IVT injections in nurses’ hands
A 68-year-old patient, Mr Han Boon Huat, has to receive an intravitreal (IVT) injection monthly at the Tan Tock Seng Hospital (TTSH) to treat his age-related macular degeneration. However, unlike other patients who obtain this injection, Han is among the first few at this establishment to have his injections administered by a nurse.
Prior to this, only doctors did the procedure but Han does not mind the change. He said, “As long as they are trained, it doesn't really matter if the injection is carried out by a nurse or a doctor, as I felt no significant differences during the injection.”
Some conditions that warrant the IVT injections are such as wet age-related macular degeneration, diabetic maculopathy and retinal vein occlusions. Many of these eye diseases are linked to diabetes – a condition affecting one in nine of Singaporeans. One third of diabetic patients would experience some type of diabetic retinopathy prevalence, threatening their vision.
Two nurses have been trained thus far and have administered roughly 30 injections under supervision of doctors. There has been a growing demand for these shots with 6,508 jabs given in 2016 compared to 528 jabs just three years prior to this. Current trends indicate that these numbers are bound to increase.
Meeting rising demand and freeing up doctors’ time
At TTSH’s current capacity of 6,500 injections a year, which is normally administered by doctors, the hospital's eye clinic is not able to meet the increasing demand. Hence, training nurses to conduct this procedure will lead to less waiting time for the patients as well as frees up time for doctors at the eye clinic to see more new cases. At the moment, the standard waiting time for an appointment is about one to two weeks. In fact, clinicians are occasionally required to conduct the procedure after clinic hours.
Nurses here go through thorough training to be qualified for this. They must be selected to be part of the service and undergo a specially designed curriculum including e-learning, lectures, hands-on sessions and even tests.
Ms Chow Peck Foong, 59, a senior staff nurse who has been working for over 30 years relayed her thoughts on this, “I was really glad and excited to be given the opportunity to learn something new, and I believe that taking on bigger responsibilities is a trend for nurses to go into for the future.”
An expansion of nurses’ roles
Some nurses have called for an expansion of their roles in various healthcare avenues. Lee Kay Yan, wrote in to the ‘Straits Times’ saying, “The overall costs of health screening could be cut significantly by having qualified nurses take over some roles of doctors in subsequent consultations.”
She added that the National Heart Centre, for example, has started to allow senior nurses and even pharmacists to conduct consultations and follow-up for warfarin monitoring.
Another writer to the ‘Straits Times’ expressed, “Health screening is often routine and repetitive, and can be time-consuming. It is not necessary to have only a doctor perform any medical consultation associated with the screening. Many health screenings are conducted by trained nurses, who flag abnormal results to doctors for further testing and evaluation. Using allied health professionals, instead of doctors, can decrease the cost of screening without adversely affecting the quality of the screening.” MIMS
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