The Royal College of Ophthalmologists
Quality Standards Development Group
Quality Standards for Glaucoma* Services – September 2013
Introduction
There are a number of reasons for wanting to know how well a clinical service is
working. A commissioning organisation or a regulatory body may want evidence of
quality to inform a commissioning decision or as part of an inspection. A department
may wish to know how well it is doing in comparison with another department or
whether it is improving, standing still, or deteriorating over a period of time. There
are many possible ways of measuring quality ranging from opinions of service users
and staff to hard measures of outcome such as mortality. However, good measures
of quality may be defined as ones which ask questions which discriminate accurately
between a service which is serving its patients well and one which is failing its
patients.
The College's Quality Standards Group has produced a suite of simple selfassessment tools in draft form for the following clinical services: cataract, glaucoma,
diabetic retinopathy, children and young adults, oculoplastics, age-related macular
degeneration (AMD) and vitreoretinal surgery. The tools do not attempt to assess
every aspect of each service, but focus on areas where problems are likely to show if
the service is under stress. Very few clinical services will achieve a perfect score, so
the questionnaires can be used as quality improvement tools as well as snapshot
audit tools.
In order to improve and develop the self assessment questionnaires, we will be very
grateful if you could complete the attached feedback form after you have completed
the questionnaire.
Please send feedback to Beth Barnes, Head of Professional Standards
September 2013
Review: 2015
Document Ref: 2013/PROF/141
Page 1 of 4
The high level indicators proposed below, reflect either wholly or in part, the quality domains
of effectiveness, safety and patient experience, informed by recent NICE guidance1 and
patient (clinical) safety issues2. They apply to clinical services for patients with open angle
and normal tension glaucoma, and ocular hypertension.
*Unless otherwise stated, the term “Glaucoma” includes primary open angle glaucoma, normal tension
glaucoma & ocular hypertension.
1.
2.
3.
4.
Is there a clinical lead for glaucoma* with this role specified in their job plan and job
description?
YES (score 1)
NO (score 0)
50% Effectiveness;
50% Safety
UNABLE TO ANSWER (score 0)
Are at least 80% of glaucoma* patients seen in dedicated Glaucoma services?
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
50% Effectiveness;
50% Patient Experience
Are all patients with glaucoma* managed by appropriately trained staff using clear
protocols ?
YES (score 1)
NO (score 0)
50% Effectiveness;
50% Safety
UNABLE TO ANSWER (score 0)
All patients with a diagnosis of open angle or normal tension glaucoma are reviewed
at least annually and patients with ocular hypertension are reviewed at least every 2
years (except in cases of DNA or patient-initiated cancellation).
Notes :
i) “Review” represents an indicator covering all aspects of management (treatment, care plan changes etc)
ii) The review intervals are based on the NICE 2009 guideline recommendations for open angle and normal
tension glaucoma, and ocular hypertension1.
5.
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
50% Effectiveness;
50% Patient Experience
All patients with a diagnosis of open angle or normal tension glaucoma have visual
fields measured at least once a year and patients with ocular hypertension have
visual fields measured at least every 2 years (except in cases of DNA or patientinitiated cancellation).
September 2013
Review: 2015
Document Ref: 2013/PROF/141
Page 2 of 4
Notes :
i)
“Visual Field” represents an indicator for objective assessment of disease status
ii)
The intervals for visual field measurement are based on the NICE 2009 guideline
recommendations for open angle and normal tension glaucoma, and ocular hypertension1.
6.
YES (score 1)
NO (score 0)
50% Effectiveness;
50% Safety
UNABLE TO ANSWER (score 0)
All hospital appointments occur within 15% of their intended follow up period,
including rescheduling of hospital initiated cancellations
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
100% Safety
7.
8.
9.
The unit maintains an audit of certification of visual impairment (CVI) where the
primary cause of vision impairment is open angle or normal tension glaucoma.
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
50% Effectiveness;
50% Patient Experience
Patients with glaucoma* are routinely supplied with information in an accessible
format on their diagnosis and medication
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
50% Effectiveness;
50% Patient Experience
Patients with open angle and normal tension glaucoma are routinely given instruction
on eye drop instillation technique
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
100% Patient Experience
10.
Patients with open angle and normal tension glaucoma are routinely assessed for
adherence with treatment
YES (score 1)
NO (score 0)
UNABLE TO ANSWER (score 0)
100% Patient Experience
September 2013
Review: 2015
Document Ref: 2013/PROF/141
Page 3 of 4
11.
Do at least 80% of patients attending with glaucoma or OHT or as suspected
glaucoma have baseline optic disc images (updated where a change has occurred)
available at their monitoring visit?
YES (score 1)
NO (score 0)
50% Effectiveness;
50% Safety
UNABLE TO ANSWER (score 0)
Total Score out of 11:
Effectiveness
Safety
Patient Experience
-
4
3
4
36%
28%
36%
References:
1.
NICE guidance CG85: Glaucoma: Diagnosis and management of chronic open angle
glaucoma and ocular hypertension, April 2009. http://guidance.nice.org.uk/CG85
2.
National Patient Safety Agency. Preventing delay to follow-up for patients with
glaucoma. Rapid Response Report 2009; NPSA/2009/RRR004.
Gateway reference:
11994. http://www.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=61908
3.
NICE Glaucoma Quality Standard QS7. March 2011.
http://www.nice.org.uk/guidance/QS7
Author:
Miss Parul Desai, Quality Standards Development Group
The Royal College of Ophthalmologists, London
September 2013
Review: 2015
Document Ref: 2013/PROF/141
Page 4 of 4