Audit of Eye Care for Ventilated Patients in Intensive Treatment Unit During COVID-19 Pandemic

Abstract

Introduction The protective ocular mechanisms are disrupted due to sedation and neuromuscular relaxants. This increases the risk of developing ocular surface disease (OSD) leading to increased post critical care morbidity. The risks are further increased in patients who are nursed prone as access to eyes is limited. Our aim was to determine whether eye care met the standard of the Ophthalmic Services Guidance and to improve the quality of care provided if found to be deficient. Methodology and Results A prospective audit of the eye care provided to ventilated patients in critical care was done in April, 2020. An ophthalmological examination including fluoresce in staining was done to ascertain the prevalence of ocular morbidity present. Twenty-seven patients met the inclusion criteria and 88% patients were ventilated secondary to COVID-19 pneumonia. 35% of them were nursed prone at time of assessment; 81% had lagophthalmos (incomplete eye closure) while 53% of patients had a variant of OSD, including 23% with swollen conjunctival prolapse, 18% with conjunctivitis and 12% with corneal abrasions. None of the patients with lagophthalmos had received eye lubricants. Of the proned patients 50% had their eyes taped closed but only 33% had eye lubrication applied. We introduced local best practice guidance adapted from the Ophthalmic Services guidance. Education of critical care staff was undertaken and simplified guidance was exhibited in clinical areas. Post-intervention audit was carried out against the standard after a one-month interval and 24 patients were included (80% COVID-19 pneumonia); 67% had eye lubrication and 50% had eyes taped as per guidance in supine position. 100% of proned patients had eye lubricants with micropore taping. Conclusion During the COVID-19 pandemic, staffs were recruited from diverse backgrounds including theatre scrub nurses, recovery practitioners and operation department practitioners, to work alongside critical care nurses caring for ventilated patients. Education on the best ophthalmic practice guidance enabled holistic care to be provided to many ventilated patients by staff with limited prior experience in eye care in critical care.