Effect of Exposure Keratopathy Protocol Implementation on the Incidence of Exposure Keratopathy Across Different Intensive Care Units

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PURPOSE: Exposure keratopathy (EK) is a preventable condition commonly affecting critically ill patients. A 2017 to 2018 study at our institution reported high EK incidence across the medical intensive care unit (MICU), neurologic ICU (NICU), and pediatric ICU (PICU). This study reassesses EK incidence after the implementation of a prophylaxis protocol implemented within the electronic medical record (EMR). METHODS: This is a prospective cohort study of patients admitted to the MICU, NICU, and PICU. Patients were enrolled within 24 hours of admission to the ICU and underwent daily ocular surface examinations assessing lagophthalmos, conjunctival injection, chemosis, punctate epithelial erosions, ulceration, Bell reflex, and blink reflex. Compliance with the prophylaxis protocol was assessed via review of the EMR for ocular lubricant order and administration history. RESULTS: Sixty patients were recruited (20 each from MICU, NICU, and PICU). Postimplementation, EK incidence decreased significantly overall (11.7% vs. 38.5%, P < 0.001), with notable reductions in the MICU (15.0% vs. 60.0%, P = 0.011) and NICU (5.0% vs. 47.8%, P = 0.002). PICU EK incidence did not significantly change (15.0% vs. 18.5%, P = 1.000). In univariable analysis, intubation (P = 0.0496), lagophthalmos (P = 0.013), injection (P < 0.001), and chemosis (P = 0.004) were associated with EK risk. No variable remained significant in multivariable analysis. Although all patients had EK prophylaxis ordered, only 53.3% received both correctly ordered and administered prophylaxis. CONCLUSIONS: EK incidence decreased significantly in the MICU and NICU because of an EMR-based prophylaxis protocol. Continued provider education is needed to enhance compliance and further reduce EK rates.

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