Herpes simplex keratitis (HSK) is one the major causes of unilateral blindness in
the developed world. Evidence-based recommendations for HSK had not been properly
translated into practice. The overall aim of this thesis was to develop, implement, and
evaluate a local HSK treatment guideline at the Sydney Eye Hospital.
The Registered Nurses’ Association of Ontario (RNAO) Toolkit: ‘Implementation
of Best Practice Guidelines’ was utilised to develop, implement, and evaluate the
guideline at the Hospital. A retrospective review was conducted to determine the
knowledge gap. All HSK patients prescribed with antivirals, aged 18 years and above,
from 2012 to 2013 were included. To assess the response to the guideline, an audit of all
HSK patients aged 18 and over presenting during 6-months post-guideline
implementation was conducted. A web-based survey assessed clinician awareness, usage
and level of knowledge of the guideline. Patients were identified from viral swab results,
pharmacy records, and hospital coding data.
296 patients were included in the retrospective review and 85 patients in the
audit. The dose of prescribed antiviral medications was in alignment with the local
guideline in 80% (51/64) of patients compared to 73% prior to implementation (p =
0.331). Post-implementation alignment was found in 72% (26/36) of patients with
epithelial HSK vs 89% prior to implementation (124/139), p = 0.009. With SHSK-U,
33% (1/3) vs 9% (2/22), p = 0.3. With endothelial HSK, 67% (2/3) vs 33% (6/18), p =
0.5. With HSK prophylaxis, 100% (22/22) on prophylaxis vs 70% (31/44), p = 0.003.
The web-based survey was sent to 95 clinicians, 41 (43%) responded. Of these,
35 (85%) were aware of the guidelines, 31 (75%) accessed them through the hardcopy
and electronic versions available.
Most clinicians were aware of and adhered to the implemented local HSK
treatment guideline. The guideline aided clinicians, mainly trainees, in prescribing
antivirals for HSK according to the evidence to improve clinical outcomes.