13STRATEGIES TO IMPROVE VISUAL ASSESSMENT IN PATIENTS ATTENDING A DAY HOSPITAL: A CLOSED AUDIT LOOP


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Abstract

Evidence-base: Visual impairment (VI) is a well- established risk factor for falls. Compared with normal-sighted people, people with VI are almost twice as likely to fall and have recurrent falls with subsequent fractures.1 Poor vision is commonly under-recognised, and elderly patients often fail to attend for free NHS eye examinations. The NICE guideline on falls prevention recommends that all patients undergoing falls assessment are screened for visual impairment.2Change-strategies: The initial audit assessed current visual assessments and follow up in patients undergoing falls assessment in a day hospital, by prospective case note review over an 8 week period. Following this, an education session on a newly designed assessment tool, referral pathway guideline and provision of a standardised referral letter to optometry services, was delivered to the multidisciplinary day hospital team. A re-audit was then conducted over the same time frame and statistical analysis performed.Change effects: 'There were 87 patients in Cycle 1, and 99 patients in Cycle 2. Following the intervention, significantly more patients underwent assessment of visual acuity (99% vs 87%, p = 0.0023). Of those identified with VI, there was a significant improvement in referral to optometry services (55% vs 33%, p = 0.0028) and less patients with VI were discharged from the day hospital without any follow-up (7% vs 33%, p = 0.0001).Conclusions: The interventions that were introduced led to a statistically significant improvement in the assessment of visual acuity. More patients identified with visual impairment were referred for ongoing assessment by their optometrist and fewer patients were left without follow-up. These results were presented back to the day hospital team in order to reinforce the new protocols for assessment and onward referral.

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