• Eye Protection in Anesthesia

    Author(s): Morgan McMahon, RN, BSN; Elliot Barnwell, RN, BSN; Matthew Raymond, RN, BSN; Susan McMullan, PhD, MSN, CRNA, CNE, CHSE, University of Alabama at Birmingham School of Nursing

    Inadequate or inappropriate protection of the eyes by anesthesia providers can leave patients at risk for developing serious eye and skin related injuries.

    Background: A landmark study found 21 out of 60,965 patients developed a corneal abrasion (CA), the most common ocular injury in non-ocular procedures, after anesthesia. Inadequate or inappropriate protection of the eyes by anesthesia providers can leave patients at risk for developing serious eye and skin related injuries. To the best of our knowledge, there is not a standard eye-care protocol in place, causing a gap between evidence-based practice guidelines and the care currently provided. In addition, there is a lack of documentation in many hospitals. A questionnaire survey was used to gather data to investigate CRNA practice for eye care. The purpose of this project was to analyze those data collected, to look for patterns of practice, and to compare it to evidence-based practice in order to decrease the number of CAs and eliminate the pain and suffering patients experience from CAs.

    Method: Following the linear Donabedian model and approval by the University of Alabama at Birmingham School of Nursing, a questionnaire survey was sent to all CRNAs at three facilities in the southeast including a community hospital, a metropolitan private practice hospital, and a major academic medical center. The survey was created in Survey Monkey and consisted of 15 questions that investigated CRNA habits for eye care, experiences with CAs, documentation of eye care, and other information. The survey was made available for 1 month to the CRNAs and all answers were anonymously collected. Data were extracted through the collection and analysis of the completed surveys and compared with current evidence-based practice. Data and privacy protection were ensured by the use of a de-identified dataset, by not collecting IP addresses, and storage of data on a locked computer in a locked office.

    Results: Sixty-three practicing CRNAs responded to the questionnaire, which represents a 38% response rate for the survey. CRNAs reported over 30% (n=19) had an experience with a patient that suffered a CA. Over 50% (n=34) reported that there was no place in the medical record to document CAs or did not know where to document them. Forty percent (n=25) of participants indicated their anesthesia department does not have a standardized eye care protocol and found that the eye protection they use varies based on what is available at their facility. All respondents indicated (n=166) that there is a specific location to document performing eye care. A majority of participants (n=50, 80%) stated they have encountered patients with issues with adhesive tapes. The top three types of eye care applications used alone or in conjunction with other eye care methods include: tegaderm (n=38, 60%), eye lubricant (n=33, 53%), silicone or plastic tape (n=27, 43%). Over 75% of CRNAs reported placing eye protection after placement of the airway device (n=49).

    Discussion: Despite literature reports that CAs occur only in 0.03% of cases, in this project over 30% of CRNAs indicated that they were aware of one or more patient(s) developing a CA. There is a lack of clear institutional guidelines on the management of intraoperative eye care amongst CRNAs. Furthermore, CRNAs are not aware if there is a process to formally document CAs should they occur in the anesthesia department. There was a taping method variance from provider to provider and depended on the current supplies available at the hospital. This suggests that CRNAs use what is available to them and potentially not what is safest for the patient. The results of the surveys were then shared with each facility in conjunction with evidence-based articles. The wide range of eye methods utilized signifies the need for standardized care given the high incidence of reported CAs. However, the problem is complex and compounded by the possible risk of skin tears in special populations, positioning, and other idiosyncratic traits that anesthesia providers must evaluate when choosing an appropriate eye care method. This project is the first step in the development of a standard of care protocol. More research needs to be conducted on the current practice of eye care methods, high risk factors for developing CAs, and comparison of eye care methods before this can be accomplished.

    Funding Sources: This project was funded by the Dean Hayden Student Research and Evidence Based Practice Grant.