Intensive care unit contact lens care: Evaluating staff understanding and promoting patient safety

Dear Editor,

We would like to share lessons learned from a recent case. Following a brief admission to our intensive care unit (ICU) a patient with intentional overdose woke up after 2 days reporting eye pain due to a retained contact lens (CL). Specialist review ruled out corneal infection and injury, and the patient was discharged. Despite regular pupil checks, ICU Staff reported that they do not routinely screen for CLs and were unfamiliar with their management or care. Discussions with colleagues at different units suggested that this is a widespread issue, as they neither had any safeguards in place, nor implemented them after similar events.

Investigation

An online questionnaire was circulated to all ICU staff (~90 nursing, ~30 medical) asking them to rate their own confidence and awareness of CLs, to identify CLs in pictures of eyes, and to gauge their knowledge of lens safety and use. We received 44 responses over a month (Response rate of ~80% amongst medical staff, ~25% for nursing), half of them reported personal lens use.

Staff overwhelmingly admitted not actively considering or checking for patient contact lenses, with an average score of 1.4 (1 = Never, 5 = Always). Staff were marginally more confident in their ability to identify CLs (average 2.8) and in recognising the signs and symptoms of lens-related injury (2.5).

None of the participants scored the full 10 marks in identifying lenses, however, the highest score of 9 was by one nurse who reported no personal lens experience. Among cohorts, non-consultant doctors were most proficient (average 5.5), closely followed by senior nurses (5.3).

Background knowledge assessment showed that all staff had significant gaps in their understanding of safe storage or use, including those reporting personal CL use. Half underestimated UK adult CL prevalence (10%) ¹ and 93% of staff overestimated the financial costs of CL use, with 40% overestimating the £100 for a year’s supply ² by 300%.

Actions

These results confirmed our suspicions and highlighted areas for improvement on ICU. A sticker was added to admission proformas to encourage both admitting doctors and nurses to consider CL presence. A protocol for care and awareness posters were developed by liaising with Ophthalmology team. Local opticians kindly donated storage materials, and staff were signposted to e-learning, ³ and colleagues for practical demonstrations (Figure 1).

Figure 1.

An (enhanced) image from the quiz; Almost no staff identified the CL displaced to the lateral canthus.

Conclusions

As CLs continue to decrease in cost and increase in popularity, healthcare professionals should be more vigilant about lenses in any critically-ill patient, without socioeconomic bias. Our initial patient was only monitored; without needing intubation. Had it occurred, the risk of lasting corneal injury could have been much higher.

This simple and effective project enabled exploration of an anecdotally widespread problem and incorporated effective interventions to minimise risk of further episodes of potentially significant harm. The format of an online quiz allowed broad staff engagement and an easy means of education, and local opticians were more than willing to help encourage eye health when approached.

As clinicians faced the same challenges regardless of their personal experience in using CLs, we encourage all readers to evaluate their own practice of identifying and instituting safeguards against retained lenses to ensure optimal patient care and safety.