EMERGENCY DEPARTMENT
[Your hospital name]
Morgan Lens
Competency Assessment
COMPETENCY GOALS: To demonstrate the safe and appropriate technique related to the set-up,
insertion, maintenance, and removal of the Morgan Lens.
Directions:
Y
N
Check Y (Yes) if skill is performed correctly
Check N (No) if skill is not performed correctly
Check RDR if a repeat demonstration was required
RDR
PERFORMANCE CRITERIA
1. Verbalizes indications and contraindications for use of the Morgan Lens
2. Verbalizes the need to institute standing orders/protocols or to obtain physician
orders for use of the Morgan Lens, topical anesthetic, and irrigation solution
3. Verbalizes need for universal precautions
4. Prepares and explains procedure to patient
5. Demonstrates proper set-up procedure
6. Demonstrates correct insertion technique
7. Demonstrates securing tubing to forehead with tape
8. Demonstrates proper methods for monitoring fluid level and flow rates during use
9. Demonstrates proper removal technique
10. Verbalizes the necessary documentation components
Comments:
Name:
Date:
This person has been validated as competent to perform this skill by:
Evaluator Name:
Evaluator Title:
P.O. Box 8719, Missoula, Montana 59807 USA
HOW TO USE YOUR MORGAN LENS COMPETENCY ASSESSMENT FORM
Dear Educator/Competency Evaluator:
Enclosed you will find a competency form that can be used to assess your staff's
proficiency in using the Morgan Lens. In order to properly assess their ability to demonstrate
correct techniques for insertion and removal, we also have available a life-like training tool to
use in conjunction with the competency assessment form.
Check Y (Yes) if the provider was able to perform all performance criteria correctly. If
remediation or a repeat demonstration was required, indicate this by checking N (No) and RDR.
Once the criteria has been met, indicate this by checking Y (Yes) on the form. Comments can be
made at the bottom of the form to indicate excellent performances or to note areas in need of
improvement.
KEY ANSWERS FOR COMPETENCY ASSESSMENT FORM
1. Verbalizes indications and contraindications for use of the Morgan Lens
Indications:
-for continuous medication or lavage to the cornea, conjunctiva, and entire cul-de-sac
-ocular injuries due to acid burns or solvents, gasoline, detergents, etc.
-alkali burns
-thermal or actinic burns
-non-embedded foreign bodies
-foreign body sensation with no visible foreign body
-severe infections
Contraindications:
-penetrating eye injuries
-suspected or actual rupture of the globe
-to instilling anesthetic agents with known allergies
2. Verbalizes the need to institute standing orders/protocols or to obtain physician orders
for use of the Morgan Lens, topical anesthetic, and irrigation solution
Some institutions have standing orders or protocols for use of the Morgan Lens. Because
time is of the essence when treating a chemical burn, this is preferable as all medical providers
should have the proper training and authorization to initiate immediate treatment. If a standing
order is not available in your institution, a physician's order would be necessary before initiating
therapy. The order should specifically include the use of the Morgan Lens, what type and
strength of anesthetic to be instilled, and the type and amount of irrigation solution to be utilized.
**Note: MorTan, Inc. recommends the use of lactated Ringer's (Hartmann's Solution) for
irrigation due to its pH and buffering capacity:
pH of normal tears:
approximately 7.1
pH of Normal Saline: 4.5 to 7.0
pH of lactated Ringer's: 6.0 to 7.5
3. Verbalizes need for universal precautions
Universal precautions should be maintained while providing patient care. Institutional
guidelines should be followed for specific recommendations.
4. Prepares and explains procedure to patient
The irrigation procedure should be explained to the patient, stressing that the Morgan
Lens will not be touching the injured eye but instead will float on the irrigating solution. Remind
the patient that the irrigation will immediately begin to dilute and wash out the chemical or
particulate material, quickly starting to relieve the pain. Letting the patient know that the process
may be cold or wet is preferable over a statement that may cause further agitation.
5. Demonstrates proper set-up procedure
-Gather necessary equipment. one or two 2 Morgan Lenses, topical anesthetic, one Morgan
Lens Delivery Set, one bag of lactated Ringer's solution, two Medi-Ducts (note that IV
tubing may be substituted for the Delivery Set, and towels, blue pads or some other
collection device may be used in place of the Medi-Duct)
-Instill topical anesthetic, if no known allergies
-Attach Morgan Lens to Morgan Lens Delivery Set or I.V. tubing
-Prime tubing and Morgan Lens with irrigation solution
6. Demonstrates correct insertion technique
-Start a minimal flow of irrigating solution
-Have the patient look down, insert the Morgan Lens under the upper eyelid
-Have the patient look up, retract the lower lid, drop the lens into place
-Release the lower lid over the Morgan Lens
-Adjust flow of fluid to desired rate
7. Demonstrates securing tubing to forehead with tape
The tubing should be taped to the patient's forehead to prevent accidental removal. Also,
the outflow should be absorbed with a Medi-Duct taped to the side of the patient's head (tape
should be applied to the plastic sleeve and not the fabric in order to allow maximum flow).
Towels, blue pads, or another suitable collection device may be used.
8. Demonstrates proper methods for monitoring fluid level and flow rates during use
During irrigation, periodically check the flow rate and ensure that the irrigation solution
does not run out. Solution should run continuously throughout the process. Replace saturated
blue pads or towels, or check that Medi-Duct is securely attached and wicking properly.
If additional anesthetic is needed, this can be done without removing the Morgan Lens.
Pinch the tubing to temporarily stop the flow of irrigating solution and instill the anesthetic into
the eye alongside the nose.
If patient wears contact lenses, these may be removed after a period of irrigation. Initial
treatment should not be delayed to remove contact lenses, and often they are easier to remove
once the eye has been irrigated. Since they may contain residual caustics, the contact lenses
should be discarded after removal.
9. Demonstrates proper removal technique
-Continue flow
-Have patient look up, retract lower lid and hold position
-Slide the Morgan Lens out
-Terminate flow
10. Verbalizes the necessary documentation components
-Use of Morgan Lens
-Type, amount, and strength of topical anesthetic and absence of allergy to medication
-Type and amount of irrigating solution, and length of time of irrigation
-Other:
-Which eye/eyes irrigated
-Patient tolerance to procedure
-Visual acuity (both pre- and post-therapy if available)
-pH readings (both pre- and post-therapy if available)
-Other injuries treated
-Concurrent use of gross decontamination (if indicated)
P.O. Box 8719, Missoula, Montana 59807 USA
Morgan Lens Eye Irrigation
[Your Hospital Name]
Sample Policy
PURPOSE:
To provide ocular irrigation to the cornea, cul-de-sac, and conjunctiva for the removal of
chemical irritants or non-embedded foreign bodies.
GENERAL INFORMATION:
The device is a scleral lens, molded of medical grade materials to maximum quality, with
directional fins, attached tubing, and standard luer loc adapter (which may be attached to the
Morgan Lens Delivery Set, a standard IV set, or a syringe). One or both eyes may be irrigated
simultaneously. The use of the Morgan Lens allows the concurrent treatment of other injuries
and/or the transportation of the patient without stopping the irrigation process.
INDICATIONS:
-For continuous medication or lavage to the cornea, cul-de-sac, and conjunctiva
-Ocular injuries due to acid burns or solvents, gasoline, detergents, etc.
-Alkali burns
-Thermal or actinic burns
-Non-embedded foreign bodies
-Foreign body sensation with no visible foreign body
-Severe infections
CONTRAINDICATIONS:
-Penetrating eye injuries
-Suspected or actual rupture of the globe
-To instilling ocular anesthetic agents with known allergies
PERSONNEL UTILIZED TO PERFORM:
MorTan recommends a policy that allows all medical personnel be trained to perform all parts
of this procedure in order to minimize the time necessary to initiate ocular irrigation.
Initial Assessment- (depends on institutional standards)
Medication Administration- (depends on institutional standards)
Procedure- (depends on institutional standards)
EQUIPMENT NEEDED:
MorTan recommends the following materials, with the possible exception of the anesthetic, but
assembled and maintained in a suitable "eye tray" or cart in order to reduce the time necessary to
initiate ocular irrigation.
-Morgan Lens (one per eye)
-Morgan Lens Delivery Set (one for irrigating one or both eyes) or IV set (one per eye)
-IV solution for irrigation (see note below)
-Medi-Duct (one per eye) or towels, blue pads, or other suitable fluid collection device
**Note: MorTan, Inc. recommends the use of lactated Ringer's (Hartmann's Solution) for
irrigation due to its pH and buffering capacity:
pH of normal tears:
approximately 7.1
pH of Normal Saline: 4.5 to 7.0
pH of lactated Ringer's: 6.0 to 7.5
PROCEDURE FOR OCULAR IRRIGATION WITH THE MORGAN LENS:
1. Institute standing orders/protocols for use of the Morgan Lens, or obtain physician's order
specifically approving use of the Morgan Lens, the type, amount, and strength of a local
ocular anesthetic to be instilled, and the type and amount of irrigating solution to be utilized.
2. Gather necessary equipment
3. Follow institutional guidelines for necessary universal precautions
4. Prepare and explain procedure to patient
5. Instill prescribed ocular anesthetic, if no known allergies
6. Attach Morgan Lens to Morgan Lens Delivery Set or IV tubing
7. Prime tubing and lens with irrigating solution
8. Start minimal flow of irrigation solution
9. INSERT LENS: Have patient look down, insert lens under upper eyelid
10. Have patient look up, retract lower lid, drop lens in place
11. Release lower lid over Morgan Lens
12. Adjust flow to desired rate
13. Tape tubing to patient's forehead to prevent accidental removal
14. Direct and absorb outflow with Medi-Duct, towels, blue pads, or fluid collection device
15. Irrigate with amount specified in protocol or physician's order (generally continue irrigation
until the pH of the eye returns to 7.5 to 8.0). Do not allow flow to stop.
16. REMOVE LENS: Continue flow, have patient look up, retract lower lid
17. Hold position and slide lens out. Terminate flow.
18. Wait 5 to 10 minutes and check pH of eye to ensure it remains in acceptable range. Repeat
irrigation if necessary until pH stabilizes.
19. Document procedure, noting use of the Morgan Lens, type, amount, and strength of topical
anesthetic and absence of allergy to medication, type and amount of irrigating solution used
and length of time of irrigation, which eye/eyes were irrigated, patient tolerance to
procedure, visual acuity (both pre- and post-therapy if available), pH readings (both pre- and
post-therapy if available), and any treatment of other injuries or concurrent use of gross
decontamination (if indicated).
20. Charge patient for supplies utilized