Post- interven+on data and new pro forma. Improving the management of pa0ents with acute red eyes in a large London Accident and Emergency Department

Transcription

1 Post- interven+on data and new pro Improving the management of paents with acute red eyes in a large London Accident and Emergency Department

2 Rela+onship between the use of clerking pro s for pa+ents with an ul+mate diagnosis of acute conjunc+vi+s and the documenta+on of contact lens status Contact lens status not Contact lens status No New pro Old pro New pro used? Total

3 Propor+on of pa+ents with contact lens status based on the use of a clerking pro 1% 9% 8% 7% 6% 5% 4% 3% % 1% Contact lens status not Contact lens status % No New pro Old pro Pro used? Total

4 3 Documenta+on of contact lens status based on grade of clinician CL status not CL status?? Dr,? grade ENP GP JCF SHO SpR Grade of clinician 1% 8% 6% 4% % % Propor+on of the different grades of clinicians who document contact lens status?? Dr,? ENP GP JCF SHO SpR grade Grade of clinician CL status not CL status NB:?? denotes that grade of clinician was not in ED medical notes

5 3 Use of pro s based on grade of clinician 25 No pro used Old pro New pro ?? Dr,? grade ENP GP JCF SHO SpR Grade of clinician

6 Formal documenta+on of acuity based on use of clerking pro Acuity not Acuity 1 New pro Old pro No pro Total Pro

7 The use of pinhole acuity correc+on when acuity < 6/9 (n = 45) Pinhole not used when acuity < 6/9 Pinhole used when acuity < 6/9 New pro Old pro No pro Pro use Total Use of slit lamp based on grade of clinician Slit lamp not used Slit lamp used?? Dr,? grade ENP GP Grade of clinician JCF SHO SpR Total

8 An+bio+cs An+bio+c prescrip+on where contact lens status known Correct anwbiowcs Incorrect anwbiotcs CL status unknown An+bio+c prescrip+on Influence of pro on appropriate an+bio+c prescrip+on New pro Old pro No pro Pro use Unknown Incorrect anwbiotcs Correct anwbiowcs

9 Influence of pro on safety- neqng No safety net Safety net 1 New pro Old pro No pro Pro use

10 ! A&E Eye Examination Pro Form completed by: Name... Role... Date & Time... Patient Details Name:... DOB:... Hosp. No:... Presenting complaint (1line):... Contact Lens Wearer: Yes No Distance Glasses Wearer: Yes No Contact lens wearers are at increased risk of sight threatening infections. Please see Kwiki guidance. Right Eye Left Eye Visual Acuity Write as: 6 / patient acuity Use distance glasses / CL Use pinhole if 6/9 Ocular Movements Either write grossly full or describe abnormalities Normal or Visual Fields Select normal or shade areas of visual loss or Normal Shape: Regular Irregular Light Reaction: Normal Slow Absent Yes No Pupils RAPD Relative afferent pupillary defect swinging light test Shape: Regular Irregular Light Reaction: Normal Slow Absent Yes No everted upper lid Lids normal outer upper/lower Lids Select lids normal or draw abnormalities eg: stye / cyst / inflammation / ptosis / xanthelasma / trichiasis outer upper/lower everted upper lid Lids normal white discharge red oedema Other: Normal or normal hyphaema (blood) hazy hypopyon (pus) Other: Conjunctiva Corneas Slit lamp used: Yes No Select normal or draw abnormalities eg: stain uptake / trauma / infiltrates (white spots) / foreign body Anterior Chamber Slit lamp used: Yes No Any other findings Other relevant examination, eg: fundoscopy, neurology white discharge red oedema Other: or Normal normal hyphaema (blood) hazy hypopyon (pus) Other: Patient Outcome Home with advice (specify)... Discharged to GP Eye clinic review <48hrs as per Red Eye in a Contact Lens Wearer / Chemical Injury pro: Attach relevant pro & cas card and fax to eye clinic on am-5pm: Call 1418/5466 (ERS triage nurse) to book appointment and record date & time:... After 5pm ERS Administrator please contact patient and book appointment Eye clinic review in..days as per discussion with Ophthalmology SpR (name) Other (specify). All notes must be deposited in eye symptom box in reception

11 Red Eye in a Contact Lens Wearer Please fill in check boxes as each stage is complete, and ahach to the A&E eye examinawon pro Thorough history Previous eye problems/surgery Eye drops Trauma Chemical injury (soluwons) Type of lens (rigid/sob; daily/weekly/fortnightly/monthly) How old are current contact lenses / cleaning soluwon Any overnight contact lens wear (i.e. slept with lenses in) Use of tap water to wash lenses/ eye washing with lenses in Any swimming with contact lenses in place PaWent Details/SWcker: Name: DOB: Hospital No... Form completed by: Name: Role: ExaminaWon to include: Acuity Fluorescein stain + blue light Corneal stain uptake OR white patch on cornea? YES or UNSURE Refer to 1 st on- call ophthalmologist NO ConjuncWval swab Send contact lens/ lens case + soluwon for microbiology (where available) Discharge with ofloxacin 4 hourly Eye clinic review within 24-48hrs (see instrucons on A&E eye examinaon pro)

12 Chemical Injury to an Eye Please fill in check boxes as each stage is complete, and ahach to the A&E eye examinawon pro Topical anaesthewc (eg: 1% tetracaine) + COPIOUS IRRIGATION WITH SALINE UnWl ph neutralised, usually 1-2L Use Morgan contact lens if available PaWent Details/SWcker: Name: DOB: Hospital No... Form completed by: Name: Role: Thorough history, including nature of injury (acid / alkali) ExaminaWon to include: Acuity Slit lamp with: Everted eyelids Fluorescein stain + blue light ph of eyes YES or UNSURE Corneal stain uptake or white patch on cornea? NO Refer to 1 st on- call Ophthalmologist MODERATE /SEVERE ConjuncWval congeswon? MILD Discharge with chloramphenicol drops QDS Eye clinic review in 24-48hrs (see eye examinaon pro)