10 Essential Risk Management Tips for Ophthalmologists

As with all specialties, complications may arise following eye surgery, and a patient may suffer an adverse outcome. Such outcomes may range in severity from minor to a permanent loss of vision. As a result, the injured patient may initiate a claim of negligence. PMP’s article, Learning from Ophthalmic Cases: Minimise the Risks discusses PMP’s experience of negligence cases and contributory factors leading to claims.

Although the majority of ophthalmologists will already be undertaking these strategies as standard, the following list offers some essential tips to help you go back to the basics, mitigate your risk and enhance patient safety.

1. Ongoing performance improvement

• Ophthalmologists should ensure their skills and knowledge of surgical techniques are regularly updated and that they follow best practice guidance.
• Ongoing evaluation of procedural skills and competency with equipment is critically important.

2. Conduct a thorough assessment of the patient

• Pre-operatively, ensure that all testing and specialty evaluations are available for review.
• Dissatisfaction following cataract surgery is often due to the refractive outcome. Take a careful history of prior refractive correction (contact lenses, glasses, refractive surgery), age, lifestyle and the characteristics of the pre-operative refraction (hypermetropia, myopia, astigmatism, anisometropia).
• Update and review medical and family history at every visit to ensure the best decision-making.

3. Communication

• Communicate adequate, clear, and appropriate information to patients and use open questions about work and family to explore what might be important to the individual patient.
• Use layman’s terms when talking about procedures, anticipated benefits and potential risks, in order to ensure that you meet the patients’ communication and language needs.
• Listen to what your patient would consider to be a successful outcome.
• Use a technique — such as teach-back (also called ‘show-me’)— to gauge patient understanding of the information you have relayed. This can help reduce the risk of miscommunication, and support the patient’s adherence to a care plan.

4. Consent

• In accordance with the GMC’s Decision making and consent, clinicians should ensure they have a meaningful discussion with the patient prior to the procedure to enable the patient to make an informed choice. This will include details of the procedure, risks, benefits and available alternatives. In addition, consider what is most important to the individual patient, taking into account their lifestyle and employment.
• Provide the patient with all the information they will need to make a decision, including the consent form, prior to the day of the surgery.
• If using a pre-printed consent form, ensure the appropriate risks are fully detailed.
• Document in detail the content of your discussion in the patient’s medical records.

5. Engage patients as active participants in their care

• Consider the patient’s health literacy and other comprehension barriers.
• Give thorough and clear patient instructions for aftercare and follow-up.
• If the patient is self-funding an intervention, ensure they are provided with clear information about all the costs involved, including those associated with post-operative follow-up. In addition, ensure they are made aware of their right to a refund or return of deposit if they change their mind about the proposed treatment plan.

6. Equipment

• Verify that all necessary equipment and supplies are available prior to the start of each procedure.

7. Undertake pre-operative checks and surgical team timeouts prior to commencement of surgical procedures

• Participate in the completion of the WHO Surgical Checklist.
• For implants, check the implant make, model and dioptric power and spherical equivalent refractive target.
• Ensure any post-operative deterioration and/or complications are communicated, investigated and managed in a timely and appropriate manner. These details should be fully recorded in the patient’s medical records.

8. Documentation

• Maintain clear and accurate medical records.
• Document a complete, concise, and accurate operative report on the day each procedure is undertaken. Ensure the entry is dated, timed and signed.

The surgical record is critically important for detailing the pre-operative patient assessment, intraoperative steps, and post-operative sequence of events. Any discrepancies or gaps in the details or timing make it much more difficult to build a supportive defence framework against potential complaints or claims of clinical negligence.

9. Learning from adverse events

• An adverse event should be used as an opportunity to reflect, learn and adapt changes to a clinician’s practice and ultimately to improve care. Following an adverse outcome, it is essential to investigate, explain and apologise to the patient. Please refer to the GMC’s Openness and honesty when things go wrong: The professional duty of candour.

10. Professional indemnity insurance

• Ensure adequate professional indemnity insurance is in place to cover all interventions undertaken. Please remember that, in accordance with the terms and conditions of your insurance policy, you must advise PMP of any changes to the scope of your practice. Your insurance cover may be impacted if you do not inform us of such changes.

If you receive a complaint from a patient, or a patient suffers an adverse event, please call the PMP medicolegal helpline as soon as possible. The PMP medicolegal helpline team, provided by Clyde & Co LLP (a law firm), can assist customers in preparing an appropriate response.