Care Population Research Articles

The challenge of reforming child protection in Eastern Europe: The cases of Hungary and Romania

This paper discusses the challenges of reforming the child welfare and protection systems in Hungary and Romania –two countries in transition from socialism to capitalism– and the impact on children, young people, families, and professionals. Brief overviews of the social, political, and economic characteristics of the two countries and of the evolution of their child welfare systems set the context of discussion. The focus is on the efforts made to deinstitutionalise children from large institutions, develop local prevention services, and develop alternatives to institutional care. The two countries had different starting points in transforming the child protection system: Romania started only after 1989 under political and economic pressures with little internal initiative, whilst Hungary begun in the mid 1980s, being more advanced than other transition countries in developing alternative services. Whilst statistical data show a decline in the care population and a shift between institutionalisation and foster care, demonstrating progress and change, the slow implementation of the reforms generate wide gaps between the UNCRC-based legislation and national plans and the quality of life and wellbeing of children. Among the factors causing this discrepancy are: insufficient financial investment, lack of professionalization and accountability, and underuse of research and evaluation to clarify the link between services and needs.

HIV-exposed infants

Each year over a million infants are born to HIV-infected mothers. With scale up of prevention of mother-to-child transmission (PMTCT) interventions, only 210 000 of the 1.3 million infants born to mothers with HIV/AIDS in 2012 became infected. Current programmatic efforts directed at infants born to HIV-infected mothers are primarily focused on decreasing their risk of infection, but an emphasis on maternal interventions has meant follow-up of exposed infants has been poor. Programs are struggling to retain this population in care until the end of exposure, typically at the cessation of breastfeeding, between 12 and 24 months of age. But HIV exposure is a life-long condition that continues to impact the health and well being of a child long after exposure has ended. A better understanding of the impact of HIV on exposed infants is needed and new programs and interventions must take into consideration the long-term health needs of this growing population. The introduction of lifelong treatment for all HIV-infected pregnant women is an opportunity to rethink how we provide services adapted for the long-term retention of mother-infant pairs.

Adolescent Bariatric Surgery: The Canadian Perspective

Canada faces a similar epidemic of obesity in their adolescent population as other Western countries. However, the development of programs to treat obesity and manage its sequelae has evolved in a unique way. This is in part due to differences in health care funding, population distribution, public demand, and availability of expertise and resources. In this article, we will describe the evolution of adolescent bariatric care in Canada and describe the current programs and future directions. The focus will be on the province of Ontario, the site of the first adolescent bariatric program in the country.

TCT-183 ENERGY 1,000 Patient Registry with a Thin Strut Bare Metal Stent with Passive Coating presenting Two Year Data

The PRO-Kinetic Energy is a thin strut (60μm) cobalt chromium alloy bare metal stent, which is coated with a thin layer of amorphous silicon carbide. The aim of this registry is to evaluate its clinical performance in a large patient population in standard clinical care. 1,016 consecutive patients

A critical analysis of sarcoidosis incidence assessment

Valid sarcoidosis incidence assessment is contingent on access to medical care, thoroughness of reportage, assiduity of radiographic interpretation, employment and health care screening policies, misclassification, and population ethnicity. To diminish ambiguity and foster inter-population comparison, the term “sarcoidosis incidence” must be modified to convey the methodology employed in compiling the numerator. In age-delimited cohorts, valid comparison to population incidence requires age adjustment due to the age-dependency of incidence. The “true incidence” of sarcoidosis is a notional concept: more than 90% of cases are subclinical and radiographically inevident. Occupational causal inference based on incidence differential vs. populations has been undermined by methodological differences in ascertainment and computation.

Barriers and strategies to manage CVD in India (SPECTRUM): a nationwide survey

Purpose: India has high rates of cardiovascular diseases (CVD). Yet there are no representative data on the barriers and strategies to improve CVD care in India. We aimed to analyse the barriers and elicit strategies, which are important to implement programs and policies. Methods: We conducted a nationwide cross-sectional study among physicians at randomly selected hospitals, stratified by region, population and level of health care. Sample size for hospitals was based on community prevalence of CVD. At each hospital we randomly selected an average of 10 physicians. All self reported questionnaires were anonymously collected between March 2012 and January 2013. The questions included description of physicians, patients seen, risk factors, barriers perceived and strategies suggested to manage CVD. Results: We received completed questionnaires from 1,271 physicians (from 124 hospitals at 75 cities in 22 states that represent 94.1% of the population). Physicians were internists (54.3%), specialists (27.7%) and generalists (18.0%). The median years since qualification were 7 (inter quartile range 3.0 – 16.0) and they practiced for 8.4 (± 3.01) hours a day. Most (70%) used international guidelines for management. The stated barriers for optimal CVD management were cost and access to medication (92.0%), literacy (86.9%), complex regimen (86.1%), lack of family support (79.0%), poor follow up (75.0%), lack of adequate hospital staff (56.6%), complementary and alternative medication (50.0%) and high patient load (49.9%). Strategies suggested to improve CVD management were related to practice (use non physicians 90.4%, additional medical staff 88.6%), patients (more education 93.4%, provide written material 83.6%, mobile text reminder 52.0%), physicians (better access to guidelines and updates 95.3%, compulsory CME 87.0%, better internet access 85.1%, clinical research participation 79.8%) and policy (better infrastructure 94.0%, hospital registries 93.3%, IT infrastructure 88.5%, Government subsidy for treatments 87.5%, universal health insurance 83.3%). Conclusions: This first nationwide survey identified significant barriers and elicited practical strategies for better CVD care. The Government and health care providers must urgently consider these findings to implement policies and programs to reduce the high CVD mortality in India.

Transforming Health Care Leadership: A Systems Guide to Improve Patient Care, Decrease Costs, and Improve Population Health

Transforming Health Care Leadership: A Systems Guide to Improve Patient Care, Decrease Costs, and Improve Population Health

Revisiting the Methodology of Measuring HIV Community Viral Load

Revisiting the Methodology of Measuring HIV Community Viral Load

Dementia care and offender populations

284 British Journal of Community Nursing Vol 18, No 6 T he healthcare of offenders was transferred from Her Majesty’s Prison Service to primary care trusts, since April commissioning for services in England now rests with NHS England (formerly known as the NHS Commissioning Board). NHS England is responsible for ensuring that services are commissioned in ways that support consistency; consistency in ensuring high standards of quality across the country (NHS England, 2013). Prison services that provide health care are also required to register with the Care Quality Commission (CQC). The CQC monitors, inspects and reports on services, checking to ensure that they operate like a community health service. Providers in prisons should be able to demonstrate that they comply with CQC regulations using the same information that is used to demonstrate that they meet Her Majesty’s Inspectorate of Prisons (HMIP) expectations (CQC, 2010). Offender care therefore, must be provided on par with those offered by other healthcare services. Dementia care is high on the political agenda. The prime minister has issued the first ever national challenge on dementia care and research. The Department of Health (DH) (2012) has set out its response to improving care for people with dementia. It is estimated that there are approximately 800 000 people with dementia in the UK and by 2040 the number of people affected is expected to double (DH, 2013). Dementia is primarily a disorder of later life; however there are some people under 65 who are also affected. The data noted should be treated with caution as these figures refer to formal diagnosis and as such this may be an under estimation. There are offenders in prisons and other places of detention who have dementia. The strategies suggested by the DH should be applied and extended into prisons, yet there seems to be no evidence of this occurring in a consistent manner across the UK. Given the projected increase in the number of people with dementia in the population generally (this will also apply to the prison population) as well as the fact people are living longer, dementia presents a future problem for prisons who are responsible for a growing population of older people. The issue of dementia has attracted little attention for this population and appears to have been essentially overlooked (Moll, 2013). Prisons are ill equipped to provide and match the level of service provision that the rest of the population receive. Nurses providing care to the offender population are therefore at risk of failing in their duty of care as well as contravening the tenets of the Code of Conduct (Nursing and Midwifery Council, 2008). There is a changing demographic in prisons in England and Wales, the number of sentenced prisoners aged over 50 has risen by 74% to nearly 10 000 in the past decade. Male offenders over 50 are the fastest growing group in prisons. In prisons the over-60s population has increased eight-fold since 1990. Offenders are often considered to be physiologically ‘older’ than their chronological age, this is associated with the psychological and physical impact of imprisonment coupled with preceding issues, for example, substance misuse, suggesting that those suffering from dementia were affected earlier than the wider population (Moll, 2013).

Report on Health Provision to Nomads: Improving Medical Staffing at Haima Hospital, Jiddat-Il-Harasiis, Oman

Introduction In January 2012 the authors visited Haima Hospital in the Jiddat-il-Harasiis, Al Wusta province, Sultanate of Oman (Figure 1). It is the most remote secondary health care service in the country--nearly five hundred miles from the capital, Muscat, and five hundred miles from Salalah in the south (Figure 2). The visit was part of a larger research initiative to document contemporary life among the Harasiis pastoral camel- and goat-herding nomads and those Harasiis families newly settled in the government-built 'tribal centre' at Haima. This initiative followed on from the original United Nations Development Programme (UNDP) project to extend government services to pastoral nomads in the interior deserts of Oman without forcing them to settle. The UNDP project helped support the development of weekly boarding schools, mobile primary health care and expanded immunization initiatives as well as the establishment of social affairs offices, veterinary support and other government initiatives (Chatty 1996: 92). The Harasiis are a mobile herding tribe of approximately five thousand people spread out over a traditional territory, which they have occupied for several centuries, of about forty-two thousand square miles, an area about the size of Scotland, along the edge of the Empty Quarter (Rub' al-Khali). For several decades, the government of the Sultanate has tried to extend meaningful health services to this largely mobile if not entirely nomadic population. Over the years several hospitals have been built on this site; and mobile services have been initiated and just as suddenly stopped. Difficulties in maintaining a consistent level of use have meant that it has been very hard to retain staff and the services offered at these institutions have generally shrunk to the bare minimum, making the hospitals at times no more than primary health care units. This report attempts to examine the difficulties of providing secondary health care services to a widely dispersed population and makes a number of suggestions for enhancing and improving health care delivery to remote and widely dispersed populations in general. Background Basic health care provision for pastoral peoples in the Middle East has been difficult to provide due to their remoteness and mobility. These marginal mobile or recently settled populations have had limited access to government health care provision. In addition, the populations of the Middle East have experienced particularly rapid socio-economic change over the past forty years, due largely to the discovery and exploitation of oil and the consolidation of the nation state. The basic social, political and cultural rights of the pastoral populations of the peninsula have largely been ignored, in part due to their remoteness and inaccessibility, but also due to the very fact of their mobility. Government services, based upon Western models, are designed for fixed, permanently domiciled populations. The organization of pastoral societies, with their mobile and constantly shifting households, does not fit into existing paradigms of Western-inspired development. A shortage in the resources and funds of government ministries has restricted public health services and the establishment of mobile clinics. Furthermore, pastoral societies' communal, traditional pattern of land use has not been understood by states in the region. This has resulted in serious societal upheaval, loss of control over vital grazing lands and often coercive pressure to settle and farm or enter the unskilled labour market. In the arena of health care, these marginal, mobile and remote populations have largely been excluded or have excluded themselves from government initiatives. Those that have settled have had only limited provision within or nearby their rural villages. In addition, the providers are largely focused on curative aspects rather than health promotion and disease prevention. [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] Many of the Harasiis have moved into social housing provided by the government in the tribal centre at Haima. …

Prise en charge des patients atteints de maladies chroniques. Concepts, évaluations et enseignements internationaux

The growing number of people with chronic diseases is a major challenge for health care systems in terms of morbidity, mortality, quality of care and financial impact. A range of organizational concepts for structured chronic disease care have been developed to address this challenge. The purpose of this literature review is to identify the key concepts, results and success factors of recent initiatives in this area. Four main concepts related to the broader notion of integrated care were identified: case management, disease management, the chronic care model and population management. The available evidence suggests that the expected results in terms of health gains and cost reductions have only been partially achieved, but that the quality of care has improved. The study identified several critical success factors for initiatives aimed at improving chronic care: the integration of patient education, the implementation of a patient identification system, provider feedback, primary care performance and financial incentives. Improved care for patients with chronic illness requires a range of interdependent measures. However, it is important to note that initiatives in this area are not usually associated with shortterm savings, but represent an investment for the future.

A Model for Patient-Centered Army Primary Care

This pilot evaluated a novel method of primary care delivery in a military family practice setting. A registered nurse, registered nurse case manager, and primary care provider formed the patient management team. Approximately 2,500 empanelled patients participated in a pilot program that applied a patient-centered approach to primary care. The pilot tracked outcome measures, which included (1) panel size, (2) access to care, (3) care utilization, (4) continuity of care, (5) nurse and provider productivity, (6) Healthcare Effectiveness Data and Information Set measures, and (7) satisfaction measures. When compared to the standard family practice clinic, the patients in the pilot were able to access the family practice clinic more frequently (p < 0.05), were less seen in the urgent care (p < 0.05), and had a lower no-show rate (p < 0.001) for scheduled appointments. The providers were able to see their own empanelled patients significantly more frequently (p < 0.05) and virtually all Healthcare Effectiveness Data and Information Set markers improved with colon cancer screening, low-density lipoprotein annual exams, low-density lipoprotein control, and breast cancer screening/mammogram being significantly improved over the comparison group (p < 0.05). These results suggest a change in staffing and a focus on patient-centered care can significantly improve outpatient care access and population health maintenance.

In response to: Method of electronic health record documentation and quality of primary care

We read with interest the article by Linder, Schnipper, and Middleton comparing dictation, free-text typing, and structured data entry to quality outcomes.1 The authors conclude that using dictation appeared to provide a lower quality of care, but that conclusion seems unsupported by the reported results. Most importantly, the authors themselves note that most of the differences found were not actually quality of care or clinical outcome measures. The authors write that ‘even if documentation style were only associated with better documentation quality, a complete and accurate record is important to demonstrate high-quality care and inform clinical decision support and population management.’ However, the methodology states that text notes were not used for quality assessment, so the ‘missing’ data elements might have been just as completely and accurately …

A Probability Sample for Monitoring the HIV-infected Population in Care in the U.S. and in Selected States

Epidemiologic and clinical changes in the HIV epidemic over time have presented a challenge to public health surveillance to monitor behavioral and clinical factors that affect disease progression and HIV transmission. The Medical Monitoring Project (MMP) is a supplemental surveillance project designed to provide representative, population-based data on clinical status, care, outcomes, and behaviors of HIV-infected persons receiving care at the national level. We describe a three-stage probability sampling method that provides both nationally and state-level representative estimates.In stage-I, 20 states, which included 6 separately funded cities/counties, were selected using probability proportional to size (PPS) sampling. PPS sampling was also used in stage-II to select facilities for participation in each of the 26 funded areas. In stage-III, patients were randomly selected from sampled facilities in a manner that maximized the possibility of having overall equal selection probabilities for every patient in the state or city/county. The sampling methods for MMP could be adapted to other research projects at national or sub-national levels to monitor populations of interest or evaluate outcomes and care for a range of specific diseases or conditions.

Translation and adaption of the interRAI suite to local requirements in Belgian hospitals

BackgroundThe interRAI Suite contains comprehensive geriatric assessment tools designed for various healthcare settings. Although each instrument is developed for a particular population, together they form an integrated health evaluation system. The interRAI Acute Care Minimum Data Set (interRAI AC) is tailored for hospitalized older persons. Our aim in this study was to translate and adapt the interRAI AC to the Belgian hospital context, where it can be used together with the interRAI Home Care (HC) and the interRAI Long Term Care Facility (LTCF).MethodsA systematic, comprehensive, and rigorous 10-step approach was used to adapt the interRAI AC to local requirements. After linguistic translation by an official translator, five researchers assessed the translation for appropriate hospital jargon. Three researchers double-checked for translation accuracy and proposed additional items. A provisional version was converted into the three official languages of Belgium—Flemish, French, and German. Next, a multidisciplinary panel of nine experts judged item relevance to the Belgian care context and advised which country-specific items should be added. After these suggestions were incorporated into the interRAI AC, hospital staff from nine Flemish hospitals field-tested the tool in their practice. After evaluating field-test results, we compared the interRAI AC with Belgian versions of the interRAI HC and interRAI LTCF. Next, the Flemish, French, and German versions of the Belgian interRAI portfolio were harmonized. Finally, we submitted the Belgian interRAI AC to the interRAI organization for ratification.ResultsEighteen administrative items of the interRAI AC were adapted to the Belgian healthcare context (e.g., usual residence, formal community services prior to admission). Fourteen items assessing the ‘informal caregiver’, and 17 items, including country-specific items, were added (e.g., advanced directive for euthanasia).ConclusionsThe interRAI AC was adapted to local requirements using a meticulous and recursive 10-step approach. As use of the interRAI Suite continues to grow worldwide and as it continues to expand to other care settings and populations, this procedure can guide future translations. This procedure might also be used by others facing similar challenges of complex translation and adaptation situations, where multidimensional instruments are used across multiple care settings in multiple languages.

ART—a method on its way into dentistry

In this issue of the journal, we present a comprehensiveoverview on the state of the art concerning AtraumaticRestorative Treatment (ART) [1]. Although quite a numberof assessments including systematic reviews have been pub-lished on ART already, it was the intension of this article todescribe the potentials and the limitations of ART for den-tistry as such, i.e., an attempt to describe the role of ART indentistry. The development of ARTstarted in the eighties ofthe last century as a necessity to provide dental care inpopulations who were deprived of any dental treatmentand whose alternative would have been and was so far:tooth extractions. Over the years, the ART method and therespective materials were further developed, and a largenumber of studies were published. Reports were available,e.g., on survival rates and on acceptance of this techniquemainly in low- and medium-income countries, indicatingthat ARTcould indeed be regarded not only as an alternativeto tooth extractions practiced so far but also as a way toimprove dental health. These data have been the basis forrespective WHO statements recommending this techniqueunder these circumstances. But, not only was a new treat-ment method created, control criteria and hand instrumentswere also developed for this technique, which weredesigned to fit best these procedures. So far, so good.However, with increasing success of this method in theabove-described deprived populations, the idea was bornthat this method could be used in these populations insteadof introducing classical dental treatment, like the placementof amalgam filling. Indeed, some studies performed in low-and medium-income countries showed for one-surfacecavities that ART revealed equally good results as classicalrestorations. Clear limitations were observed in larger thanone-surface cavities.Then, apparently, the idea emerged that ART would alsobe interesting for developed countries. In these countries,there are special populationgroups,like (small) children, thehandicapped, and anxious or elderly patients, who couldpotentially benefit from such a treatment method due tomany reasons. However, now, the alternative was not any-more tooth extraction, but classical dental treatment with thehighly developed canon of sophisticated materials andmethods, which had been developed over the recent deca-des. ART was entering a new arena.Due to the minimally invasive character, it indeed wasprima vista plausible to assume that ART could also find aplace there. However, now, ART had to and will have tocompete in outcome results derived from classical methodsand materials of restorative dentistry and with hundreds ofstudies—though with different levels of quality—availableconcerning failure or survival rates. Furthermore, the ques-tion now is, is this still ART? Caries removal with anexcavator is not new, and the author of this editorial wastaught this many years ago in dental school as well as thepossibility of not using engine-powered drills in certainclinical cases like anxious children. Also, glass ionomercement (GIC) was used in such cases before ART wasintroduced. On the other side, widening of the opening ofsmall cavities with hand instruments or the use of(improved) GIC in occlusal surfaces has been attributed toART. It would be helpful, though, if a common basis ofunderstanding what ART contributed to dentistry could beformulated. Again, the present overview article [1] could bea starting point.The comparative evaluation between results with classi-cal methods and materials in restorative dentistry and dataderived from ARTstudies was and is difficult due to several

Can teletechnology improve patient experience and reduce the use of health care resource?

Introduction: By 2050 it is estimated that there will be 16 million people over the age of 65 years. With the expansion in the older population and improvements in health care the number people living with a chronic health condition (Long Term Condition, LTC) is increasing. Many people will have more than one LTC e.g. diabetes and cardiac disease. With pressure on the health economy and available resources increasing, managing as many people outside of hospital as appropriately possible is essential. The white paper “Our health our care our say” (DH 2006), challenges local health and social care communities to deliver more care closer to the patients own home. The Kent Telehealth pilot study, undertaken in 2005, investigated whether the use of Telehealth in the UK health care setting could replicate the outcomes of the Veterans Administration programme in the US. Methods: The pilot examined the role of Telehealth in supporting users and their carers, and assessed its impact on hospital admissions, length of stay, GP contact and nursing visits. Patients acted as their own controls. SF12 and QuIL were used for the qualitative evaluation. Health Ethics approval was granted. All participants provided informed consent. Those meeting the eligibility criteria—of at least one LTC (diabetes, COPD, heart failure) were recruited, equipment was provided to record their vital signs. Vital signs parameters were agreed for individual users with their clinician. Data were automatically uploaded to a web based server, accessible to health care staff responsible for the care of the individual. The frequency of data review was dependent on the service delivery model and appropriate communications were undertaken with the user to facilitate any change in their agreed management plan. Results: Two hundred and fifty users were recruited, data were available for 202 users for the final analysis. There were 88 less A&E visits and 536 bed days were saved. If admitted the length of stay was shorter by up to 4 days. There was a 28% reduction in calls to the GP, a 23% reduction in visits to the surgery, and an 18% reduction in home visits. It has been estimated that over a six-month period, Telehealth intervention saved an average of £1878 per user (£1038 to £2718, p=0.01). Using Hospital Episode Statistics estimates savings that could be generated across Kent (2006–2007 prices) could be £7.56 million (CI £4.18 million to £10.942 million) annually. Users reported an increased peace of mind, increase quality of life with increased empowerment and self management with improvements in SF12 scores improved for General Health +5.7, for Physical health +8.7. Conclusions: Telehealth is a potentially valuable adjunct in the management of people with LTCs. Patients become more empowered and independent and as a result, reduced their reliance on primary and secondary care. There is the potential for significant financial gains to be realised, through improved working and reduction in attendance at hospital for admission and or outpatient consultations. Patient quality of life also improved which impacts on how and when they interact with services.

HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality

Hepatitis C virus (HCV) has emerged as an important health problem in the era of effective HIV treatment. However, very few data exist on the health status and disease burden of HIV/HCV-coinfected Canadians. HIV/HCV-coinfected patients were enrolled prospectively in a multicentre cohort from 16 centres across Canada between 2003 and 2010 and followed every 6 months. We determined rates of a first liver fibrosis or endstage liver disease (ESLD) event and all-cause mortality since cohort enrolment and calculated standardized mortality ratios compared with the general Canadian population. A total of 955 participants were enrolled in the study and followed for a median of 1.4 (interquartile range 0.5-2.3) years. Most were male (73%) with a median age of 44.5 years; 13% self-identified as aboriginal. There were high levels of current injecting drug and alcohol use and poverty. Observed event rates [per 100 person-years; 95% confidence interval (CI)] were: significant fibrosis (10.21; 8.49, 12.19), ESLD (3.16; 2.32, 4.20) and death (3.72; 2.86, 4.77). The overall standardized mortality ratio was 17.08 (95% CI 12.83, 21.34); 12.80 (95% CI 9.10, 16.50) for male patients and 28.74 (95% CI 14.66, 42.83) for female patients. The primary causes of death were ESLD (29%) and overdose (24%). We observed excessive morbidity and mortality in this HIV/HCV-coinfected population in care. Over 50% of observed deaths may have been preventable. Interventions aimed at improving social circumstances, reducing harm from drug and alcohol use and increasing the delivery of HCV treatment in particular will be necessary to reduce adverse health outcomes among HIV/HCV-coinfected persons.

Problems of high-tech health care in federal institutions of the North-West Federal District, and St. Petersburg

Currently available to the population of high-tech medical care is not provided in full, which is one of the reasons for high levels of preventable death and disability in the population, and causes the legitimate grievances of people. In this regard, the priority national project "Health" the development of high-tech medical aid was allocated in a separate direction. In just five years as part of the priority national project "Health" this kind of assistance could receive more than one million patients. The results achieved have had a positive impact on health and demographic indicators in the Russian Federation

Corneal defects: do they matter?

Introduction Ocular defence mechanisms are challenged in the intensive care environment secondary to sedation, paralysis and mechanical ventilation. Defects may develop in the exposed cornea. These are painful, may cause agitation and can lead to bacterial keratitis, with potentially devastating effects on vision. Protective treatments are available but there are no universal guidelines for eye care. Literature review revealed a paucity of knowledge within the paediatric population. Aims Establish incidence and risk factors for development of corneal defects within a paediatric intensive care (PICU) population. Directly assess the effect of the introduction of an eye care guideline. Methods A prospective audit was undertaken. Weekly eye examinations of all mechanically ventilated children were performed by an ophthalmology SpR and intensive care fellow. Current eye care, eyelid position and presence of any corneal abnormalities were assessed. New eye care guidelines were developed and introduced by means of tutorials, bedside demonstrations and posters. Repeat audit assessed improvements in eye care. Results 45 children were examined prior to implementation of the new guidelines. 33.3% had defects in at least one eye. 20% had bilateral defects. Incomplete eye closure and longer stay increased the risk of defect development. 80% were receiving no formal eye care, and when used treatment choices were inconsistent. 37 children were examined following introduction of the new guidelines. 35 (94%) received formal eye care according to the protocol. There was a significant reduction in the incidence of corneal defects (p=0.019), 10.8% having a defect in at least one eye and 5.4% bilateral defects. Although rates of incomplete eye closure were not reduced, there was a significant reduction in the incidence of defects within incompletely closed eyes (86.7% vs 19.9%). All patients with defects commenced regular simple eye ointment and had complete resolution at follow-up. Implications Corneal defects are a source of unrecognised morbidity within PICU. Simple preventive measures are available. Use of eye care guidelines reduces the incidence of corneal defects. Vigilant eye care is essential for all intensive care patients.