Management of corneal foreign bodies in the Emergency Department

Quality Improvement Poster Download

Background & Problems

Corneal foreign body is the commonest eye presentation to the Gloucester Emergency Department but despite this, there is great variation in how this presentation is managed.

Aim

• 75% of patients over 18 presenting to GRH ED to be correctly assessed and treated:
  • Correct prescription of antibiotics
  • Use a Slit Lamp
  • Fluorescein administration
  • Eyelid eversion.

Method

Measuring against gold-standard criteria, current practice showed large heterogeneity of how professionals treated this condition across grades within the department. Data collection showed that only 12% of patients were receiving “perfect” management according to criteria in November 2015. Due to this we sent out a survey to identify the root cause of this spread.

Results

Initial data collection showed spikes of improvement with each intervention, which rapidly tailed off. Despite the short effects of each change, the baseline did slightly improve.The guidelines have shown the greatest single improvement, as professionals are able to supplement any knowledge they lack. Initial data from teaching has shown significant improvement, and in light of this, we have engaged an ENP to continue teaching so this improvement can be maintained.

Implications

Thorough assessment and appropriate management of corneal foreign bodies is vital in the prevention of complications which can be sight damaging.

• With appropriate education and guidance, all areas of gold standard treatment can be achieved.
• Confidence and knowledge are the two greatest limits to effective care.
• There is a need for ongoing reinforcement and education to maintain improvement.