Pediatric Intensive Care Unit (PICU)


Interdisciplinary Collaboration Impacting Ophthalmologic Complications

In the critical care unit there is often a focus on problems that are seen as life threatening.  However, up to a third of these patients can develop ophthalmologic complications during their illness.  These complications can necessitate surgical intervention, and even lead to vision loss.  In the Pediatric Critical Care Unit, a conversation between a nurse and a consulting physician about eye care led us to examine our current practices.  While we routinely provided eye lubrication to patients receiving neuromuscular blocking medications, there were several additional at-risk populations of children who were not being provided eye care.  In looking back over the previous six months, we also identified that three patients had developed serious ophthalmologic complications that may have been preventable.

 A collaborative team of critical care nurses and physicians, as well as pediatric ophthalmologists, met to review current literature, and determine best practices.  What we found is that we had an opportunity to improve our current routine eye care, by including eye washing in addition to lubrication.  We also identified which children were most at-risk for ophthalmologic complications and designed an algorithm to determine frequency of eye care and eye assessment, as well as when to consider an ophthalmology consult.  As we move forward, these new practices will allow us to better recognize our rates of both minor and serious ophthalmologic complications in the pediatric critical care unit.

As this work has evolved, we have provided education to all of our nurses, and now have a core eye care team who will continue to champion this initiative.  As we constantly work toward delivering the highest level of nursing care, these efforts are now preventing children from having to deal with vision complications as they recover from critical illness.  Since implementation of this work in April 2014, a child identified as having significant risk factors by members of the eye care team, received early intervention following the algorithm, and as a result has likely avoided long-term vision loss.


Nursing Staff Involved:

Marcy Smith BSN, RN
Dana Carter BSN, RN
Nikita Vandenbosch RN, CPNP-AC
Lindsey Jelsma RN, BSN, CCRN
Caryn Steenland MSN, RN, CCRN


Physician Staff Involved:

John Winters MD
Patrick Droste MS, MD
Brooke Geddie DO