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Quality and Safety

Healthcare quality and safety must be paramount in all ophthalmic services and at the centre of ophthalmic clinical professional practice. Clinical governance is the system or process by which quality and safety are delivered and continuously improved.

High quality care essentially describes care which achieves good outcomes for patients through the provision of evidence based healthcare delivery (clinical effectiveness), which minimises harm (patient safety) and which provides the patient with a positive, personal experience of care (patient experience).

The College promotes quality and safety in all aspects of ophthalmology and produces many standards and guidelines to support this as well as the following clinical governance guides.

Ophthalmic Safety Alerts:

  • Zeiss Lucia 611P intraocular lens safety alert 
    The College has been made aware of two ophthalmic units with a run of a small number of cases of fibrin membrane deposition in association with the Zeiss Lucia 611P intraocular lens.
  • Do not use apraclonidine in infants below six months of age
    The College has recently received a report from NHS Improvement of a severe adverse reaction in a six month old child with anisocoria who had been administered apraclonidine 1% to help exclude Horner syndrome.
  • Do not use nitrous oxide when there is gas in an operated eye
    The patient safety team at NHS Improvement has reported an incident involving a patient who had undergone retinal detachment repair and had a gas bubble in their eye while the anaesthetist did not seem to be aware that the use of nitrous oxide was contraindicated.
  • Ozurdex recall alert
    Allergan Pharmaceuticals Ireland is recalling numerous batches of Ozurdex due to the possibility that a single loose silicone particle of approximately 300 microns in diameter may become detached from the needle sleeve during administration of the implant and may be delivered into the eye along with the implant.
  • Detachment of cannulas during ophthalmic surgery
    The NHS Improvement national patient safety team have informed the College of the continued trend of incidents involving issues with detachment of cannulas during ophthalmic surgery (cannula-associated ocular injury, COI).
  • Intracameral cefuroxime
    The College recommends that for those using a non licensed product, users should check the SmPCs and avoid use of any product which specifically cautions against intraocular use.
  • Diabetic control and safe cataract surgery
    The College has received queries from members to clarify whether there is a specific cut off for glycaemic control, either measured via HbA1C or a blood glucose level on the day, beyond which it is unsafe to proceed with cataract surgery.
Correct IOL implantation in cataract surgery – quality standard 2018 Quality standard which builds on the NICE guideline for cataract in adults and is based on published evidence and expert consensus. It provides detailed guidance for units how to take all possible precautions to reduce the likelihood of wrong IOL never events.
Quality safety and clinical governance in ophthalmology An overview
This document aims to provide a simple overview of the principles and systems which currently exist in the UK for quality and safety, and how they have evolved. It is supplemented by other more detailed documents on specific areas.
Clinical Audit and Clinical Effectiveness in Ophthalmology 2016 This document provides a simple overview of the principles and practice of clinical effectiveness and clinical audit for ophthalmologists