A Project to Improve Eye Protection to Prevent Eye Injuries Under General Anaesthesia, and Provision of a Toolkit to Manage Eye Injuries that Do Occur

Objective
Eye injuries during general anaesthesia (GA) are not common, and are much easier to prevent than to treat, providing theatre staff take care to use correct eye protection. Some operations are at higher risk than others. Our hospital had a recent series of eye injuries which triggered action to investigate the route cause, improve prevention, and provide clinicians with a toolkit to manage those that do occur.
Setting
This quality improvement project was done across two hospitals within one trust - Bristol Royal Infirmary and St Michael’s Hospital, both within University Hospitals Bristol and Weston NHS Foundation Trust.
Intervention
We introduced local training to raise awareness in eye injuries, and an eye guideline (standard operating procedure) which as uploaded onto the trust intranet to clarify eye protection measures for all staff, in addition to guiding management for eye injuries that occur.
Discussion
Our guideline divided patients into 2 groups - high risk and low risk for eye injuries. Those with a low risk had their eyes taped. Those meeting criteria for “high risk” included operations on the head and neck, patients with positioning such as prone positioning, lateral positioning, or prolonged/steep head down positioning. These patients are treated with lubricant and dedicated eye tape. We introduced an “Eye Box” which resides in theatre recovery, which can be used by clinicians reviewing patients with a suspected eye injury. This streamlines the process of assessment by consolidating all required equipment and information in one box. The box contains the guideline, equipment to assess the eye (local anaesthetic, fluorescein, ophthalmoscope), as well as chloramphenicol ointment to allow clinicians to initiate treatment immediately.