Eye care - Governance

Section

Recommendation statement

Grade of recommendation

17.

Eye care interventions should be included as part of a comprehensive patient care plan.

C

Consensus

18.

All ICUs must ensure clinical staff are competent in the delivery of appropriate eye care.

D

19.

All clinical staff must maintain contemporaneous documentation of eye health and interventions. A flowchart, checklist or check box tool is suggested, which should be completed on shift handover for this purpose.

D

20.

All ICUs should monitor the effectiveness of eye care delivered by monitoring for iatrogenic ophthalmological complications. This could include:

  • review of adverse events as reported
  • audit of practice
  • review of ICU eye consults
  • review of health of donated corneas
  • point prevalence studies.

D

Governance mechanisms are essential if the eye health of critically ill patients is to be maintained and incidence of iatrogenic ophthalmological complications minimised. These mechanisms include:

  • contemporaneous documentation
  • inclusion of ophthalmological problems of critical illness in clinician education
  • evaluation of practices and patient outcomes.

Eye care interventions should be included in a comprehensive patient care plan, which is regularly reviewed and updated. This approach facilitates awareness of changes to the patient’s condition, eye care treatment requirements and a record of treatment outcomes (1). Standing orders may be useful in ensuring timely intervention such as the initiation of ocular antibiotics where infection is suspected. Contemporaneous documentation of patient eye status (and treatment), recorded each nursing shift as a minimum, may be aided by the use of a tick box checklist tool for attachment to either paper flow chart, or CIS entry.

Staff training in eye care practice has been identified as being essential to addressing the incidence of OSD in ICU (2). For this reason, staff education on the essentials of eye care practice, including hand hygiene and infection control for eye care management, has been recommended. A comprehensive education program is also suggested, including content covering ocular physiology and pathophysiology, treatment options, eye care guidelines and care plan development.

Currently, Australasian data on the epidemiology of iatrogenic ophthalmological complications in ICU is limited. To date, limited data has been obtained in NSW through the use of the IIMS incidence reporting mechanism. Ongoing monitoring OSD rates and the effectiveness of eye care practices does have support in the literature (1). The use of existing auditing tools and outcome assessment measures, such as IIMS and practice audit reporting, should be considered in order to identify both individual and system issues negatively affecting patient quality of care. Consensus among GDN members also supports the usefulness of auditing processes to track the rate and need for ophthalmologic intervention, to review the health of donated corneal tissue, and for use as a point prevalence study to identify the incidence of OSD for patients in the ICU unit at any time point.. In conclusion, it has also been recommended that the use of data and information gathered through auditing processes, iteratively inform eye care practice and policy development at a local ICU level.

Grade of recommendation Description

A

Body of evidence can be trusted to guide evidence

B

Body of evidence can be trusted to guide practice in most situations

C

Body of evidence provides some support for recommendation/s but care should be taken in its application

D

Body of evidence is weak and recommendation must be applied with caution

Consensus

Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (3)

References

  1. Marshall A, Elliott R, Rolls K, Schacht S, Boyle M. Eyecare in the critically ill: Clinical practice guideline. ACCCN (Australian College of Critical Care Nurses). 2008;21:97-109.
  2. Ezra D, Chan M, Solebo L, Malik A, Crane E, Coombes A, et al. Randomized trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Medicine. 2009;35:455-61.
  3. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.