Aim

To introduce a universal screening programme for all children in North East Wales NHS Trust in line with the current recommendations. This involved Orthoptists being responsible for vision screening in Schools with children in the reception class i.e aged 4 - 5 years of age. This was a new development for the Orthoptic department.

Methodology

Discussions were held with the Child and Family Directorate to decide how to take the project forward. A pilot project was done involving schools in the Community First areas. Orthoptists screened all the children in those schools using Logmar test and also performed other Orthoptic tests. Following the success of the pilot project it ws agreed to roll the project out across all schools in the Trust. Protocols were developed in line with the Health for all children document and the uptake of screening improved from 34% at Health Visitor screening to 99% coverage.

Results

Orthoptists now vision screen all children aged 4 - 5 years in North East Wales. This has resulted in a reduction in the number of inappropriate referrals into secondary care and has speeded up the process for those children who have a visual problem as it was found that Orthoptists are more likely to refer those children with visual problems more quickly than when school nurses were responsible for screening.

Since Orthoptists have been screening we have found that the percentage of children with visual problems is actually higher in our area than stated in the literature

Evaluation

The scheme works extremely well , all staff involved have managed the change in the process and feedback has been good. The school health attendants who assist with the screening programme are very positive. The vision test used for all children has now been changed to Logmar testing and the Orthoptists have provided training for this. The Head Orthoptist attends regular meetings of the Well Child Group to discuss the scheme.

The consent criteria has been changed recently so that the vision screening is included in the initial consent for all screening in school. No child is screened without positive parental consent

Reflection

The implementation of a universal screening scheme for all children in North East Wales was quite daunting at the outset but has worked extremely well. The scheme only worked well with the cooperation and enthusiasm of all those invovled school nurses, school health attendants and Orthoptists also Director of Nursing and Well Child Group. The development of protocols has been extremely useful and the referral criteria have been tightened up.

Further action

We are about to develop a scheme with Local Optometrists which will enable children to be refracted by local optometrists who would be part of the scheme . The children would then be under the joint care of the optometrists and the Orthoptic Service. The Head Orthoptist will be having talks with the Local Health Board and optometrists to decide how to take this forward.