Cataract surgery is the most frequently performed eye procedure at the Fremont Ambulatory Surgery Department (ASD). During this outpatient surgery, the clouded natural lens, which becomes opaque due to aging, injury, or disease-is emulsified using ultrasound technology and replaced with a clear silicone intraocular lens to restore vision.
Our goal at the Fremont ASD is zero wrong-eye errors. We accomplish this through rigorous verification processes as well as adhering to Universal Protocol standards for site marking, time-outs, consent, and lens implant verification. This is to ensure accurate eye procedures by establishing clear communication protocols between the surgical team, patient, and nursing staff before the patient enters the operating room.
Correct site should be marked by the surgeon in the pre-op area. The pre-op and sedation nurse confirm the consent, patient identifier, correct biometrics, and the lens implant needed for the patient. Additionally, video interpreters are used when a language barrier exists between the staff and the patient.
The ASD has designed a hand-off sheet, which travels with the patient to each area of the ASD and is signed by the pre-op, OR and PACU nurse to ensure clear communication between these areas. During the operating room time-out, the surgeon, circulating nurse, sedation nurse, and scrub technician jointly confirm two patient identifiers, allergies, procedure type, consent documentation, and biometric-verified lens/eye alignment with the whiteboard details. To better prevent errors, the department now has daily external audits of OR time-outs from neutral observers verifying strict adherence to patient verification protocols.
The implementation of the hand-off sheet and time-out audits has strengthened patient safety in the ASD. It is imperative that we have effective communication throughout the department, which directly impacts patient outcomes, patient safety and team efficiency. Ongoing feedback from the team helps us improve patient care and ensure safe practice.