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Description
When I was working in the ophthalmic ward during the daytime shift, I encountered an 86-year-old British woman. The lady (will be referred to as Mrs. B for privacy reasons) came to the hospital in the company of her daughter. The patient was scheduled for cataract surgery in the afternoon but the hospital was operating behind schedule as a result of time-consuming activities that had been conducted in the morning. The daughter excused herself from staying at the hospital but she requested us to call her about an hour before her mothers procedure was over. I started conducting pre-op tests on Mrs. B including checking her integrated care pathway (ICP) for allergies, current medications, blood sugar, and blood pressure (Pager and McCluskey 485). Mrs. B was diabetic but her blood sugar levels were normal. However, after evaluating her current medications I found that she was taking Warfarin tablets. This latter development prompted me to conduct an international normalized ratio (INR) which had not been done two weeks before the surgery in accordance with normal procedures. The results of this test revealed that the patients INR was not within the therapeutic ratio. Consequently, Mrs. Bs scheduled surgery was promptly canceled by the attending surgeon. Following this incident, Mrs. Bs daughter was not happy as she felt this mishap could have been avoided. I felt bad because I knew that the disappointment in Mrs. Bs daughter was justified. Mrs. B was then scheduled for another surgery appointment at the earliest possible date.
Feelings
I felt bad for Mrs. Bs canceled surgery because I realized that it was hard for her to access the hospital. The incident concerning the patient could have been avoided if the patient had been pre-assessed properly. I also felt bad for Mrs. Bs daughter because I realized that she had to find time from her busy schedule to accompany her mother to the hospital for a second time. It had been a hectic day for the hospitals staff but I felt that it was our duty as healthcare professionals to fulfill the promises that we make to our patients (Rose 72). There was no viable justification for not pre-assessing the patient in a thorough manner. The lack of therapeutic levels of INR during cataract surgery is known to cause haemorrhages in patients (Pesudovs and Coster 621). Overlooking or lack of information concerning this anomaly could have spelled doom for Mrs. B.
Evaluation
The incident with Mrs. B gave me insight into the complicated nature of medical procedures no matter how simple they might be. The pre-operation activities that precede cataract surgery are as important as the procedure itself. The patient and her daughter had driven several miles to the hospital with the hope of receiving treatment. However, a simple error of omission was responsible for the cancellation of the entire procedure. Mrs. Bs daughter was particularly troubled by the procedures cancellation. On the other hand, simple procedures can be complicated by little omissions such as the one in Mrs. Bs case. Mrs. B had come to the hospital without any hesitations but the pre-checks helped her understand how delicate surgical procedures can be. However, I was buoyed by Mrs. Bs understanding of nature, a trait that is rare among most modern patients (Fedorowicz, Lawrence and Gutierrez 74). My experience with Mrs. B enabled me to work with an elderly but cooperative patient. In addition, cataract issues are common with elderly patients and the encounter with Mrs. B was a valuable experience. According to industry-based research, an ophthalmic nurse practitioner would gain competence after approximately 8 years: Bachelor of Nursing (3 years), practical nursing experience (2 years), Ophthalmic Nursing Certificate (6 months), Master of Nursing (2 years) (Williams 115).
I attended to Mrs. B with the assistance of a fellow nurse. Our approach was to handle Mrs. Bs situation as fast as possible because we were behind schedule when it came to the days activities. Consequently, while my colleague was making accommodation arrangements with the patients daughter, I proceeded with pre-assessment. It is common knowledge that most clinics are scheduled to maximum capacity at any given day. Consequently, there is a risk of patients conditions worsening between the time they are diagnosed and the time when they finally receive their cataract surgeries (Gericke 291). The postponement of Mrs. Bs procedure concerned me because the surgery was supposed to ease her condition. Therefore, postponing the scheduled appointment did not help Mrs. Bs condition. The main reason why our ophthalmology clinic enlists the services of two nurses per shift is to ensure that we adhere to the set schedules. My colleague and I were working hard to cover the lost time when Mrs. B and her daughter came in for the procedure.
Analysis
The incident with Mrs. B allowed me to explore the role that is often played by escorts during cataract-related procedures (Hargraves 638). Ordinarily, the patients who receive cataract surgeries have deficiencies that necessitate the presence of an escort. For instance, the patients usually receive an eye patch and this makes it hard for them to drive or get back to their homes safely. It is not a mandatory requirement for patients to have an escort but it is very advisable (Hopley, Carter and Mitchell 523). Mrs. Bs escort was her daughter and she mostly assumed the role of driver to her mother. For example, the daughter did not ask any questions concerning her mothers procedure. In the future, it is important to revisit the role of the escort. If we had taken time to explain the specifics of the procedure to Mrs. Bs daughter, we would have neutralized her disappointment over the postponement of the procedure (Lamoureux 1477).
Conclusion
Cataract surgery involves a lot of pre and post assessment activities. However, the procedure itself is simple and it has low risks (De Coster, Dik and Bellan 570). Mrs. Bs scenario provided me with an opportunity to assess the importance of pre and post assessment procedures (Ahmed 101). In this scenario, I was able to identify an anomaly, isolate a problem, and avert a potential risk to Mrs. Bs wellbeing. It is now clear that with specialist training and concise protocols, ophthalmic nurse practitioners can contribute to the management of cataract patients and help hospitals to deal with the increasing public demand for cataract surgery (Herbert 985).
Action Plan
After the incident with Mrs. B, I discussed the ensuing problem with both my nursing colleague and the surgical practitioner. I found that even though mistakes are unavoidable, every little detail matters in ophthalmology. If a similar situation arose again, I would ensure that I neutralize the situation by explaining to the patient that there were errors of omission during pre-assessment. I would also send a memo to the pre-assessment nurses and inform them about the importance of being thorough in their pre-assessment duties.
Works Cited
Ahmed, Iqbal. Revisiting early postoperative follow-up after phacoemulsification. Â Journal of Cataract & Refractive Surgery 28.1 (2002): 100-108. Print.
De Coster, Carolyn, Natalia Dik, and Lorne Bellan. Health care utilization for injury in cataract surgery patients. Canadian Journal of Ophthalmology/Journal Canadien dOphtalmologie 42.4 (2007): 567-572. Print.
Fedorowicz, Zbys, David Lawrence, and Peter Gutierrez. Day care versus inpatient surgery for agerelated cataract. The Cochrane Library 13.1 (2005). 71-75. Print.
Gericke, Christian. Intervention complexity: A conceptual framework to inform priority-setting in health. Bulletin of the World Health Organization 83.4 (2005): 285-293. Print.
Hargraves, Lee. Adjusting for patient characteristics when analyzing reports from patients about hospital care. Medical care 39.6 (2001): 635-641. Print.
Herbert, Edward. Complications of phacoemulsification on the first postoperative day: can follow-up be safely changed?. Journal of Cataract & Refractive Surgery 25.7 (2009): 985-988. Print.
Hopley, Charles, Rob Carter, and Paul Mitchell. Measurement of the economic impact of visual impairment from agerelated macular degeneration in Australia. Clinical & experimental ophthalmology 31.6 (2003): 522-529. Print.
Lamoureux, Ecosse. The effectiveness of low-vision rehabilitation on participation in daily living and quality of life. Investigative Ophthalmology & Visual Science 48.4 (2007): 1476-1482. Print.
Pager, Chet K., and Peter J. McCluskey. Public versus private patient priorities and satisfaction in cataract surgery. Clinical & experimental ophthalmology 32.5 (2004): 482-487. Print.
Pesudovs, Konrad, and Douglas J. Coster. An instrument for assessment of subjective visual disability in cataract patients. British journal of ophthalmology 82.6 (2008): 617-624. Print.
Rose, Karen. Management of day-surgery patients with cataract attending a peripheral ophthalmic clinic. Eye 13.1 (2009): 71-75. Print.
Williams, Samuel. Improving the quality of patient care: patient satisfaction with a nurse-led fracture clinic service. Annals of the Royal College of Surgeons of England 85.2 (2003): 115. Print.
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