Myuran Tharsika
King's College Hospital.
BMJ Qual Improv Rep. 2017 Jan 16;6(1). doi: 10.1136/bmjquality.u211253.w4618. eCollection 2017.
Up to 30% of patients who have periorbital trauma will have ocular injury with devastating consequences if missed. All staff working with acutely injured Oral and Maxillofacial Surgery (OMFS) patients should be competent in a basic eye examination with documentation of visual acuity, gross visual fields, eye movements, diplopia, and pupillary responses at a minimum. As a standard we adapted guidance published by the Emergency Care Institute New South Wales to assess the documentation of the eye examination in OMFS patients at King's College Hospital with any periorbital injury. After initial assessment we presented the data in the departmental audit meeting, then gave a detailed teaching session to junior doctors and introduced an 'eye exam' proforma sticker designed to act as an aide memoir. At baseline, 38 eye assessments across all clinical environments and by all seniority of clinician were assessed at random. Of these, 41% of these had visual acuity documented, 5% visual fields, 47% pupils, and 83% movements. After presentation of data, reaudit showed progress to 81%, 0%, 94%, and 100% respectively. Following the teaching session reaudit showed final progression to 83%, 46%, 83%, and 100%. Teaching sessions and use of an eye sticker proforma has been shown to improve rates of documentation of the eye exam for those OMFS patients presenting with periorbital injuries.
高达30%的眼眶周围创伤患者若未被及时发现，将会出现眼部损伤并带来灾难性后果。所有处理口腔颌面外科（OMFS）急性损伤患者的工作人员都应具备基本的眼部检查能力，至少要记录视力、大致视野、眼球运动、复视和瞳孔反应。作为一项标准，我们采用了新南威尔士州急救研究所发布的指南，以评估国王学院医院患有眼眶周围损伤的OMFS患者的眼部检查记录情况。在初步评估后，我们在部门审核会议上展示了数据，然后为初级医生举办了详细的教学课程，并引入了一种“眼部检查”表格贴纸，用作备忘辅助工具。在基线时，随机评估了所有临床环境中所有资历的临床医生进行的38次眼部评估。其中，41%记录了视力，5%记录了视野，47%记录了瞳孔，83%记录了眼球运动。在展示数据后，重新审核显示分别进展到了81%、0%、94%和100%。在教学课程之后，重新审核显示最终进展到了83%、46%、83%和100%。教学课程和使用眼部贴纸表格已被证明可提高患有眼眶周围损伤的OMFS患者眼部检查记录的比例。
