A case-control study of an intraoperative corneal abrasion prevention program: holding the gains made with a continuous quality improvement effort.

BACKGROUND: Corneal injury is the most frequent ocular complication during general anesthesia. Although prevention has appeared feasible, inconsistent use and timing of conventional eye ointment and eyelid tape had failed to adequately prevent intraoperative corneal injuries at a department of anesthesiology in an academic medical center. A continuous quality improvement (CQI) program was thus undertaken to prevent intraoperative corneal injury. PLAN-DO-CHECK-ACT: A departmentwide Plan-Do-Check-Act cycle, and specifically the Seven-Step Problem-Solving Model, were applied. The new standardized eye- protection method involved eye lubrication with aqueous-based gel and application of clear, square occlusive dressings that were large enough to cover the eyelids and surrounding skin. Standardized documentation of patient eye protection in the electronic anesthesia record was also implemented. A systematic approach maximized departmental awareness about this new eye-protection method and its documentation. Subsequent individual practitioner counseling and reinforcement was undertaken.
RESULTS: A total of 50,151 sequential general anesthetics before and 113,044 sequential general anesthetics after implementation of the new corneal injury prevention program were analyzed. The corneal injury rate was 1.20/1,000 general anesthetics before versus 0.09/1,000 general anesthetics after implementing our prevention program (p < .001). This pattern of a marked reduction in intraoperative corneal injuries was sustained for the entire 45-month follow-up period. DISCUSSION: A simple and cost-effective method for preventing intraoperative corneal injuries was successfully identified, implemented, and sustained. The systematic approach involved a rigorous reiterative approach and resulted in a fundamental change in local practice pattern.