title: A safety audit of the first 10 000 intravitreal ranibizumab injections performed by nurse practitioners.
abstract: OBJECTIVE
  To evaluate the safety of a nurse practitioner (NP)-delivered injection service for the treatment of wet age-related macular degeneration (wAMD) with ranibizumab.
  
  
  METHODS
  An evaluation of medical staffing resources for providing an injection service for wAMD highlighted difficulties covering lists. An alternative strategy of an NP-delivered injection service was evaluated. Two suitable NPs with previous extensive experience in minor surgical procedures were identified. The department's senior vitreo-retinal consultant supervised the NP's training programme. A prospective safety audit was conducted for the first 5.5 years of the service.
  
  
  RESULTS
  The NPs administered 10 006 injections in the first 5.5 years of the service (1 May 2008 to 8 October 2013). This represented 84.1% of the total injections performed during this period. Four patients developed presumed infectious endophthalmitis (1 was culture positive and 3 were culture negative). The incidence of post-injection endophthalmitis was 0.04%. There was no evidence of lens touch, retinal detachment, or systemic thrombo-embolic events.
  
  
  CONCLUSIONS
  Carefully selected and well-trained NPs are capable of delivering a safe and effective wAMD injection treatment service. This work demonstrates how such a service can be established and provides safety data that other units can use as a benchmark when evaluating their own practice.
authors.affiliation: West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: P
authors.initials: P
authors.lastname: Simcock
authors.affiliation: West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: B
authors.initials: B
authors.lastname: Kingett
authors.affiliation: West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: N
authors.initials: N
authors.lastname: Mann
authors.affiliation: West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.affiliation: West of England Eye Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: J
authors.initials: J
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D009877:Endophthalmitis / Q000209:etiology; D015818:Eye Infections, Bacterial / Q000209:etiology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D000069579:Ranibizumab; D013203:Staphylococcal Infections / Q000209:etiology; D013222:State Medicine / Q000706:statistics & numerical data*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab