APNA receives many queries from primary health care nurses about the performance of ear irrigation procedures. Among the most common questions received are:
- Do I have to be accredited to perform ear irrigation?
- How do I become accredited in ear irrigation?
- What do I do when my practice manager has told me I am not covered by the practice insurance to perform this procedure yet the doctors still want me to perform it?
- Does my PI insurance cover me if something goes wrong when I perform this procedure?
As nurses working in primary health care, we are accountable and responsible for the care we provide. Ultimately, it is our role to certify quality and safety in every task we perform, ensuring the best possible outcome for our patients and for ourselves.
Ear syringing is a good example of an activity in which we need to make a professional judgement. The risks and pitfalls of ear irrigation are many and this is evidenced by the number of medico-legal cases which arise. The ratio of litigation is 1:1000.
Complications and No. of cases
Failure to examine ear prior 5
Excessive pressure 26
Faulty equipment 26
Poor technique 43
Complication Ratio — MDU (Medical Defence Union (UK) Medico legal aspects related to ear syringing).
To meet this professional obligation, nurses who irrigate ears need to be able to demonstrate that they have:
- Undertaken ear irrigation in the presence of a mentor or suitably qualified clinician who can confirm the technique, which is sound, best practice, quality and safe. How do you verify you are providing patients with a safe and quality service.
- A checklist of the issues that need to be covered in patient history taking and examination.
- A protocol for the use of softening agents.
- A procedure for checking equipment — to ensure it is in working order at the point of use.
- A written procedure for ear irrigation that is evidence-based, current and provides safeguards to the known risks of ear irrigation.
- A post-procedure information sheet for patients.
- Professional indemnity insurance that covers this activity.
Thinking of ear irrigation as a combination of good skills and knowledge, a safe work system and patient involvement can assist nurses to generalise these questions and put these into practice when other areas of clinical complexity arise. The individual nurse must determine whether performing this procedure is within their scope of practice, according to and provided they can demonstrate the conditions above.
This article was originally published in APNA’s journal magazine Primary Times in September 2011 (page 4) – click here to view the issue online.