Process Improvement: Perioperative Eye Protection under General Anesthesia for Nonocular Surgery

Abstract

Purpose. This process improvement project aimed to promote systematic perioperative eye protection for patients who undergo general anesthesia for nonocular surgery.Background. Perioperative eye injuries can cause distress from severe pain, vision loss, and even blindness. Anesthesia practice pattern is associated with perioperative eye protection outcomes. Eye protection beyond taping the eyes with general anesthesia is institution and practitioner dependent. Clinical evidence indicated that consistent anesthesia department-wide eye protection practice changes improve outcomes. Presenting current practice-based evidence could promote local process improvement toward a sustained result. Methods. The Ottawa Model of Research Use Theory guided this education and survey-based project design. All eligible anesthesia providers (n=12) were invited to review a PowerPoint presentation of an innovative four-step eye protection Bundle and its associated theory and clinical evidence. Their current practice and future practice change were surveyed for each component of the Bundle. Two data points—the participation rate and the Bundle acceptance rate in the post-survey—have to reach a predetermined threshold to consider implementing any component of the Bundle. In addition, the post-survey must receive a higher approval rate than the corresponding pre-survey question. Results. The first data point is the participation rate which is 67% (8/12), over the threshold of 50%. The second data point is that Five Bundle components reached the threshold of 60% in the post-presentation survey with three of the five components showing significant differences from pre-presentation survey. The three components are Individualized eye protection- “Need-based product choice,” “implementing an anesthesia department-wide perioperative eye complication treatment protocol, and collecting data on eye-protection outcomes. Conclusions. This project identified three priority areas of practice change for local process improvement.