Aim

In 1996 it was recognised that children with moderate severe learning disability attending Childrens Eye Clinics found the experience difficult because

The children were in a strange location

Waiting in clinic to see an orthoptist and ophthalmologist and for eye drops to take effect

Also there was a high DNA rate amongst this population

We wanted to improve the service provided for this vulnerable group of children and their parents/guardians.

Methodology

Following consultation with Community Paediatricians, Ophthalmologists, Community Nurses, Orthoptists, Parents/Carers and the Special School attended by the majority of these children in our area it was decided to transfer 6 Eye and Orthoptic clinics per annum to the school.

The clinics would be staffed by a Paediatric Associate Specialist Ophthalmologist, Orthoptist, Eye Clinic Nurse and the School Nurse.

Appointment letters were designed. Parents are invited to attend the clinic if they were able to so. The appointment letter also includes a consent form for eye/orthoptic examination and for the instillation of cyclopentolate 1% eye drops and consent to sharing information with school staff for those children who attend without their parent or guardian.

Results

 The clinics started early in 1997 and are considered a success:

• Children are less stressed when attending.
  • They either come to clinic with their parents/guardian or with a teacher or class room assistant. Occasionally they will bring a friend.
  • They do not wait to be seen.
  • If eye drops are needed the child returns to his/her class while they are taking effect.

• DNA rates have been reduced
• Parents/guardians can choose to attend with their child but in many cases it is better for the child and easier for the parent/guardian for the child to attend with his/her teacher. The parent/guardians are informed informed of the outcome of the appointment by letter. If they wish they can contact an Orthoptist or School Nurse at any time.
• School and Health Professionals are able to request referral to the clinic
  Direct contact with teachers is very helpful when these children

Evaluation

The service is audited and continues to be supported by the local Eye Unit, Paediatrics and by the School.

Reflection

We were able to set up an eye service for a vulnerable group of children without additional cost by transferring the location of an existing clinic.

Further action

To continue to monitor the efficiency of the clinic