So the other day I was walking around one of my ORs sort of waiting for the case to start. Usually, while in this holding pattern, I am gathering my wits thinking about a whole cadre of things. Then my eye fell on the corner of one of our carts, a corner where sat two bottles–eye drop bottles. One my mind discarded and another triggered a wondering-warning: generic moxyfloxacin? I don’t know whether I stopped immediately, or whether my thoughts came chasing me around the room a few minutes later, but at some point, a red flag went a waving.
The one my mind ignored was the prednisolone. But the other one, the one with the red flag went a bit like this: “That did not look like Vigamox sitting there ready for the nurse to dispense. Hold it; we can’t put that in the eye!”
See, the ACGME has been pushing patient safety as well as quality improvement projects. In 2015, one of my senior residents, Amanda Henderson, presented a quality improvement project on the use of intracameral antibiotics at the end of cataract surgery. Shortly after that our department began the routine use of intracameral Vigamox.
Then three years later generic started showing up. Well, a certain safety has been established in the use of brand name Vigamox®. It took me a while to feel comfortable using Vigamox in this way for the cataract surgery is very routine. Infection is very uncommon. The last thing we need to be doing is using a new product with an unspecified safety profile at the end of a passel of cases. It might go alright…or the preservatives might kick up inflammation storm in the eye. So, I wasted no time in telling my OR staff that this cannot be used in the eye. I mentioned it to my colleagues, and sure enough, this situation spread to my other ORs not long after.
Moxyfloxacin and patient safety
This situation raised an important teaching point in the residency beyond just OR safety. Things can sneak into the surgery suite in an innocuous manner but leave behind a trail far from the benign. In this case, we worry about TASS, not the Russian news agency, but Toxic Anterior Segment Syndrome. So, in your OR be vigilant; watch out for a PreservaTASS in an OR near you.
A curious thing on that label…
Look again at the moxyfloxacin ophthalmic solution label. See where it says “For use in the eyes only?” Hmmm, “in the eyes?” I bet they mean on the eyes like on the skin. Of course, taken literally it might seem like an intracameral medication. I bet we are not to be taking this one literally.