Hong Kong Eye Hospital2012 Quality Assurance Forum
Standardization of A&K Measurement Record
22 March 2012
PAPDNSAPN CHIU Wai Yee
Background
• Cataract extraction and IOL implantation is the most common surgery in HKEH. (~ 6200 cases / year)
• A&K measurement record is one of important clinical and legal documents.
• 3 professions involve in measurement of the power of IOL (Orthoptist, Optometrist & nurse)
• Different professions produce different formats of measurement records
• More than 5 types of machines are used to measure axial length.
Challenge
• Potential medical incident: wrong IOL insertion post-op refraction surprise
• Time consuming in “Time-out” procedure lengthen operative time
• Reprint A&K record according to surgeon’s preference on OT day interruption of service
• Need manual calculation if IOL of other model is required peri-operatively calculation error
Review of Old A&K measurement
Using Canon within one department
Using Nidex by
different departments
Using different types of machine within one department
Using IOL Master by different staffs within
one department
Improvement work• A work group was formed and leaded by
Dr NM Lam and L Wong.• Members comprised of all concerned parti
es, e.g. orthoptist, optometrist, DSU nurse, PAPD nurse
• The 1st meeting was held on 15 July 2011.• 1st version of standardized A&K measure
ment record was used from September 2011.
• 2nd version of standardized record was used by all departments of HKEH and UEC from Jan 2012 to present.
Aims of Standardization
11 Patient safety• Correct IOL model and diopter is i
mplanted into the correct eye
11 Efficiency confusion caused by different fo
rmat of print out the checking time of IOL model
& diopter• Facilitate “Time out” procedure
Aims of Standardization
11 Smoothness of service the frequency of changing IOL
on table choice of IOL models at printout ad hoc reprint IOL
4. Better communication between all staffs (surgeon, day ward nurse, OT nurse, Shroff)
5. Proper documentation
1st version of standardized A&K Measurement Record
2nd
version
2nd
version
Reprint
A&K form
Print-out by IOL Master
Print-out by IOL Master