Minimizing Surgical Errors in Ophthalmology

Background

• Recommendations aim to minimize wrong-site (e.g., wrong eye, wrong procedure) surgical errors.
• Collaborative effort of various ophthalmology organizations.

Introduction

• Ophthalmologists perform diverse surgeries in varied settings (hospitals, ASCs, office-based).
• Some surgeries require specific refractive or prismatic calculations (e.g., cataract, LASIK, strabismus).
• Document outlines general guidelines then focused recommendations for measurement-specific procedures.
• Current systems for preventing errors are generally effective.
• Goal is to suggest further ways to minimize preventable surgical errors.

Steps Taken Prior to Surgery Day

• Formal surgical order documented in patient records.
• Order should be detailed (procedure, operative eye, adjunctive meds, etc.).
• Clear communication between clinic and surgery staff crucial.
• Electronic or paper-based documentation crucial.

Steps Taken On the Day of Surgery

• Informed consent process varies.
• Patients, or representatives, should actively participate.
• Informed consent forms should be understandable.
• If only one eye is operated on, correct eye should be clearly noted.

Hard Stop

• Hospitals and ASCs should have policies for "hard stops."
• Staff can halt preparation if inconsistencies or errors are found.
• Staff should not fear reprimand for calling a hard stop.

Marking the Operative Eye

• Accreditation bodies and state statutes define marking procedures for operative eye.
• Surgeons in non-accredited ASCs or jurisdictions lacking specific statues can establish their own policies in consultation with management.
• Crucial to have clear documentation and verbal verification by patients or guardian confirming operative eye if surgery is on one eye only.
• Discrepancies should halt the procedure (hard stop).
• Surgery staff needs marking protocols for patient safety.
• Placement marking on the cheek instead of forehead may mitigate potential errors with draping.

Time-Out

• Crucial opportunity to verify the correct procedure and eye.
• Involves entire operating room team and patient (if able).
• Data verified during time-out include patient details, procedure, operated eye(s), and IOL details.
• Recommendations for using two patient identifiers for reduced errors.

Procedures Dependent on Preoperative Calculations

• Many procedures require specific data (e.g., IOL power, refraction, resection size) detailed before surgery.

• Accurate communication and measurement crucial for surgical success.

• Specific Considerations for Intraocular Lens (IOL) Surgery: Double-check IOL powers, re-checking if needed, and documenting requested type and post-operative refractive target.

• Specific Considerations for Keratorefractive Surgery: Document the post-operative refractive target (e.g., monovision) during time-out.

• Specific Considerations for Strabismus Surgery: Ensure written documentation of case details are available to the surgeon.

• Specific Considerations for Oculofacial Plastic Surgery: Surgeons to mark the correct surgery site.