Ear syringing

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:

  1. 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.
  2. A checklist of the issues that need to be covered in patient history taking and examination.
  3. A protocol for the use of softening agents.
  4. A procedure for checking equipment — to ensure it is in working order at the point of use.
  5. A written procedure for ear irrigation that is evidence-based, current and provides safeguards to the known risks of ear irrigation.
  6. A post-procedure information sheet for patients.
  7. 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.

5 thoughts on “Ear syringing

  1. Unfortunately in Rural centres we don’t have the experts who have been appropriately trained to get the mentor that we need to provide us with the expertise. Also doctors aren’t willing or able to show the proper technique as most times they haven’t been shown as well. Something that APNA can provide as an educational session…. Along with other things?
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  2. It can be challenging accessing training in rural areas. It is critical that we share information with our practice colleagues about nursing scope of practice and education and training requirements and that we work within our scope of practice. Ear irrigation is a contentious issue and often litigated so endorsed training by a recognised training provider establishes safe, evidence based practice.(there are RTOs who regularly provide this training). One of my fit for purpose tests for undertaking any procedure is whether you can identify the anatomy, cite reasons for the procedure, whether the patient meets these criteria, possible complications and the measures taken to avoid these.

    cheers,
    Jo
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  3. I gained my accreditation through The Benchmarque Group, which is a registered training organisation.
    It might be worth while contacting them to see if there is an online course that you could do either with them, or someone else.
    Following the course theory you just need to do ear syringing under supervision until confident and then be signed off by a GP.
    It is not cheap – approx $350 ( benchmarque) but your place of employment may be willing to contribute. I personally paid it myself and just claimed it as a tax deductions at the end of the financial year.
    I hope this info is helpful.
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  4. I think appropriate training is essential but feel that the Benchmarque is overpriced for what it offers. I think it would be great if the APNA could develop an online module with appropriate theory assessments and then require a certain number of supervised (by either experienced & competent doctor or RN) procedures for a person to become accredited.
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