Perioperative Corneal Abrasion Prevention Protocol in Prone and Lateral Positioned Patients

Abstract

Problem & Purpose: Corneal abrasions (CAs) are the most common anesthesia-related perioperative ocular injury in non-ocular surgery. Studies show the most common patient-related risk factors include advanced age, dry eyes, and an ophthalmic history. Procedure-related risk factors include general anesthesia, lateral or prone positioning, longer procedures, and robotic surgery. Properly taping eyes closed prior to airway manipulation can prevent corneal abrasions. Anesthesia providers at a medium-sized community hospital found approximately five CAs out of 500 cases occurred in adult surgical patients despite preventative efforts. This Quality Improvement (QI) project implemented a preoperative CAs risk assessment and intraoperative CA prevention protocol to improve the detection of risk factors and implement intraoperative prevention methods. Methods: Inclusion criteria for the preoperative risk assessment were adult patients, scheduled for elective surgery, and receiving general anesthesia. Exclusion criteria included pediatrics, parturient, non-elective surgery, and not receiving general anesthesia. The inclusion and exclusion criteria for the intraoperative prevention protocol remained the same, with the addition of those placed in lateral or prone position to be included and other positions to be excluded. Ocular occlusive dressings were stocked in all operating rooms. Implementation of yes/no checklist forms included a Preoperative CA Risk Assessment of Patient-Related Factors (five-item) and Procedure-Related Factors (four-item), and an Intraoperative CA Prevention Protocol (15-item). Education was provided to preoperative nurses and anesthesia providers. Completed forms were deposited into a locked box in the anesthesia lounge. Baseline data collection began at the start of the implementation period, and weekly thereafter. Data was recorded without identifiers using a secure data management Excel spreadsheet based on inclusion and exclusion criteria. Outcome measures included use of the preoperative risk assessment and the intraoperative prevention protocol with compliance rates displayed using run charts. Results and Conclusion: The risk assessment had compliance rates from 5% to 61% (median=30%). The prevention protocol had compliance rates from 6% to 100% (median=89%). The occurrence of corneal abrasion decreased from 2 to zero per week. A QI project implementing a preoperative CA risk assessment and an intraoperative prevention protocol will improve the delivery of quality care and patient outcomes in the perioperative period.