Reducing omission of eye drops during hospital admission.

BACKGROUND/AIMS: Chronic ophthalmic conditions, such as glaucoma and dry eye disease, are frequently encountered debilitating eye conditions that can lead to substantial reduction in vision and quality of life. However, there is ongoing evidence to suggest that topical ophthalmic therapy is inappropriately omitted on admission to hospital. The primary aim of this audit was to investigate the trust adherence to the National Institute for Health and Care Excellence guideline on the prescribing standard of eye drops during hospital admission. The secondary aim was to raise awareness and ensure successful compliance with national standards to reduce unintentional omission of eye drops on admission and subsequent complications. METHOD: Electronic medical records of all medical and surgical adult inpatients were studied prospectively on two different occasions. The quality of documentation of eye drops in clerking notes, the length of time taken between the admission and prescription of eye drops, and the accuracy of the prescription were examined. Following the initial audit, interventions focusing on clinician education were implemented. This includes highlighting the importance of eye drops in all departmental mandatory introductory sessions and putting up posters on all the wards as prompts. The same data collection method was used in the reaudit. RESULTS: In the initial audit, 64 (mean age 81.8±8.9 years) patients with regular prescriptions for eye drops were identified; 38 (59.4%) patients had eye drops for dry eye disease only, 20 (31.3%) patients had eye drops for glaucoma only, and six (9.4%) patients had eye drops for both. In the reaudit, 57 (mean age 76.7±15.3 years) patients were identified; 42 (73.7%) patients had eye drops for dry eye disease only, 10 (17.5%) patients had eye drops for glaucoma only, and five (8.8%) patients had eye drops for both. Following the intervention, there was a significant improvement in documentation of ocular diagnosis and eye drops on clerking notes from 41% to 65% (P=0.008), and eye drop reconciliation within 24 hours of admission improved from 45% to 75% (P=0.0008). All patients (100%) received the correct eye drop prescription before and after the intervention. CONCLUSIONS: Education is effective in promoting adherence to national guidelines and reducing the incidence of inappropriate omission of eye drops on admission to hospital.

Retinal microaneurysmal closure following focal laser photocoagulation in diabetic macular edema.

OBJECTIVE: To determine the temporal relationship of microaneurysmal dosure following focal laser photocoagulation in diabetic macular edema. PATIENTS AND METHODS: This prospective study included 25 eyes of 23 diabetic patients with clinically significant macular edema. Ten to 20 well-defined microaneurysms were preselected and marked on an enlarged photograph of the prelaser fundus fluorescein angiogram. These preselected microaneurysms were focally lasered and followed up angiographically at 48 hours, 1 week, 3 weeks, 6 weeks, and 12 weeks after photocoagulation. Thereafter, the average time span between photocoagulation and the closure of the microaneurysms was determined. RESULTS: The mean number of preselected microaneurysms at baseline was 18.24 +/- 3.51, which remained the same at 48 hours. However, the mean microaneurysmal count decreased to 11.76 +/- 2.65 (35% reduction) at 1 week, 9.12 +/- 2.53 (50% reduction), 7.12 +/- 2.26 (61% reduction), and 4.56 +/- 1.32 (75% reduction) at 3, 6, and 12 weeks, respectively. The majority of the microaneurysms (35%) closed between 48 hours and 1 week. CONCLUSIONS: The microaneurysmal closure following focal laser photocoagulation is a delayed process. None of the preselected microaneurysms showed closure within 48 hours, and 75% of the preselected microaneurysms closed at the end of 12 weeks.