When cornea specialist Sahar Kohanim, MD, MPH, noticed a high number of patients experiencing severe corneal ulcers due to exposure keratopathy in the Intensive Care Unit (ICU) she set out to make changes. Collaborating with residents and medical students, she designed an Improvement in Medical Practice project for Maintenance of Certification to quantify and reduce the incidence of exposure keratopathy-related corneal ulceration.
“Exposure keratopathy is completely preventable or treatable with lubrication and taping of the eyelids,” Dr. Kohanim noted in her project. “Over the past several years, we have subjectively noted a high number of ophthalmology consultations on patients in our ICUs who have developed devastating corneal ulcers due to unrecognized/untreated exposure keratopathy. Early recognition and implementation of preventative measures are vital in eye care of ICU patients to prevent devastating vision loss.”
Working with her team, Dr. Kohanim created a plan to examine two measures: untreated exposure keratopathy (a process measure) and improvement in corneal ulcer (an outcome measure). Based on eye care protocols suggested in a 2015 article from the Journal of Intensive Care, Dr. Kohanim’s plan called for the implementation of a new protocol for the trauma unit nursing staff to screen for and treat exposure keratopathy and to educate the nursing staff about the protocol through an educational seminar and poster presentation. Even though the degrees of ocular exposure were essentially unchanged after the intervention, the frequency of exposure keratopathy decreased by more than 70% as the staff understood the need for appropriate topical lubrication. The protocol was implemented through a didactic session and a poster in the nurse’s break room.
Dr. Kohanim’s efforts will be honored next month with the 2018 Clarkson Quality Improvement Award, presented at AAO 2018 during the ABO’s Learning Lounge session. The Clarkson Quality Improvement Award celebrates the passion, pride, and professionalism exemplified by ABO diplomates in their efforts to continuously improve the practice of ophthalmology and serve as leaders in physician excellence. Named in honor of former ABO Executive Director and Chief Executive Officer John G. Clarkson, MD, the award is given annually to the diplomate whose self-directed quality improvement project has demonstrated noteworthy success in implementing quality improvement interventions.
Dr. Kohanim is an Assistant Professor of Clinical Ophthalmology at Vanderbilt and a cornea and cataract surgeon at the Tennessee Valley VA. She received her medical degree from Johns Hopkins University School of Medicine, and completed her residency in ophthalmology as well as her fellowship in cornea, external disease, and refractive surgery at Harvard Medical School/Massachusetts Eye and Ear Infirmary. She also has an MPH degree in epidemiology from Vanderbilt University School of Medicine. Dr. Kohanim has been a diplomate of the ABO since 2013. She has numerous publications and has given talks at national and international meetings. She was selected to serve on the American Academy of Ophthalmology’s IRIS Registry Outcomes Development Task Force. Her research interests include quality improvement, surgical outcomes, and healthcare disparities.