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Microsoft word - g_cs_65 sop cataract surgery in community hospitals.doc


Standard Operating Procedure for the Pre-
operative, Peri-operative and Post-Operative
Care for Cataract Surgery Patients
John Coupland Hospital
Johnson Community Hospital
Name of originator / author: Matron, John Coupland Hospital Name of responsible committee / Individual Quality Scrutiny Group Community Hospital Staff Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Standard Operating Procedure for the Pre-operative, Peri-operative and Post-
Operative Care for Cataract Surgery Patients
John Coupland Hospital and Johnson Community Hospital
Version Control Sheet Copyright 2015 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in wholeor in part without the permission of the copyright owner Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Standard Operating Procedure for the Pre-operative, Peri-operative and Post-
Operative Care for Cataract Surgery Patients
John Coupland Hospital and Johnson Community Hospital
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Standard Operating Procedure for the Pre-operative, Peri-operative and Post-
Operative Care for Cataract Surgery Patients
John Coupland Hospital and
Johnson Community Hospital
Procedural Document Statement
To ensure a standardised approach to the care deliveredto patients undergoing cataract surgery within LCHSCommunity Hospital Services This document outlines the pathways and procedures which will be followed in order to provide safe andevidenced based delivery of care to cataract surgerypatients.
It is the responsibility of all staff to ensure they arefamiliar with the SOP and act in accordance with allcomponents.
It is the responsibility of the staff involved and line managers to ensure that the required competenciesare developed and maintained in accordance with theskills required throughout the pathways. Externalsupport is required to achieve some of thecompetencies.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Standard Operating Procedure for the Pre-operative, Peri-operative and Post-
Operative Care for Cataract Surgery Patients
John Coupland Hospital and
Johnson Community Hospital
SOP comes into effectSOP Review datePurpose The SOP details the procedures and processes which will be followed byLCHS staff during the pre-operative, perioperative and post operative phasesof cataract surgery when performed at LCHS community hospital sites.
The SOP details the processes and procedures which will be performed byLCHS staff but does not include the activities performed by ULHTConsultants, visiting ULHT theatre staff, pharmacy teams or companyrepresentatives.
Author Signature: Approval Signature: Position:
Service manager
Has responsibility for authorising the use of the
SOP and ensuring it complies with any relevant
legislation that may cover the procedures detailed
within.

Outline the responsibilities of the staff who will operate within the SOP.
All staff working within the standard operating procedure are
responsible for identifying any deficiencies in the SOP and notifying
their line manager accordingly.
All staff have a duty of care under the Health and Safety at Work Act
1974. Staff should also be familiar with the Trusts Whistle- Blowing
Policy and should be able to share concerns without fear of
recrimination.
All staff have a responsibility to access, be familiar with and comply
with all policies relating to this SOP.
Staff must always practice within the bounds of their own competence
and in accordance with their own Code of Professional Conduct if
applicable.
All staff have a responsibility to report near misses, adverse incidents
and serious untoward incidents as detailed in Incident Reporting Policy.

Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan It is the responsibility of the manager to inform their staff of the
implementation of the SOP and to ensure that the necessary training
has been undertaken to enable staff to carry out safely the procedures
detailed in the SOP.
It is the responsibility of the manager to ensure all staff have access to
all policies that relate to their place of work and role within the
organization.

All staff who will be working to this SOP should sign below to say they have read and
understood the SOP and agree to act in accordance with its requirements.

Job Title
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan EXCLUSION CRITERIA FOR CATARACT SURGERY
LCHS COMMUNITY HOSPITALS All patients will be assessed by the Consultant at the time they are listed for cataractsurgery.
The following may not be suitable for cataract surgery at JCH:  Any health condition that will prevent the patient from lying flat for 30 minutes  Any condition requiring continual oxygen therapy  Any condition with uncontrollable tremor or involuntary movement  Unpredictable mental health issues which would make surgery in a confined space  Severe claustrophobia  Patients with severe communication difficulties  Weight in excess of 225kg or BMI greater than 40  Previous severe anaphylactic response to local anaesthesia or if unknown cause  Patients under 18 years of age.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan PRE-OPERATIVE ASSESSMENT CRITERIA FOR CATARACT SURGERY
LCHS COMMUNITY HOSPITALS  Blood pressure must be below 180/95. Refer to GP for monitoring prior to surgery.
Inform Consultant.
 INR must be within the patient's therapeutic range. INR test should be performed within 1 week of surgery. Anti-coagulant medication to be continued. Patient must beasked to inform SDU of INR result if out of range and surgery must be postponed.
Inform Consultant.
 Blood Glucose must be below 20mmol/l. Check at POA clinic. Inform Consultant if greater than 20mmol/l.
 Inform Consultant if patient taking IFIS (intra-operative floppy iris syndrome) medication (any alpha blockers i.e. doxasozin, tamsulosin).
 Inform Consultant if patient has clotting disorder.
 MRSA screening to be performed for previous MRSA positive patients or patients who have been hospitalised within the last 12 months (i.e. admission as an in-patientfollowing surgery or medical admission).
 If unable to obtain biometry, patient must be referred to ULHT pre-op sisters (clinic 8) for ultrasound biometry (A scan).
 Postpone biometry if patient wears contact lenses (1 week-soft lens and 4 weeks- hard lens) Postpone admission if required so that biometry is performed prior toadmission (not on the day of admission).
 Patients are advised to eat and drink normally on day of admission.
 All medication should be taken as prescribed. Patients should be advised not to omit any medication on day of admission.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan REQUEST TO SUPPLY TTO MEDICATION
CATARACT SERVICE- JOHN COUPLAND HOSPITAL Consultant: MISS GOSSEDate of procedure: Dexamethasone Eye One drop four times Left or Right eye daily for four weeks Chloramphenicol Eye One drop four times Left of Right eye daily for two weeks Patient Name / Details
Eye (Left or Right)
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Patient Name / Details
Eye (Left or Right)
Ordered by Prescriber:
Print name:
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan Cyclopentolate 1% Issued by:
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan STANDARD OPERATING PROCEDURE CATARACT SURGERY
PREPARATION OF CEFUROXIME FOR INTRACAMERAL USE
LCHS COMMUNITY HOSPITALS The Circulating and Scrub Practitioner will check Cefuroxime 250mg and two 10ml ampoulesof Sodium Chloride 0.9%.
Use the following procedure to prepare Cefuroxime 1mg in 0.1ml injection for intracameraluse.
 Dilute 250mg vial of Cefuroxime with 10ml Sodium Chloride. Shake to dissolve. This gives a 25mg/ml solution.
 Draw up 1.5ml of Sodium Chloride in a 2.5ml syringe.
 Draw up 1ml of the Cefuroxime solution in the same 2.5ml syringe to make a final volume of 2.5ml. Mix well.
 Using a 1ml syringe, draw up 0.1ml of the Cefuroxime solution from the 2.5ml syringe. The Cefuroxime solution is 1mg in 0.1ml.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan STANDARD OPERATING PROCEDURE CATARACT SURGERY
MIXING BALANCED SALT SOLUTION WITH POVIDINE IODINE
LCHS COMMUNITY HOSPITALS The Registered Practitioner will check Povidine Iodine (Aqueous Betadine) 10% andBalanced Salt Solution (BSS) 19mls prior to the patient entering the theatre environment.
 Open the 19ml ampoule of BSS and draw up 9mls in a 10ml syringe. Dispose of the 9mls of BSS.
 Draw up 10mls of Aqueous Betadine 10% in a 10ml syringe. Inject the 10mls of Aqueous Betadine 10% into the 19ml BSS ampoule.
 Complete Topical Anaesthesia label. Ensure label is signed, documenting time and date of preparation. Place completed label in the patients integrated care pathway.
 Administer as per prescription sheet and in accordance with the procedure for administration of eye drops in the Anaesthetic room.
 The remaining solution will be used in theatre by the Surgeon for preparation prior to Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan STANDARD OPERATING PROCEDURE CATARACT SURGERY
MIXING BALANCED SALT SOLUTION WITH ADRENALINE
LCHS COMMUNITY HOSPITALS The Circulating and Scrub Practitioner will check Adrenaline 1:1000 and Balanced SaltSolution 500ml.
 Draw up 0.5ml of the adrenaline in a 2ml syringe.
 Circulating and Scrub Practitioner check adrenaline drawn up.
 Peel back the metal foil on Balanced Salt Solution bottle. Inject the 0.5ml of adrenaline into the Balanced Salt Solution.
 Place label (Adrenaline 0.5ml- 1:1000) on Balanced Salt Solution bottle.
 Ensure label is signed, documenting time and date of preparation.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan STANDARD OPERATING PROCEDURE CATARACT SURGERY
ADMINISTRATION OF EYE DROPS (ANAESTHETIC ROOM)
LCHS COMMUNITY HOSPITALS The administration of eye drops will take place in the Anaesthetic room by a RegisteredPractitioner who has checked the expiry dates of the Proxymetacaine 0.5%, Povidine Iodine10% Solution and Balanced Salt Solution before the patient has entered the theatreenvironment. The Povidine Iodine Solution will be diluted with Balanced Salt Solution (BSS)prior to the patient entering the anaesthetic room. See SOP for mixing of Povidine IodineSolution with BSS.
 Confirm the identity of the patient and if there are any known allergies.
 Position the patient comfortably on the trolley or in a wheelchair and explain the procedure and the effects of the eye drops.
 Administer 1 drop of Proxymetacaine 0.5% to the patients' eye. Repeat the process after 30 seconds and again after 1 minute. Ensure three doses are given in total.
During this process advise the patient to close their eye gently to provide a betteranaesthetic effect but not too tightly as this will cause excessive drying of the cornea.
 After one minute whilst the patient's eye is still gently closed, administer 2 drops of the diluted Povidine Iodine Solution to the inner corner of the eye. Then ask thepatient to open their eye, blink a few times and then close it again gently.
 Repeat the administration of povidine Iodine as above for a second time. Using a sterile gauze swab, whilst the patient's eye is closed, use any excess solution toclean around the eye.
 Administer 1 drop every minute thereafter of the Proxymetacaine until the minim is Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan INSTRUCTIONS FOLLOWING CATARACT SURGERY
 Keep the plastic eye shield on overnight until the morning following your surgery.
 Leave the eye shield off during the day but put it back on at night for the next 2  Surgical tape to keep it in place can be bought at any pharmacy or most Bathing your eye:  On the morning following your surgery, you may clean around your eye. Do not touch the eyeball itself, just wipe gently across the lids. You will be provided with somesaline, a pot and some gauze swabs to do this.
 If needed continue to bathe in the morning using cooled down boiled water.
 Start using your eye drops the morning following your surgery. Follow the instructions as stated on the medication.
 Ensure the Chloramphenical is stored in the fridge.
 Repeat prescriptions can be obtained from your GP.
 Your eye may feel gritty for several days following your surgery. It may also take up to 4 weeks for the vision to completely settle. This is quite normal.
 It is normal to experience mild discomfort. You can take your normal analgesia if  If you experience excessive pain or discharge, please contact your GP or Clinic 8 for Things to avoid for the next 2 weeks:  Heavy lifting Bending forward for long periods of time Swimming  Ball games such as bowling and golf Getting soap or shampoo in your eye Environments with lots of dust.
 On discharge you will receive a card with the serial number of your implant on it.
Please keep this safe.
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan  You will be given a letter for you to take to your GP which will inform them of the details of your surgery. Please drop this in at your GP surgery following yourdischarge.
 You will be given a letter for you Optician. It is important to make an appointment with them in 4 weeks' time for a check-up. Please take the letter with you to thatappointment.
 If you need an appointment to be seen for follow-up with the Hospital, you will be given this on discharge.
Clinic 8, Lincoln County Hospital (within normal working hours)- 01522 512512
Digby ward (out of hours)- 01522 512512 ext 3161
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan The SOP has been produced to ensure Briefly give an outline of the key standardised practice is achieved when cataract objectives of the policy; what it's intended surgery is performed within the community outcome is and who the intended hospitals. This will ensure staff follow the same beneficiaries are expected to be processes and that patients receive the sameinformation throughout their journey.
The SOP will impact on patients and staff in a Does the policy have an impact on positive manner. Procedures within the pathway patients, carers or staff, or the wider are clearly described ensuring staff have a community that we have links with? reference document to follow. Patient information is Please give details
detailed within the SOP so this will ensure patientsreceive the same information to support theprocedures performed.
Is there is any evidence that the None identified.
policy service relates to an area with
known inequalities? Please give details
Will/Does the implementation of thepolicy service result in different impactsfor protected characteristics? Sexual Orientation Gender Reassignment Religion or Belief If you have answered ‘Yes' to any of the questions then you are required to carry out a
full Equality Analysis which should be approved by the Equality and Human Rights Lead
– please go to section 2

The above named policy has been considered and does not require a full equality analysis
Equality Analysis Carried out by:
Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan NHSLA Monitoring Template
e.g. audit
relating to thisSOP Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan

Source: http://www.lincolnshirecommunityhealthservices.nhs.uk/sites/default/files/documents/policies_guidance/G_CS_65%20SOP%20Cataract%20Surgery%20in%20Community%20Hospitals.pdf

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THE EPIDEMIOLOGY OF TETRACYCLINE AND CEFTIOFUR RESISTANCE IN COMMENSAL ESCHERICHIA COLI MATTHEW THOMAS MCGOWAN B.S., Kansas State University, 2011 submitted in partial fulfillment of the requirements for the degree MASTER OF SCIENCE Department of Biomedical Science College of Veterinary Medicine KANSAS STATE UNIVERSITY Manhattan, Kansas Dr. H. Morgan Scott