Children's Vision Screening Pathway Development in Wales
Orthoptists in Wales collaborated to create a standardized vision screening pathway for children aged 4-5 years to ensure equitable and effective service delivery. The pathway development involved consultations, evaluations, equipment purchases, and training programs for healthcare support workers and school nurses. Annual audits were established to promote accountability and continuous improvement in vision screening practices.
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CHILDRENS VISION SCREENING PATHWAY Nicola Turner Orthoptist Aneurin Bevan University Health Board September 2017
INTRODUCTION Orthoptists are autonomous practitioners. Diagnose, manage and treat a variety of binocular vision defects and eye movement disorders including amblyopia. Work as part of Ophthalmology team. Orthoptists experts in vision screening. Current NSC recommendations supported by RCOphth recommend Orthoptic led screening for children aged 4-5 years. WG requested development of All Wales Pathway.
WHY A SCREENING PATHWAY ? Discrepancies between vision screening service provided by Orthoptic Departments across Wales. To provide a flexible and auditable pathway for vision screening. To provide a service that is both equitable and effective. One that is accessible to all.
HOW WAS THE PATHWAY DEVELOPED? Meetings involving: Orthoptists and Optometrists from each Health Board in Wales. WG. All Orthoptic Departments across Wales were involved and consulted. British and Irish Orthoptic Society including Special Interest Group (School Screening). Consultation with Child Health.
TIMESCALE By When By Who Resources Needed/ Evidence Outcome Measure Objective 1 To scope current provision of vision screening of children aged 4 5 years and identify development requirements to achieve equitable provision across Wales Sept 2013 All Wales Orthoptic Advisory Committee (AWOAC) and Welsh British & Irish Orthoptic Society (BIOS) Consultation via AWOAC and Welsh BIOS Current documentation Evaluate cost implications Production of updated AWOAC document Summary of development requirements to achieve equitable provision of vision screening across Wales 2 To agree the logMAR test to be used for vision screening Sept 2013 AWOAC and Welsh BIOS Evaluate tests available Funding to purchase equipment Evidence from existing pathways, e.g. audits of effectiveness and costs Evaluate cost implications / cost analysis Equipment purchased 3 To review the All Wales Vision Screening Pathway Dec 2013 Representative/s for Orthoptists/Optome trists/ Ophthalmologists/H CSW/School Nurse (SN) Manager Production of updated pathway
Objective By When By Who Resources Needed/ Evidence Outcome Measure 4 To plan and To To Provide training and development to designated Healthcare Support Workers (HCSWs) & School Nurses who undertake the vision screening. To develop system of annual audit, that enables accountability and continuous improvement within open governance structures July 2014 AWOAC and Welsh BIOS with support from CVSAG and SN Manager Scope current training Produce training package Cost implication of implementing training across Wales Funding to deliver training Evaluate current audit systems Identify system that enables consistent monitoring, evaluation and review Evaluate cost implications Funding as identified in objectives 1, and 3 Training package with competencies Designated staff trained Database of trained staff 5 Sept 2014 Orthoptists/Optom etrists/HCSW/SNs and support from appropriate advisory group/s on audit design and implementation and CVSAG Agreed audit system 6 To implement equitable provision of vision screening of children aged 4 - 5 years across Wales Sept 2014 Orthoptists/Optom etrists/HCSW / SNs Vision screening standardised across Wales Audit of screening services and outcomes reported annually
SPECIAL SCHOOLS Children attending Special Schools in ABUHB Area are not included in the screening programme as they are unable to follow the WG Pathway. Many of these children are seen in HES from birth. Pilot study by Optometrists undertaken to provide this service.
VISION SCREENING PROCESS All Wales Screening Pathway Agreed. WG Policy (February 2015). All Wales KPIs identified (2016). Worked in partnership Child health team to implement / further improve Pathway / Referrals. ABUHB Orthoptic / Optometry processes reviewed and implemented in line with All Wales Pathway. Data collection.
KEY PERFORMANCE INDICATORS 2016 Performance Indicators for Vision Screening Pathway (by Health Board) Action detail Structure staff in place/leadership/staff trained Y 1 Named Orthoptist as screening programme lead: Y Named Lead School nurse Y Named Ophthalmologist Y Named Optometrist 99% 2 Proportion of school nurses and HCSW with up to date competencies in vision screening Y 3 A quality assurance system in place for maintaining competency of staff administering screening Process- pathway compliance with standards, satisfaction, failsafe Y 4 WG recommended children's vision screening pathway in use for all children Y 5 Crowded logMAR test used to screen Screening programme outputs and outcomes 6 Total number of children in cohort (Age 4-5 years) ordinarily resident in the health board area 7138 7 Total number of children screened (Age 4-5 years) ordinarily resident in the health board area 7065 8 Number of children screened in cohort (age 4-5 years) referred to Hospital Eye Service 897 9 Proportion of children screened in cohort (age 4-5 years) referred to Hospital Eye Service 12.70% 10Number of children screened referred for full sight test in primary care 24 11Proportion of children screened referred for full sight test in primary care 0.34% 877 12Number of children referred to HES seen in HES unknown 13Number of children referred to primary care seen in primary care
OUTCOMES 2016 All Wales Screening Pathway Implemented. 99% of children aged 4-5 years (7065)underwent Vision Screen. Achieved RTT of 12 weeks in 84.2 % of cohort. KPI s Audited and results returned to WG. (August 2016). 897 referrals were received by Orthoptic Department. Improved Communication between Child Health, GP and Parents. Orthoptic led competency training package introduced for SN and HCSW. Completion and update of database.
OUTCOMES 2017 ABUHB Interim Figures 97 % (6598) underwent vision screening Achieved RTT (12 weeks) in 91.5 % (Orthoptic + Refraction) Achieved RTT (12 weeks) in 97.8 % (Orthoptics only) To date 878 referrals received by Orthoptic Department. Use of E screening form for data collection.
WHY IS VISION SCREENING IMPORTANT This is the only vision test child will receive. Parents are often unaware of defect in vision. Impact on visual requirement later in life. Small window of opportunity when treatment is effective.
CONCLUSIONS Vision Screening is now in place in 5 out of 6 HB s in Wales. Data collection for audit purposes to WG. Orthoptic led screening provides a robust and auditable screening service.
REFERENCES National Screening Committee. Wales Vision Strategy Plan. Welsh Health Circular ( Children s Vision Pathway). British and Irish Orthoptic Society.
