Implementation of an Intraoperative Prevention Protocol and Post-Operative Treatment for Corneal Abrasions

Abstract

Problem: The incidence of corneal abrasions (CAs) at a medium-sized urban community hospital in the Mid-Atlantic region of the United States occurs approximately three-to-five times per month. CAs are the most common ocular injury in patients undergoing general anesthesia for non-ocular procedures and are the result of mechanical, thermal, or chemical damage directly to the corneal epithelium. Development of a perioperative CA is incredibly painful for most patients, and poses the risks of keratitis, infection, corneal scarring, and vision loss. During general anesthesia, the normal protective reflexes of the eye become absent, further exposing the patient to injury. When the eyelid does not completely close, up to 44% of patients develop a CA. Evidence-based methods of eye protection such as taping the eyes closed, using goggles, methylcellulose-based lubrication, or gel drops during general anesthesia decrease the incidence of CAs to less than 0.02%. If a corneal abrasion is suspected, patients require eye patching, anesthetic eye drops, antibiotic ointment, and an Ophthalmologic consultation. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate an evidenced-based prevention plan and treatment algorithm for CAs, decreasing the number of ocular injuries and streamlining the treatment process in those patients who sustain a corneal abrasion. Methods: The anesthesia Quality Assurance (QA) documentation form was updated with a checklist for anesthesia providers to document CA prevention methods and patient positioning. Formal education was provided to the anesthesia department regarding current anesthesia practice recommendations, proper documentation, objectives and goals of the QI initiative. Data collection was achieved with weekly paper QA form audits. Data analysis was based on completion of the checklist on the QA form. Results: Documentation of CA prevention methods increased from 0% to a median of 80% during the 15-week implementation and data collection phase. Peak compliance reached 85% during week nine. The rate of CAs decreased to zero and remained there for weeks 11-15. Conclusions: Implementation of an intra-operative CA prevention plan and documentation system decreased the number of corneal abrasions experienced at a medium-sized urban community hospital.