1. Hong Kong Eye Hospital 2012 Quality Assurance Forum Standardization of A&K Measurement Record 22 March 2012 PAPDNS APN CHIU Wai Yee

2. 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.

3. 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

4. Review of Old A&K measurement

5. Using Canon within one department

6. Using Nidex by different departments

7. Using different types of machine within one department

8. Using IOL Master by different staffs within one department

9. Improvement work A work group was formed and leaded by Dr NM Lam and L Wong. Members comprised of all concerned parties, e.g. orthoptist, optometrist, DSU nurse, PAPD nurse The 1st meeting was held on 15 July 2011. 1st version of standardized A&K measurement 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.

10. Aims of Standardization 1.  Patient safety Correct IOL model and diopter is implanted into the correct eye 2.  Efficiency  confusion caused by different format of print out  the checking time of IOL model & diopter Facilitate “Time out” procedure

11. Aims of Standardization 3.  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

12. 1st version of standardized A&K Measurement Record

13. 2nd version

15. Reprint A&K form

16. Print-out by IOL Master

17. Print-out by IOL Master