Abstract
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Background: Driving is a crucial component of daily living; however, visual field defects (VFDs) from intracranial tumours and strokes can impair safe driving. Intracranial tumours and cerebrovascular accidents are amongst the most common causes of acquired VFDs. Clinicians are obligated to provide and document driving advice aligned with the Driver and Vehicle Licensing Agency (DVLA) guidance to ensure public safety and prevent medico-legal risk in the United Kingdom.
Aims & Objectives: This audit aims to determine whether patients with clinically significant VFDs, secondary to strokes or intracranial tumours, had documented evidence of receiving driving advice in accordance with DVLA guidelines. Based on the findings, targeted quality improvement interventions may be suggested to improve documentation. A re-audit cycle will be planned to assess the effectiveness of recommended changes.
Methods: This is a retrospective audit of electronic patient records of patients within the ophthalmology department of the Manchester Royal Eye Hospital in the United Kingdom. Data were obtained from the tumour (ORTUM) and stroke (ORSTROKE) neuro-ophthalmology clinics, with documentation completed by orthoptists within a six month period. Descriptive statistical analysis was performed, and documentation and compliance rates were calculated. Based on the findings, targeted quality improvement interventions are suggested to improve documentation. The target compliance rate was set at 100%, reflecting the expectation that all eligible patients should have clear and documented evidence of driving advice within the clinical record.
Results: 54 patients with VFDs secondary to intracranial tumours or stroke were included in the audit. ORTUM (n = 37) had a mean age of 54.9 years compared with 71.2 years in the stroke cohort (n = 17). Overall, 50.0% (n = 27) of patients had no documented driving advice. Across the combined cohort, full compliance with DVLA guidance was 11.1% (n = 6). This audit demonstrated that documentation of driving advice is below national standards. Stroke patients demonstrated higher rates of driving-related documentation compared with tumour patients (64.7% vs 43.2%). The current ORSTROKE proforma has more check boxes regarding VF loss, counselling and driving advice compared to the ORTUM proforma, which just has one question to ask if they are drivers or not. This may result in more consistent inclusion of driving advice for stroke patients. Tumour-related VFDs may be less immediately recognised as requiring formal DVLA advice, particularly if symptoms are subtle or progressive.
Conclusion: DVLA-compliant documentation of driving advice in patients with VFDs was suboptimal. Findings demonstrate a clinical governance gap and support implementation of standardised documentation. clinicians have a professional duty to provide information regarding driving fitness, DVLA notification, potential cessation and further assessment where appropriate.
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