Standard Operating Procedure for the Preoperative, Peri-operative and Post-Operative Care for Cataract Surgery Patients

Transcription

1 Standard Operating Procedure for the Preoperative, Peri-operative and Post-Operative Care for Cataract Surgery Patients John Coupland Hospital Johnson Community Hospital Reference No: G_CS_65 Version 1.1 Ratified by: LCHS Trust Board Date ratified: 30 th June 2015 Name of originator / author: Matron, John Coupland Hospital Name of responsible committee / Individual Quality Scrutiny Group Date issued: September 2017 Review date: December 2017 Target audience: Community Hospital Staff Distributed via Website 1

2 Standard Operating Procedure for the Pre-operative, Peri-operative and Post- Operative Care for Cataract Surgery Patients John Coupland Hospital and Johnson Community Hospital Version Control Sheet Version Section / Para / Appendi Version / Description of Amendments Date Author / Amended by 1 New SOP Clare Credland Etended September 17 Corporate 1.1 Assurance Team Copyright 2017 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner 2

3 Standard Operating Procedure for the Pre-operative, Peri-operative and Post- Operative Care for Cataract Surgery Patients John Coupland Hospital and Johnson Community Hospital Contents Procedural Document Statement... 4 EXCLUSION CRITERIA FOR CATARACT SURGERY... 7 PRE-OPERATIVE ASSESSMENT CRITERIA FOR CATARACT SURGERY... 8 REQUEST TO SUPPLY TTO MEDICATION... 9 MEDICATION CHART...11 PREPARATION OF CEFUROXIME FOR INTRACAMERAL USE...12 MIXING BALANCED SALT SOLUTION WITH POVIDINE IODINE...13 MIXING BALANCED SALT SOLUTION WITH ADRENALINE...14 ADMINISTRATION OF EYE DROPS (ANAESTHETIC ROOM)...15 INSTRUCTIONS FOLLOWING CATARACT SURGERY...16 Equality analysis...18 NHSLA Monitoring Template

4 Standard Operating Procedure for the Pre-operative, Peri-operative and Post- Operative Care for Cataract Surgery Patients John Coupland Hospital and Johnson Community Hospital Procedural Document Statement Background Statement Responsibilities Training To ensure a standardised approach to the care delivered to patients undergoing cataract surgery within LCHS Community Hospital Services This document outlines the pathways and procedures which will be followed in order to provide safe and evidenced based delivery of care to cataract surgery patients. It is the responsibility of all staff to ensure they are familiar with the SOP and act in accordance with all components. It is the responsibility of the staff involved and line managers to ensure that the required competencies are developed and maintained in accordance with the skills required throughout the pathways. Eternal support is required to achieve some of the competencies. Dissemination Website 4

5 Standard Operating Procedure for the Pre-operative, Peri-operative and Post- Operative Care for Cataract Surgery Patients John Coupland Hospital and Johnson Community Hospital SOP comes into effect SOP Review date Purpose Scope The SOP details the procedures and processes which will be followed by LCHS staff during the pre-operative, perioperative and post operative phases of cataract surgery when performed at LCHS community hospital sites. The SOP details the processes and procedures which will be performed by LCHS staff but does not include the activities performed by ULHT Consultants, visiting ULHT theatre staff, pharmacy teams or company representatives. Author Signature: Date: Approval Signature: Date: Name: Position: Name: Position: Service manager Has responsibility for authorising the use of the SOP and ensuring it complies with any relevant legislation that may cover the procedures detailed within. Responsibilities Staff Outline the responsibilities of the staff who will operate within the SOP. All staff working within the standard operating procedure are responsible for identifying any deficiencies in the SOP and notifying their line manager accordingly. All staff have a duty of care under the Health and Safety at Work Act Staff should also be familiar with the Trusts Whistle- Blowing Policy and should be able to share concerns without fear of recrimination. All staff have a responsibility to access, be familiar with and comply with all policies relating to this SOP. Staff must always practice within the bounds of their own competence and in accordance with their own Code of Professional Conduct if applicable. All staff have a responsibility to report near misses, adverse incidents and serious untoward incidents as detailed in Incident Reporting Policy. 5

6 Responsibilities Manager It is the responsibility of the manager to inform their staff of the implementation of the SOP and to ensure that the necessary training has been undertaken to enable staff to carry out safely the procedures detailed in the SOP. It is the responsibility of the manager to ensure all staff have access to all policies that relate to their place of work and role within the organization. All staff who will be working to this SOP should sign below to say they have read and understood the SOP and agree to act in accordance with its requirements. Name Job Title Signature Date 6

7 EXCLUSION CRITERIA FOR CATARACT SURGERY LCHS COMMUNITY HOSPITALS All patients will be assessed by the Consultant at the time they are listed for cataract surgery. The following may not be suitable for cataract surgery at JCH: Any health condition that will prevent the patient from lying flat for 30 minutes Any condition requiring continual oygen therapy Any condition with uncontrollable tremor or involuntary movement Unpredictable mental health issues which would make surgery in a confined space difficult Severe claustrophobia Patients with severe communication difficulties Weight in ecess of 225kg or BMI greater than 40 Previous severe anaphylactic response to local anaesthesia or if unknown cause Patients under 18 years of age. 7

8 PRE-OPERATIVE ASSESSMENT CRITERIA FOR CATARACT SURGERY LCHS COMMUNITY HOSPITALS Blood pressure must be below 180/95. Refer to GP for monitoring prior to surgery. Inform Consultant. INR must be within the patient s therapeutic range. INR test should be performed within 1 week of surgery. Anti-coagulant medication to be continued. Patient must be asked to inform SDU of INR result if out of range and surgery must be postponed. Inform Consultant. Blood Glucose must be below 20mmol/l. Check at POA clinic. Inform Consultant if greater than 20mmol/l. Inform Consultant if patient taking IFIS (intra-operative floppy iris syndrome) medication (any alpha blockers i.e. doasozin, tamsulosin). Inform Consultant if patient has clotting disorder. MRSA screening to be performed for previous MRSA positive patients or patients who have been hospitalised within the last 12 months (i.e. admission as an in-patient following surgery or medical admission). If unable to obtain biometry, patient must be referred to ULHT pre-op sisters (clinic 8) for ultrasound biometry (A scan). Postpone biometry if patient wears contact lenses (1 week-soft lens and 4 weekshard lens) Postpone admission if required so that biometry is performed prior to admission (not on the day of admission). Patients are advised to eat and drink normally on day of admission. All medication should be taken as prescribed. Patients should be advised not to omit any medication on day of admission. 8

9 Consultant: MISS GOSSE Date of procedure: REQUEST TO SUPPLY TTO MEDICATION CATARACT SERVICE- JOHN COUPLAND HOSPITAL Medication Dose Route Supply Deamethasone Eye One drop four times Left or Right eye 1 bottle Drops 0.1% daily for four weeks Chloramphenicol Eye Drops 0.5% One drop four times daily for two weeks Left of Right eye 1 bottle Patient Name / Details Addressograph Known allergies Eye (Left or Right) 9

10 Patient Name / Details Addressograph Known allergies Eye (Left or Right) Ordered by Prescriber: Print name: Date: Signature: 10

11 Medication Chart Medication Date: Drug Dose Route Pre-op Apraclonidine 1% drops Phenylephrine 2.5% drops Cyclopentolate 1% drops Diclofenac 0.1% drops Please circle prescription 1 drop Right / Left eye 1 drop up to 3 Right / Left eye times 1 drop up to 3 Right / Left eye times 1 drop Right / Left eye Signed Dose 1- Given by Dose 1- Time Dose 2- Given by Dose 2- Time Dose 3- Given by Dose 3- Time Anaestheti c room Proymetacaine 0.5% drops Povidone-Iodine 5% drops Up to 5 drops Up to 5 drops Right / Left eye Right / Left eye TTO s Drug Dose Route Signed Issued by: Deamethasone 0.1% drops 4 daily, 4 weeks Chloramphenicol 4 daily, 2 0.5% drops weeks Maitrol drops 4 daily, 4 weeks Please circle prescription Right / Left eye Right / Left eye Right / Left eye 11

12 STANDARD OPERATING PROCEDURE CATARACT SURGERY PREPARATION OF CEFUROXIME FOR INTRACAMERAL USE LCHS COMMUNITY HOSPITALS The Circulating and Scrub Practitioner will check Cefuroime 250mg and two 10ml ampoules of Sodium Chloride 0.9%. Use the following procedure to prepare Cefuroime 1mg in 0.1ml injection for intracameral use. Dilute 250mg vial of Cefuroime with 10ml Sodium Chloride. Shake to dissolve. This gives a 25mg/ml solution. Draw up 1.5ml of Sodium Chloride in a 2.5ml syringe. Draw up 1ml of the Cefuroime solution in the same 2.5ml syringe to make a final volume of 2.5ml. Mi well. Using a 1ml syringe, draw up 0.1ml of the Cefuroime solution from the 2.5ml syringe. The Cefuroime solution is 1mg in 0.1ml. 12

13 STANDARD OPERATING PROCEDURE CATARACT SURGERY MIXING BALANCED SALT SOLUTION WITH POVIDINE IODINE LCHS COMMUNITY HOSPITALS The Registered Practitioner will check Povidine Iodine (Aqueous Betadine) 10% and Balanced Salt Solution (BSS) 19mls prior to the patient entering the theatre environment. Open the 19ml ampoule of BSS and draw up 9mls in a 10ml syringe. Dispose of the 9mls of BSS. Draw up 10mls of Aqueous Betadine 10% in a 10ml syringe. Inject the 10mls of Aqueous Betadine 10% into the 19ml BSS ampoule. Complete Topical Anaesthesia label. Ensure label is signed, documenting time and date of preparation. Place completed label in the patients integrated care pathway. Administer as per prescription sheet and in accordance with the procedure for administration of eye drops in the Anaesthetic room. The remaining solution will be used in theatre by the Surgeon for preparation prior to surgery. 13

14 STANDARD OPERATING PROCEDURE CATARACT SURGERY MIXING BALANCED SALT SOLUTION WITH ADRENALINE LCHS COMMUNITY HOSPITALS The Circulating and Scrub Practitioner will check Adrenaline 1:1000 and Balanced Salt Solution 500ml. Draw up 0.5ml of the adrenaline in a 2ml syringe. Circulating and Scrub Practitioner check adrenaline drawn up. Peel back the metal foil on Balanced Salt Solution bottle. Inject the 0.5ml of adrenaline into the Balanced Salt Solution. Place label (Adrenaline 0.5ml- 1:1000) on Balanced Salt Solution bottle. Ensure label is signed, documenting time and date of preparation. 14

15 STANDARD OPERATING PROCEDURE CATARACT SURGERY ADMINISTRATION OF EYE DROPS (ANAESTHETIC ROOM) LCHS COMMUNITY HOSPITALS The administration of eye drops will take place in the Anaesthetic room by a Registered Practitioner who has checked the epiry dates of the Proymetacaine 0.5%, Povidine Iodine 10% Solution and Balanced Salt Solution before the patient has entered the theatre environment. The Povidine Iodine Solution will be diluted with Balanced Salt Solution (BSS) prior to the patient entering the anaesthetic room. See SOP for miing of Povidine Iodine Solution with BSS. Confirm the identity of the patient and if there are any known allergies. Position the patient comfortably on the trolley or in a wheelchair and eplain the procedure and the effects of the eye drops. Administer 1 drop of Proymetacaine 0.5% to the patients eye. Repeat the process after 30 seconds and again after 1 minute. Ensure three doses are given in total. During this process advise the patient to close their eye gently to provide a better anaesthetic effect but not too tightly as this will cause ecessive drying of the cornea. After one minute whilst the patient s eye is still gently closed, administer 2 drops of the diluted Povidine Iodine Solution to the inner corner of the eye. Then ask the patient to open their eye, blink a few times and then close it again gently. Repeat the administration of povidine Iodine as above for a second time. Using a sterile gauze swab, whilst the patient s eye is closed, use any ecess solution to clean around the eye. Administer 1 drop every minute thereafter of the Proymetacaine until the minim is empty. 15

16 INSTRUCTIONS FOLLOWING CATARACT SURGERY The eye shield: Keep the plastic eye shield on overnight until the morning following your surgery. Leave the eye shield off during the day but put it back on at night for the net 2 weeks. Surgical tape to keep it in place can be bought at any pharmacy or most supermarkets. Bathing your eye: On the morning following your surgery, you may clean around your eye. Do not touch the eyeball itself, just wipe gently across the lids. You will be provided with some saline, a pot and some gauze swabs to do this. If needed continue to bathe in the morning using cooled down boiled water. Eye drops: Start using your eye drops the morning following your surgery. Follow the instructions as stated on the medication. Ensure the Chloramphenical is stored in the fridge. Repeat prescriptions can be obtained from your GP. Side effects: Your eye may feel gritty for several days following your surgery. It may also take up to 4 weeks for the vision to completely settle. This is quite normal. It is normal to eperience mild discomfort. You can take your normal analgesia if required. If you eperience ecessive pain or discharge, please contact your GP or Clinic 8 for advice. Things to avoid for the net 2 weeks: Heavy lifting Bending forward for long periods of time Swimming Ball games such as bowling and golf Getting soap or shampoo in your eye Environments with lots of dust. Paperwork: On discharge you will receive a card with the serial number of your implant on it. Please keep this safe. 16

17 You will be given a letter for you to take to your GP which will inform them of the details of your surgery. Please drop this in at your GP surgery following your discharge. You will be given a letter for you Optician. It is important to make an appointment with them in 4 weeks time for a check-up. Please take the letter with you to that appointment. If you need an appointment to be seen for follow-up with the Hospital, you will be given this on discharge. Contact numbers: Clinic 8, Lincoln County Hospital (within normal working hours) et 2457 Digby ward (out of hours) et

18 Equality Analysis A. B. C. D. Briefly give an outline of the key objectives of the policy; what it s intended outcome is and who the intended beneficiaries are epected to be Does the policy have an impact on patients, carers or staff, or the wider community that we have links with? Please give details Is there is any evidence that the policy\service relates to an area with known inequalities? Please give details Will/Does the implementation of the policy\service result in different impacts for protected characteristics? The SOP has been produced to ensure standardised practice is achieved when cataract surgery is performed within the community hospitals. This will ensure staff follow the same processes and that patients receive the same information throughout their journey. The SOP will impact on patients and staff in a positive manner. Procedures within the pathway are clearly described ensuring staff have a reference document to follow. Patient information is detailed within the SOP so this will ensure patients receive the same information to support the procedures performed. None identified. None indentified Disability Seual Orientation Se Gender Reassignment Race Marriage/Civil Partnership Maternity/Pregnancy Age Religion or Belief Carers Yes If you have answered Yes to any of the questions then you are required to carry out a full Equality Analysis which should be approved by the Equality and Human Rights Lead please go to section 2 The above named policy has been considered and does not require a full equality analysis Equality Analysis Carried out by: CLARE CREDLAND Date: 19/5/15 No 18

19 NHSLA Monitoring Template Minimum requirement to be monitored Monitor care pathways for patients undergoing surgery Process for monitoring e.g. audit Monitored at service/contract reviews Dati reporting of incidents relating to this SOP Responsible individuals/ group/ committee COAST CTL Matron NWBU Frequency of monitoring/audit Monitored through incident reporting presented at BU CG Responsible individuals/ group/ committee (multidisciplinary) for review of results BU CG group Medicines Management Committee associated incidents occur if Responsible individuals/ group/ committee for development of action plan COAST CTL BU CG Responsible individuals/ group/ committee for monitoring of action plan BU CG Medicines management 19