What precautions must be taken when administering ophthalmic eye medications?
Eye drops can be used to treat a wide range of eye conditions such as an infection, an allergy, a minor eye injury, to relieve dry or red eyes, for post-operative healing or in chronic conditions like glaucoma. No matter your reason for using eye drops, or for how long you are using them, it is important to use them correctly so that the medication is properly absorbed into your eye. Show
Here are some precautions to follow when using eye drops
2Assistant Clinical Professor: International Centre for Eye Health, London School of Hygiene & Tropical Medicine and Consultant Ophthalmologist, Mid Cheshire NHS Hospitals, UK. Find articles by Victor H Hu Disclaimer 1Pharmacist (Ophthalmic and ePMA): York and Scarborough Teaching Hospital, York, UK. 2Assistant Clinical Professor: International Centre for Eye Health, London School of Hygiene & Tropical Medicine and Consultant Ophthalmologist, Mid Cheshire NHS Hospitals, UK. Copyright © 2021 Alaya Khatun and Victor H Hu. This is an Open Access article distributed under the Creative Commons Attribution Non-Commercial License. The medicine prescribing and dispensing process is complex, and errors are relatively common. This article looks at the various issues around prescribing and dispensing medicines for eye care and how patients can be kept safe. Many eye conditions are treated with some form of medicine, often requiring a prescription from an appropriately trained prescriber. The process is complex and errors can occur at any point along the pathway: from writing the prescription, to the patient instilling the correct eye drops, in the correct eye (as an example). Health care workers can and do make errors when writing prescriptions, and this has been well documented. One study in the UK showed that 7% of prescriptions contained errors. The researchers found that more experienced doctors, including consultants, were just as likely to make prescribing errors as their more junior colleagues. The same study showed that pharmacists intervened before most of the prescribing errors could affect patients. “The study found that more experienced doctors, including consultants, were just as likely to make prescribing errors as their more junior colleagues.” Prescribing errorsCommon issues or errors involving prescribing eye medicines include:
Open in a separate window Pharmacists can protect patients by identifying and correcting prescription errors. Prescription writing checklist
Figure 1Open in a separate window Example prescription containing all necessary information How to avoid prescribing errorsThe majority of prescribing errors occur at the stage of writing the prescription. Prescribers can reduce the risk of these errors by checking and counter-checking each prescription before issuing it. A study from 2013 found that there were 4.7% (29/623) prescription errors during a one-month audit period. Following a process of counter-checking, this was reduced to just 0.77% (5/651). Therefore, prescribers should consider using a simple prescription writing checklist (see panel). These should meet at least the minimum legal requirements as well as other safety features, such as those recommended by the British National Fomulary: Dispensing and administering medicinesNurses and pharmacists have very important roles to play in preventing harm from prescription errors and ensuring that eye medications, including eye drops, are given correctly, so that patients gain the maximum therapeutic effect and avoid harm. Pharmacists are the final point of contact in the community, before patients take their medicines home, and nurses are the final point of contact before patients are administered their medicines in hospitals. They therefore need adequate knowledge and understanding of the relevant guidelines so they can identify potential errors and help patients to avoid them. Consider the benefits of written information, in the form of patient information leaflets, to help with patient understanding. Where available, give these to patients when prescribing medications such as systemic steroids, as they can have severe and profound adverse effects which patients should be made aware of. Patients should also be given information about how to put in eye drops as this is something many patients find difficult. A previous article in this journal included a patient information leaflet on how to instil one’s own eye drops: https://www.cehjournal.org/article/instilling-your-own-eye-drops/
Open in a separate window Show patients how to instil their own eyedrops. TANZANIA Paper-based prescribing vs electronic prescribingMany health care units benefit from electronic prescribing and medicines administration (ePMA) systems that mandate entry of the above information. Most ePMA systems also provide clinical decision support (information to help prescribers make the right decision), which is individualised for each patient, such as highlighting allergies. ePMA systems have also been known to introduce problems alongside their numerous benefits. Prescribers have heightened expectations about what an electronic prescribing system can deliver, so are often surprised when they are found to have made an error that they expect an ePMA system would prevent. For example, not highlighting the need for a ‘once only’ loading dose for doxycycline prescriptions, leading to potentially slower onset of symptom resolution, or not mandating a review date or course length for steroid eye drop prescriptions, leading to inappropriate continuation of an acute prescription. ePMA systems vary widely in terms of their level of sophistication. However, regardless of their digital maturity, you will still have to view your patient as a whole and exercise good clinical judgement when using the information they provide to care for your patients. What are the precautions to be taken while using eyedrops?Immediately after using the eye drops, wash your hands to remove any medicine that may be on them. To keep the medicine as germ-free as possible, do not touch the dropper or the applicator tip to any surface (including the eye). Always keep the container tightly closed.
What is the caution for ophthalmic preparations?It is important that the tip of the dropper or dropper bottle never touches the eye or eyelid. Contamination will result, in which case the dropper and medication should be discarded. Alcohol and alcohol-type solutions must never enter the eye. They are damaging to the corneal epithelium.
Which of the following is the correct way in administering ophthalmic medication?Place the medication bottle ½ to ¾ inch above his conjunctival sac, making sure it doesn't touch anything. Squeeze the bottle and instill the prescribed number of drops into the center of the conjunctival sac. Ask him to gently close his eyes and move them while closed to help distribute the solution.
What nursing considerations are involved in administration of eye drops?When instilling eye drops, the nurse should perform hand hygiene, apply gloves, and check the same rights of medication administration as done with other types of medication. Prior to administration of eye medication, the patient's eyes should be assessed for new or unusual redness or drainage.
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