° angled 8mm flat,blunt tip,

overall length 22mm 25 or 27GI&A Simcoe Syringe Syringe hypodermic luer lock 5ml x 2 (drawing up antibiotic,

irrigating cornea)Syringe luer lock 3ml x 2 (for AC BSS, for lidocaine)

1ml syringe (for AC/wound)Insulin syringe integral needle 1ml (for rhexis)

Needle Needle 19G 38 RB (drawing up antibiotic)Spears Spears eye surgical sponge with light blue handle 6 in pack

Labels Label white BBS+Adrenaline 0.1MG/MLLabel white 38X11MM, BSSLabel white Aprokam 10MG/MLLabel white HPMC 2% + BSS

MEH best practice VR pack

23g VR pack 25g VR pack 27g VR packMachine pack -supplier dependent

Constellation Pack 5000cpm, Valved, 0.6mm (23g)

Constellation Pack 7500cpm, Valved, 0.5mm (25+)

Constellation Pack 7500cpm Valved, Str. Endoill.0.4mm (27+)

Cannula aspiration 23g Aspiration Cannula (0.6mm) 25g Aspiration Cannula (0.5mm) 27g Aspiration Cannula (0.5mm)Tray Arm cover -supplier dependent Constellation Tray Arm Cover Constellation Tray Arm Cover

Constellation Tray Arm Cover

Table covers -could be supplier dependent

Cover back table, W/ADH (140x140cm) Soft Fold

Cover back table, W/ADH (140x140cm) Soft Fold

Cover back table, W/ADH (140x140cm) Soft Fold

Rubbish Bag drawstring Bag drawstring Bag drawstring

Chair cover Armchair Cover x 2 Armchair Cover x 2 Armchair Cover x 2

Patient drape

Drape, Incise, Non-Woven, (125x140cm)

Drape, Incise, Non-Woven, (125x140cm) Drape, Incise, Non-Woven, (125x140cm)

Prep 4ply Gauze (10x10cm) x 10 4ply Gauze (10x10cm) x 10 4ply Gauze (10x10cm) x 10Plastic Forceps (19cm) x 3 Plastic Forceps (19cm) x 3 Plastic Forceps (19cm) x 3

Plastic bowls/tray 700ml bowl 700ml bowl 700ml bowl120ml Graduated Cup x 2 120ml Graduated Cup x 2 120ml Graduated Cup x 2

3Part Tray (25x24x5cm) 3Part Tray (25x24x5cm) 3Part Tray (25x24x5cm)

Buds

Cotton tip applicator 3” (7.6cm) x 10

Cotton tip applicator 3” (7.6cm) x 10

Cotton tip applicator 3” (7.6cm) x 10

Cannula AC

20g Anterior Chamber Cannula (0.9x22mm)

20g Anterior Chamber Cannula (0.9x22mm)

20g Anterior Chamber Cannula (0.9x22mm)

Syringes 3ml Luer Lock Syringe x 2 3ml Luer Lock Syringe x 2 3ml Luer Lock Syringe x 2

Needles 25g Needle (0.5x16mm) 25g Needle (0.5x16mm) 25g Needle (0.4x16mm)19g x 1.5” Needle, ( 1.1x40mm) 19g x 1.5” Needle, ( 1.1x40mm) 19g x 1.5” Needle, ( 1.1x40mm)

Dressing

Melolin Dressing, Low ADH,( 5x5cm)

Melolin Dressing, Low ADH,( 5x5cm)

Melolin Dressing, Low ADH,( 5x5cm)

Eye Pad Eye Pad Eye PadEye shield Eye shield Eye shield

Labels Marcain Label x 2 Marcain Label x 2 Marcain Label x 2Betnesol Label x 2 Betnesol Label x 2 Betnesol Label x 2Zinacef Label x 2 Zinacef Label x 2 Zinacef Label x 2

MEH best practice phaco setIn set Extras in every theatre Alternative

Instrument Tray Instrument tray

Artery forceps (lift lid to drape) Artery forceps

Scissors Drape scissors blunt Sharp straight scissors

Speculum Phaco speculum

Small forceps Titanium corneal forceps grooved

Titanium corneal tying forceps

Second instrument Phaco chopper Mushroom and simskey hook

Needle holder Castroviejo for bending insulin needle (disposable)

Corneal needle holder Could be omitted from set and opened as extra for certain cases

Rhexis forceps 2.2mm cross over rhexis forceps (disposable)

Could be omitted from set and opened as extra for certain cases

IOL forceps Kelman-Macpherson forceps

Other Iris repositor

MHE best practice VR set

Vitrectomy Set InstrumentsDetachment extras

Barraquer speculum x1Fison Retractor 0107092 J Weiss

Spencer Wells – Curved x 4Bulldog Clip (Small)

Scissors – Straight / Blunt x1Bulldog Clip (Small)

Scissors – Straight / Sharp x1Bulldog Clip (Small)

Westcotts Spring Scissors x1Bulldog Clip (Small)

Moorfields Forceps x2Curved artery clip x3

St. Martin Forceps x1

Grooved (Hoskins) Forceps x1 - DK 2-100 (Notched forceps)

Cross-Action Plug Forceps x1

Castro. Needleholder x2

Barraquer Needleholder x1

Squint Hook – Flat x2

Glaucoma Patient Standards Provided by Karen Osborne – IGA

What the IGA does

• Funds research

• Campaigns to increase glaucoma awareness and reduce needless sight loss

• Helps people to live well with glaucomao Free advice and information o Websiteo Online forumo Telephone helpline, Mon – Fri 09.30-17.00

Most common reasons for calling the IGA helpline

1. Surgery and laser questions, worries about treatment choices

2. Eye drops – side effects & problems instilling

3. Lifestyle queries – how to live well with glaucoma

4. Driving

5. Appointment delays and cancellations

IGA information publications• Booklets

• Glaucoma - a guide Trabeculectomy

• Aqueous shunt implantation Babies and Children

• Dry eye – a guide Eye drops and aids

• Secondary glaucomas MIGS (coming soon)

• Ocular hypertension – a guide

• Leaflets

• Driving and glaucoma Blepharitis

• Laser treatment for glaucoma Pigmentary glaucoma

• Glaucoma and your relatives Glaucoma & how we help

• Syndromes and Anomalies Primary angle closure glaucoma

• Primary open angle glaucoma Delays and cancellations

• What to expect at a first appointment (coming soon)

www.glaucoma-association.com

Moorfields #KnowYourDropsto Improve Patient Compliance and QoLSarah ThomasLead Pharmacist for Satellite Services and ContractsandFiona ChiuAssociate Chief PharmacistStrategy, Procurement & Satellite Services

UK Ophthalmology Alliance

1.3.18

Moorfields #KnowYourDrops

What guidance is available on how to provide this information and best support to patients

Moorfields #KnowYourDrops

So – there is a gap in the quality of care

Moorfields #KnowYourDrops

Poor compliance

Support recommended

Lack of concrete guidance from

professional bodies

Lack of awareness

culture that eye drop

compliance is important

No standardised effective

support being given

Poor Compliance with Ophthalmic Treatments

Moorfields #KnowYourDrops

Poor compliance

Support recommended

Lack of concrete guidance from

professional bodies

Lack of awareness

culture that eye drop compliance

is important

No standardised effective

support being given

•Poor compliance could result in:• poor clinical outcomes and vision loss

• lower Quality of Life for patient and their carers - stress, difficulties with day-to-day living, difficulties at work, driving, lack of dignity, poor performance

• Polypharmacy

• More medical appointments, surgery

• Financial burden for patients paying for medicines

• Financial burden for NHS

50% patients non-compliant

Preventable sight loss estimated to cost the UK economy > £28bn

What are we at Moorfields doing to provide the necessary support

to patients?

Moorfields #KnowYourDrops

Moorfields #KnowYourDrops

#KnowYourDrops Campaign - Background

Patient Feedback

Stakeholder Engagement

Pilot clinic

Site by Site Trustwide

National & International

Moorfields #KnowYourDrops

Successfully Improving Outcomes and QoL

report improved confidence

putting in their drops

report improved ability

putting in their drops

Moorfields #KnowYourDrops

Benefits to Care• Improved patient/carer confidence in putting in eye drops

• 100% (n=95) report improved confidence• Improved patient/carer ability to administer drops

• 100% (n=95) report that the personalised session helped improve their technique

• Improved patent satisfaction and experience

• Improved treatment outcomes such as improved IOPs

• Prevention of surgery and preventable degradation in conditions

• Improved quality of life for patients and carers

• Improved social care in communities for adults and children

• Improvement management of medicines in different settings

• Tailored patient-centered support for high quality of care

• Improved waiting times and patient pathway as role removed from clinical staff

• Likely reduction in repeat prescribing and GP/hospital review appointments

Moorfields #KnowYourDrops

Q – Quality I – Improvement P – Productivity P - Prevention

How we can work together to bridge the gap

Moorfields #KnowYourDrops

Research for QoL and effects on outcomes for

patients with compliance

supportRaise

awareness of eye drop

compliance aids

Defined compliance

support guidance

Develop standardised model of care for ophthalmic

pathway

Embed ophthalmic

MUR

Improve availability of compliance

aidsChange in culture to no long overlook eye drops as

important

The status quo needs to change direction

Moorfields #KnowYourDrops

Thank you and Questions