IMPACT OF IMPLEMENTING CLINICAL GUIDELINES ON EYE HEALTH STATUS OF PATIENTS IN CRITICAL CARE DEPARTMENT, EL MANIAL UNIVERSITY HOSPITAL
Manal S. Ismail and Marwa F. Ahmad*
Medical-Surgical Nursing Department, Faculty of Nursing,
*Ophthalmology Department, Faculty of medicine, Cairo University
Background: Patients in Critical Care Departments (CCD) have impaired ocular protective mechanisms, resulting in a high risk of developing complications. Eye complications can range from mild conjunctiva infection to serious corneal injury so; specific guidelines would provide the necessary information and skills for fulfilling nursing responsibly.
Aim: To examine the impact of implementing clinical guidelines on eye health status of patients in CCD.
Design: pre-post test quasi-experimental research design has been utilized in this study.
Setting: the study was carried out in critical care department, Manial University Hospital.
Subject: Sixty patients were involved in the study. The inclusion criteria were adult critically ill patients, males and females, hospitalized in the CCD more than one week. The exclusion criteria were who's had evidence of exposure keratitis or corneal abrasion on the initial assessment; those had facial trauma, eyelid abnormalities or previous ocular disease or diabetes mellitus.
Methods: the recruited subjects were divided equally into study and control groups. They were matched according to age, gender, diagnosis, therapeutic management (e.g, mechanical ventilation, tracheostomy, and intubations), level of conscious, medications received (e.g., sedation, propofol, neuromuscular blockade). Each patient was assessed twice; first, at admission and second upon discharge. The data collection tools comprised a socioeconomic and medical data sheet, and Eye Assessment Guide (EAG).
Results: All components of EAG were significantly deteriorated upon discharge day in patients of the control group. The mean scores for all components of EAG of patients in the study group were significantly better than those for the control group (p < 0.001). Patients on the therapeutic management (mechanical ventilation, tracheostomy intubations) in the study group had significantly higher scores for inflammation (p < 0.05), eyelids (p < 0.05), conjunctiva (p < 0.05), sclera & cornea (p < 0.05), and total scores (p < 0.01).In addition, there were significant differences between patients in study group who received neuromuscular blocking agents in relation to inflammation (p < 0.05), eyelids (p < 0.05) & cornea & sclera (p < 0.05).
Recommendations: eye care should be part of care provided to all critically ill patients during their admission in CCD. Polyethylene covers (Glad wrap) were more effective for reducing the incidence of corneal abrasions.