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All staff should have access to adequate time, funding and facilities to undertake and update training that is relevant to their clinical practice, including resuscitation training.³⁹

National safety standards for invasive procedures (NatSSIPs) should be adapted for local use as local safety standards for invasive procedures.³⁹ The WHO process, for example, could be adapted to incorporate intraocular lens selection to help prevent ‘wrong lens’ errors.⁴¹

The consultant anaesthetist should be easily contactable, and should be available to attend within two minutes of being requested by the AAs.³

There should be a robust procedure for checking the laterality of the eye to be operated on prior to local anaesthetic block or general anaesthesia. This should include the eye being marked with an indelible mark by the responsible surgical team prior to admission to the operating theatre. The RCoA/ NPSA ‘Stop before you block’ protocols should be adhered to.⁴²

In single specialty centres, the anaesthetic department should adopt the generic standards described throughout GPAS. This should include a lead paediatric anaesthetist if children are treated.

All ophthalmic patients should receive the same standard of preoperative preparation, perioperative care and follow up, regardless of the type of treatment facility.^6,24

Many procedures do not have to be performed out of hours.³² Anaesthetists and surgeons together should devise departmental protocols for the handling of patients requiring urgent procedures, to allow prioritisation from both surgical and anaesthetic perspectives.

Patients assessed to be at high risk of serious perioperative complications, such as a cardiorespiratory event, should be carefully stratified for surgical and anaesthetic requirements, and may be unsuitable for surgery in isolated units without immediate access to anaesthetic/medical cover.

The majority of patients are treated as day cases. Consideration should be given to prescribing suitable analgesics to take home; it may prove useful to use protocols to optimise treatment pathways.⁴⁰

Hospitals should consider the following actions to optimise the efficient use of clinical staff and patients’ time whilst maintaining quality of care:⁴³

• use of integrated pathways to co-ordinate the patient journey
• use of screening to identify healthy ambulatory local anaesthesia patients for rapid turnover lists
• separation of lists by subspecialty; ideally by procedure (for example, a full list of...