Introduction: Pupil checks are routinely done in the ICU. Previous studies demonstrated the improved accuracy of the pupillometer compared to visual inspection via the penlight. Nonetheless, there are barriers to the use of this device. Here we describe the impact that the new pupillometer system has on our nurse’s neurological exams as well as patient outcomes.

Methods: Initial studies were with nurses in the Neuro ICU where we surveyed them on their reasons for lack of pupillometer measurements. Working with our informatics team, interfaces were developed that allowed direct download of the data. After the implantation of these devices we again surveyed the nurses on all units regarding their level of comfort as well as time saved and what they thought outcomes were.

Results: In the preliminary survey, 50% of the respondents cited lack of pupillometers and 41% cited the labor intensity associated with data entry as the reason for the reluctance to use the pupillometer. Since implementing, we have expanded the number of pupillometers in the unit to six. In our secondary survey, 73% of nurses stated lock out time as the number one reason for not using the pupillometer. With the introduction of the pupillometer, the total time it takes to assess pupils was reduced from an average of 321 minutes to 182 minutes in a seven-day period. Our final questionnaire shows 78% of nurses are very comfortable with the use of pupillometer and 83% of nurses think that it has made a difference in patient outcomes.

Conclusions: Implementation of a direct download of data to the EMR improves ICU workflow and improves documentation of pupillary findings and changes. It has also shown to be effective in decision making for further management as well as predicting patient outcomes.

Patient Care: We have shown that the use of pupillometer has made a different in out patient's outcomes. We were able changes in our patient's exams and were able to make decisions on further management. Three patients were taken to the operating room emergently due to pupils changes seen on pupillometer. These patients had less omplications and had shorter ICU stays.

Learning Objectives: Identify reasons why pupillometers were not being used. Identify ways to improve workflow and aid nurses in the neuro icu using the new pupillometer system. Identify how pupillometer can aid in decision making as well as patient outcomes.

References: Chen JW, Gombart ZJ, et al. Pupillary reactivity as an early indicator of increased intracranial pressure: The introduction of the Neurological Pupil Index. Surgical Neurology International. 2011; 2: 82. Chen JW, Vikil-Gilani K, et al. Infrared pupillometry, the Neurological Pupil Index and unilateral pupillary dilation after a traumatic brain injury: implications for treatment paradigms. Springer Plus. 2014; 3:548 Taylor W, Chen JW, Meltzer H, Gennarelli TA, Kelbch C, Knowlton S, Richardson J, Lutch MJ, Farin A, Hults KN, and Marshall LF. Quantitative pupillometry: a new technology. Normative data and preliminary observations in patients with acute head injury. J. Neurosurg 98(1):205-13, 2003.