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Author’s Name(s): Tony Chae, Andrew Samuel, Victor Penner 

Author’s Disclosure Block: Tony Chae, none; Andrew Samuel, none; Victor Penner, consultant fees from Abbie and Labtician 

Abstract Body

Purpose:Up to 60% of patients admitted in intensive care units (ICU) develop exposure keratopathy (EK). Despite the high incidence of EK and potential significant compromise to ocular health, there is an absence of a standardized protocol to reduce EK incidence. This quality improvement (QI) project aims to implement a standardized ocular protection protocol (OPP) to prevent EK in ICU patients in hopes to reduce the prevalence of EK by at least 50%. Study Design: Quality improvement Methods:  Spot audits were conducted in the ICU of two tertiary hospitals. A portable slit lamp and f luorescein dye were used at the bedside to identify the prevalence of EK. An OPP was developed drawing from the literature and consulting with various stakeholders including ophthalmologists, ICU staff and council, information technology, and pharmacists. The OPP includes administration of lubricating eye drops or ointments, and/or closure of eyelid(s) with tape depending on patient risk factors. This protocol will be integrated into the ICU order set within Connect Care, a provincial-wide (Alberta) electronic medical record system. Following the implementation of this protocol, alongside staff education, repeat spot audits will be performed to assess changes in the prevalence of EK. Results: Of the 183 ICU patients, 50.8% (n = 93) had varying degrees of EK. There was a higher prevalence of EK in patients with mechanical ventilation devices 82.2% (n = 65/79), chemosis 90.2% (n = 37/41), and lagophthalmos 100% (n = 8/8). In addition, 4.9% (n = 9/183) of patients had orders for lubricating drops as needed without any documented use. We also identified 5 patients with acute corneal pathologies, needing urgent ophthalmology referral. Following the implementation of the OPP from October 2024 onwards, the prevalence of EK will be re-evaluated with repeat spot audits between January and March 2024. These outcome and process measures pre and post implementation of the OPP will be available by April 2025. Conclusions: Congruent to current literature, this QI project similarly identified the high prevalence of EK in ICU patients and their specific risk factors in the development of EK. Moreover, the implementation of a standardized OPP in collaboration with stakeholders is anticipated to reduce the incidence of EK by at least 50% and its potential complications. Future steps include evaluating the effectiveness of the protocol through repeat spot audits and disseminating the protocol provincial wide to optimize eye care practices across the region.