The cultural variation in the implementation of the WHO surgical safety checklist in cataract surgery

Session Details

Session Title: Combined Cataract Surgery: Techniques/Practice Styles

Session Date/Time: Tuesday 13/09/2016 | 14:00-16:00

Paper Time: 15:46

Venue: Auditorium C6

First Author: : C.Gunasekera UK

Co Author(s): :                        

Abstract Details

Purpose:

The World Health Organisation (WHO) surgical safety checklist released in 2009 led to a global post-operative reduction in morbidity and mortality. Whilst cataract surgery is not commonly associated with mortality, significant morbidity could be caused by wrong site surgery and incorrect intraocular lens implantation. The implementation of the WHO surgical safety checklist aims to prevent such errors. We look to investigate and compare how errors are minimised within cataract surgery in 3 teaching hospitals around the world.

Setting:

This is a multi-centre study investigating 3 teaching hospitals around the world: - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK - Clinical Center Kragujevac, Serbia - Narayana hospital, Nellore, Andhra Pradesh, India

Methods:

A focus group was conducted amongst 3 residents from each teaching hospital. Questions looked at pre-operative, intra-operative and post-operative management. Preoperative management included referral pathways, physician assessment, biometry, medical clerking, consent and refractive aim. Intra-operative management included checklists, team briefs, confirmation of consent, lens acquisition, sterility, anaesthesia and special equipment. Post-operative management included post-operative medication, follow up and refractive outcomes.

Results:

Referral routes varied from opticians, general practitioners to mass screening camps. Ophthalmologist assessment and consent always took place prior to surgery. Some centres required an anaesthetic and internal medicine review for each patient. Biometry acquisition was found to be both nurse and resident led. Each hospital conducted a pre-operative safety checklist highlighting potential complications in surgery (e.g. ensuring iris hooks are present for small pupils). Post-operative medication was continued for 1 month in all centres. A post-operative review was generally carried out by an ophthalmologist however both nurses and optometrists followed up uncomplicated cataract cases in the UK.

Conclusions:

Large variations existed in the pre-operative and post-operative management of cataract surgery most likely due to local health economies. However, key similarities existed amongst the 3 hospitals at the critical stages in cataract surgery which could lead to a potential error. This included biometry calculation, surgical site marking, confirmation of allergies and pre-operative team briefing. This study would be of interest to anyone performing large volume cataract surgery safely. We conclude that learning from the similarities in high volume teaching centres can highlight critical steps in cataract surgery to enhance safety.

Financial Disclosure:

NONE