Improving Efficiencies Improves Patient Care

Improving Efficiencies Improves Patient Care

Dr. Jay McDonald

Declining reimbursement and demands for greater patient care for less keep us all dancing around to find a better way to more efficiently care for our most valued resource:  the patient.

Today I am going to discuss a technique we adopted several years ago when it was suggested by a fellow ophthalmologist on the ASCRS cataract internet forum.

If you are not a member of ASCRS, I suggest you consider joining as this informal discussion forum has experts answering the questions that confront us all.  Instant consult for a problem not only immediately helps the surgeon in need but also yields useful information on the common or not so common issues we have to deal with.

Several years ago, we implemented using a spray for surgical dilation instead of consecutive dropping.  We had been using a cycloplegic spray for years in the clinic for our younger patients, but I did not consider it an improvement to efficiency in the OR until mentioned by a colleague.

The “atomizer” pictured is used in the clinic for kids and is identical to the one used in surgery. We use it for a full day, then washed it with Dial soap and water, and dry it for use the next day.

Other colleagues were using a pledget, but corneal abrasions and the process of placing and removing the pledget made the spray more attractive.  The patients react positively to the spray as well, since they have their eyes closed.

First, we have the patient wash around his eye with betadine and water.  We do 2 or 3 puffs or sprays in a 1, 2, 3 count.

Then we have the patient close his eyes and we spray the eye 2-3 times with the eyes closed.  We then have him blink a few times and leave his eyes open. In 10 minutes the eye is dilated. The blinking that follows delivers the medicine to the cul-de-sac and cornea.

We mix in proparacaine as this begins the numbing process for our topical anesthesia as well.  Spray atomizers are available from any pharmaceutical supply.  They are only a few dollars, and since we are using this in a non-sterile manner and applying it to a non-sterile surface, they are easily cleaned and dried at the end of every day.

The formula for the spray is as follows:

For less than 10 Patients
Proparicaine (0.5%) 20gtts
Zymaxid 20gtts
Accuvail 20gtts
Alphagan 20gtts
AK-Dilate (10%) 20gtts
Tropicamide (1%) 20gtts
BSS 1.5cc

For 10+ Patients
Proparicaine (0.5%) 30gtts
Zymaxid 30gtts
Accuvail 30gtts
Alphagan 30gtts
AK-Dilate (10%) 30gtts
Tropicamide (1%) 30gtts
BSS 2cc

I hope this helps. If you or your nurse manager has any questions feel free to call our surgery center director on his cell:  479-366-54-five-three.

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