Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care

There is a need to evaluate different nursing procedures to determine whether in today's cost-conscious climate of health care they genuinely benefit the patient. If such procedures are indeed found to be of value, ways must be explored of ensuring that the manner in which they are performed conforms to acceptable standards. In the study reported here eyecare for the ventilated, sedated patient was examined because variations in clinical practice had been observed and a preliminary examination of the literature indicated that this patient group was at particular risks of developing serious ocular complications. The study was conducted in two phases. Phase 1 took the form of a literature review which demonstrated that although many questions remained unanswered, sufficient information relating to eyecare existed to help develop protocols to guide care. Phase 2 consisted of non-participant observation with 15 nurses employed in an intensive care unit to examine the standard of eyecare actually delivered. The standard of eyecare fell short of the ideal and as in other studies designed to observe nursing procedures accurately and in detail, there was no demonstrable relationship between clinical practice, knowledge or clinical experience. From the study overall it was possible to conclude that patients would benefit from the implementation and audit of guidelines of eyecare but that before these innovations are undertaken barriers to good practice should be explored in intensive care units.