Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Wong KN(1), Lee WS(1), Kwong KY(1), Fong KS(1), Ku SY(1), Chan WK(1), Ip WS(1)
Affiliation :
(1)Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital
Introduction :
Defense mechanisms of eye comprise eyelid closure and blinking of eyelid for distribution of tear film. Common contributing factors include impaired level of consciousness, reduced blink reflex, neurological lesions with sensory or motor loss and conjunctival oedema. The breakdown of the mechanism left cornea exposed and hence dried up. The risk of infection and scarring increase, which may even lead to poor vision or permanent visual loss.
Objectives :
(1) to develop a standard practice of eye care for PICU nurses by using EBP approach;(2) to increase the level of practice on eye care among PICU nurses; (3) to early recognize & prevent corneal dryness among patients with impaired eye defense mechanisms.
Methodology :
Literature search was conducted since August 2019. An evidence-based practice for patients with impaired eye defense mechanisms was developed based on local & international guidelines and literature review. Hypoallergenic tape with silicone adhesive was searched for eyelid closure. The prescription of eye ointment was discussed with PICU consultant and a workflow of eye care was set up. A standard practice of eye care was commenced since June 2020. Outcome measures: 1) Assess nurses' compliance to the standard practice and workflow, 2) Observe the incidence of corneal dryness among patients with impaired eye defense mechanisms.
Result & Outcome :
Before commencement of the standard practice, total 48 patients had impaired ocular defence mechanisms from January 2018 to August 2019. Only 20% (10 patients) and 4 % (2 patients) of them received eye ointment and eyelid taping respectively. 42% (20 patients) had symptoms of corneal dryness. After commencement of the standard practice from June 2020 to December 2022, 100% of the patients (total 64 patients) with impaired ocular defense mechanisms received eye ointment and eyelid taping. All nurses complied to the standard practice and workflow. Also, patients with symptoms of corneal dryness decreased from 42% to 9-13% (odd ratio = 2.33, 95% CI, 1.03 to 5.27). Conclusions: The standard practice of eye care was effective for early recognition and prevention of corneal dryness among patients with impaired eye defense mechanisms. All PICU nurses were able to follow the standard practice and workflow to provide consistent eye care.
