ABSTRACT
Introduction: Quality improvement (QI) is a systemic multidimensional approach to ensure the care provided by health professionals is safe, effective, person-centred, timely, efficient and equitable (The Health Foundation 2013). Within critical care, standards are set by organisations to provide up to date good quality care to all patients. The author identified an increase in patient proning over the last 12 months due to the Covid-19 pandemic, resulting in a large increase in incidents of eye injury by 30%, with 2 patients receiving ophthalmology treatment and manual closure of the eye. The cases highlighted could have been potentially avoidable with a standardised approach to care. Objectives: Patients within critical care are high risk for injury due to facial oedema, reduced conscious level and treatment interventions. The Intensive Care Society (ICS) endorsed a guideline to prevent eye injury and increase education surrounding the subject (Intensive Care Society 2020). Variability is still significantly affected in practice with the author's unit demonstrating a low compliance compared to ICS standards of >90% compliance. The specific aim for the author's intervention in practice was to implement changes in practice to increase compliance in line with ICS standards for eye care within critical care in 6 months. Method: Ocular surface disease is common within the author's practice with 20-42% of patients developing corneal epithelial defects (Johnson & Rolls 2014). Cases highlighted as 'severe incidents of harm' within the author's area of practice could have been avoided with a standardised approach to care. Despite the high number of patients effected by this issue there is a severe lack of education and documentation surrounding eye care within critical care. The team implemented structured educational guidance and documentation to improve compliance within critical care to reach ICS standards. Audit of assessment, treatment and documentation of nursing notes was completed at 3, 6 and 12 monthmarks whilst using a formative evaluation approach which looks at the improvement project as it evolves and suggests ways in which it can be improved. Results: Post intervention data identified an increase to 100% of patients receiving eye care. Implementation of the documentation and education to bedside nurses increased assignment of eye grade from 0% to 90% and documentation of eye care increased from 60% to 95%. 95% of nurses were confident in completing eye assessment, grading and relevant treatment compared to 0% pre intervention. Future aims are to monitor all reported eye related injuries and maintain >90% compliance in line with evidenced based practice and national guidelines. Conclusion: The study identified a significant problem in critical care that was causing potential preventable patient harm. The results of this QI project are generalisable to other areas by increasing patient safety and staff education on the potential harm of ineffective eye care within critical care. Further research and work are required to develop awareness surrounding eye care in the critically ill.