Hong Kong Eye HospitalQA Forum 2012

Guide Books On Laser and Ultrasound Bio-Microscopic (UBM)

Procedure

RN Lee Pui Yuk Ada

CMU/DSC

Presentation Outline:

1. Background of the QA initiative

2. Aims & Objectives

3. Developing Process

4. Content of Guide Books

5. Outcome

6. Way Ahead

Background of existing practice in CMU

Laser procedure

• Weekday assisted by ECA of DSC

UBM procedure

• Weekday assisted by ECA of DSC

ECA on leave or not A/V

Laser

• Assisted by CMU nurse

UBM

• Assisted by CMU nurse

Reasons for production of guide book

• New laser and UBM machines

• New nurses join CMU

• Existing nurses have limited exposure to those procedures

• Increase number of non scheduled laser and UBM procedures

• Lack of quick reference on machines operation in case of non schedule service

Cont’d

• Guide book cannot substitute a proper training. It acts as a supplementary information so as to refresh staff’s memories.

Non Scheduled Laser Cases in CMU

0

5

10

15

20

25

30

35

40

45

2009 2010 2011

No. of cases

UBM Cases in CMU

Aim

To provide a quick reference for CMU nurses on laser and UBM procedure

Objectives

• To enhance staff competency in assisting ophthalmic laser and UBM procedures

• To ensure patient safety

• To provide high quality and efficient service

Developing ProcessOct. 2011

Develop guide book for ophthalmic laser and UBM procedures

Nov.

2011

Obtain staff opinions after reviewing the guide books

Dec. 2011

Refinement of guide books

Procedure Book On Ophthalmic Laser

1. Collect laser key from C5 drawer in ward manager office(CMU) or room 146 in OPS

2. Prepare laser machine according to the type of laser treatment

Room 159 Laser Type: Argon

Wavelength: 532nm

Room 160 Laser Type: Argon / Yag

Wavelength: 532nm/1064nm

Room 161 Laser Type: Argon

Wavelength: 514nm

Before Laser Procedure

3. Prepare the appropriate aspheric lens for laser.

Lens Image PRP/Barrier Laser Iridotomy

Yag Capsulotomy

Suture lysis

Abraham Capsulotomy Yag

Abraham Iridectomy Argon

Abraham Iridectomy Yag

Hoskins Nylon Suture Argon/Diode

Ritch Nylon Suture Argon/Diode

Mainster PRP 165 Argon/Diode

Mainster Wide Field Argon/Diode

Super Quad 160 Fundus

Three Mirror Universal Argon/Diode

4. Disinfect lens by immersing it into a container filled with 3% Hydrogen Peroxide for 5 minutes , then rinse with filtered running water for 5 minutes

5. Prepare eye goggles.(Specified wavelength on the goggle must corresponds to wavelength of laser procedure)

6. Ensure patient’s identification

7. Obtain an informed consent

8. Administer eye premedication

1. Complete the time out procedure

2. Make sure the laser warning light is switched on & the door is locked ( interlock system in place)

3. Position patient comfortably with head well supported

4. Observe patient ‘s general condition during the procedure, detect any abnormalities, e.g. Vasovagal attack

During Laser Procedure

1. Irrigate the affected eye with normal saline if required

2. Administer Gutt Tobrex 0.3% after all laser procedures and Gutt Alphagan P 0.15% after Iridotomy, Iridoplasty, Capsulotomy, Membranotomy, Trabeculoplasty, Vitreolysis

3. Document the procedure in the laser record book

4. Disinfect the used lens with 3% Hydrogen Peroxide for 5 minutes , then rinse with filtered running water for 5 minutes dry and return to the original place

5. Safe custody of laser key afterwards

After Laser Procedure

+/-

Guide Book On UBM Procedure

1. Place the plastic ring onto the edge of the ring applicator, and then place a membrane on top.

2. Press the eye cap against the membrane ring applicator as a result the membrane is fixed onto the eye cap tightly with the plastic ring

Two different preparations of the P60 UBM machine:

(1) Steps for UBM with eye cap & membrane

membrane plastic ring

Eye capMembrane ring applicator

3. Immerse the eye cap with fixed membrane with Cidex OPA for 12 minutes

4. Immerse the disinfected eye cap with fixed membrane in water for irrigation for 1 minute x 3 times

5. Dry the eye cap with fixed membrane with sterile gauze

6. Fill up the eye cap with water for irrigation to the marked level

7. Screw the transducer to the probe tightly

Caution:

- Handle with care because these components are fragile and could be damaged if dropped

- Inspect for any visible damage before use

- Inform W.M. if the transducer changed color (normal: silver color)

8. Attach the water filled eye cap to the probe

Water to marked level

Water for injection

Probe without transducer Probe with transducer

Eye cap with water

9. Turn on wall power

10. Login the computer

11. Change another eye cap with fixed membrane in-between cases by repeating step 2 to 6

turn on this wall power

1. Disconnect the probe from the probe cable

2. Screw the transducer to the probe tightly, inspect for any visible damage before use

3. Immerse the probe with transducer and eye cup into Cidex OPA for 12 minutes

Caution:- Never allow liquid to enter the connector

as damage could occur- Do not immerse the probe without a

transducer installed. Failure to do so could damage the probe

(2) Steps for UBM with eye cup

4. Immerse the disinfected probe with transducer and eye cup in a sterile container filled with water for irrigation for 1minute x 3imes

5. Dry the disinfected eye cup and probe with transducer with sterile gauze

6. Attach the probe to the probe cable by matching the red spot

7. Turn on wall power

8. Login the computer

9. Assist doctor to insert eye cup securely into patient’s eye. Then fill up the eye cup with 10ml water for injection

10. Repeat step 3-6 in between cases

Turn on this wall power

Eye cup

Water for injection

(C) During the procedure :• Ensure patient’s identification• Assist patient to lie on bed comfortably covering with blanket• Apply Gutt. Novain to patient’s examined eye before the procedure• Prepare dim light environment• Monitor patient’s condition throughout the procedure

 

(D) After care :• Apply Gutt. Tobrex to patient’s examined eye after the procedure• Ensure proper documentation on the UBM record book• File the UBM result into the patient’s OPD record• Check the integrity and exact number of the items used e.g. eyecup, eye

cap, plastic rings and transducer. Sign the inventory book.• Disinfect the used items by immersing them into Cidex OPA for 12

minutes• Immerse the used items in water for irrigation for 1 minute x 3 times after

disinfection• Dry the used items by gauzes then keep them in the designated drawer • Discard the membrane each time for individual patient

Feedback From Staff

• User friendly

• Concise, informative

• Refresh their memories

• Provide quick guide in case of ad hoc procedure

Effect On Clinical Service

• Smooth Service

• Shorten preparation time

• Effective & Efficient

Outcome

• Staff competency in ophthalmic laser and UBM procedure is ensured.

• Patient safety is maintained.

• Efficiency of the service is enhanced

Way Ahead

Production of guide books for other procedures in future.