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Patients assessed to be at high risk of serious perioperative complications, such as a cardiorespiratory event, should be carefully stratified for surgical and anaesthetic requirements, and may be unsuitable for surgery in isolated units without immediate access to anaesthetic/medical cover.

The majority of patients are treated as day cases. Consideration should be given to prescribing suitable analgesics to take home; it may prove useful to use protocols to optimise treatment pathways.⁴⁶

National safety standards for invasive procedures should be adapted for local use as local safety standards for invasive procedures.⁴⁵ The WHO preoperative team brief and checklist system, for example, could be adapted to incorporate intraocular lens selection to help prevent ‘wrong lens’ errors.⁴⁷

There should be a procedure for checking the laterality of the eye to be operated on prior to local anaesthetic block or general anaesthesia. This should include the eye being marked with an indelible mark by the responsible surgical team prior to admission to the operating theatre. ‘Stop before you block’ protocols should be adhered to.⁴⁸Inadequately performed ‘sign-in’...

The following local guidelines should be held and easily accessible:

• practice guidelines for the choice of general anaesthesia or local anaesthesia or local anaesthesia with sedation for ophthalmic procedures
• management of patients requiring intravenous sedation
• management of patients requiring urgent ophthalmic surgery
• escalation to higher levels of care and the safe transfer of patients
• management of patients on anticoagulants and...

Hospitals should consider the following actions to optimise the efficient use of clinical staff and patients’ time while maintaining quality of care:^36,50,51

• use of integrated pathways to coordinate the patient journey⁵¹
• use of screening to identify healthy ambulatory local anaesthesia patients for rapid turnover lists. This includes making use of cataract hubs where available...

Research in ophthalmic anaesthesia should be encouraged, and time set aside for this activity. Where appropriate, research projects should include patient and care provider involvement.

Ophthalmic anaesthesia should be included in departmental audit programmes, which may include patient satisfaction, complications and adverse events.^2,44

All serious complications of anaesthesia should be reported, should undergo a ‘root cause analysis’ and dealt with according to locally agreed governance structures.

Multidisciplinary quality improvement initiatives strengthen joint working and develop a cohesive working environment. Time should be set aside for regular joint governance meetings looking at both morbidity and quality issues.