Checklist for ear irrigation with water This is a guide to assist your clinical judgement in irrigation. You should also follow local guidelines and be trained in ear care. Patient name DOB Date Address Has the patient had their ears irrigated with water before yes / no Irrigation with water should not be performed without valid consent and if the patient has any of the following signs and symptoms: Yes No Experienced any complications from a previous irrigation Had a middle ear infection (Otitis Media) in the last 2 months Undergone any form of ear surgery Has a perforation or there is a history of mucous discharge from the ear in the last 2 years A cleft palate (repaired or not) Presence of acute otitis externa (pain, swollen canal and tenderness of the pinna) Profound hearing loss in one ear Ensure the wax is not too hard when irrigating in the following vulnerable groups Yes No Anti-coagulants Diabetes Tinnitus Vertigo Radiotherapy that has involved the ear canal Ear preparation Duration Ensure irrigator has been decontaminated prior to that day’s use following local guidelines and a new disposable tip is clicked into place for each patient. After 15 seconds of irrigation stop and ensure the patient is comfortable with no symptoms of water entering the middle ear. Continue irrigation if there are no concerns. RED FLAG: Stop irrigation if the patient feels the sensation of water in the nose or throat or if they become very dizzy or the procedure becomes painful. PHYSICAL EXAMINATION OF BOTH EARS Pinna Ear canal entrance Adjacent scalp Right Left Yes No Yes No Light reﬂex present? Handle and lateral process of Malleus visible? Pars ﬂaccida distinguished? Normal Pars Tensa? It is recommended that all water is removed from the ear canal on completion of the irrigation procedure and prior to a final ear examination Any irregularities. Result of irrigation Hearing Concern Yes / No Referral to GP or audiologists for further assessment Yes / No Referral to ENT specialist Yes / No Print name and title Signature

Checklist for ear irrigation with water for ear irrigation with water ... You should also follow local guidelines and be trained in ear care. Patient name DOB Date Address

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Page 1: Checklist for ear irrigation with water for ear irrigation with water ... You should also follow local guidelines and be trained in ear care. Patient name DOB Date Address

Primary care essentials • 2718 July 2014

WWW.PRACTICENURSE.CO.UK

Checklist for ear irrigation with waterThis is a guide to assist your clinical judgement in irrigation. You should also follow local guidelines and be trained in ear care.

Patient name DOB Date Address

Has the patient had their ears irrigated with water before yes / no

Irrigation with water should not be performed without valid consent and if the patient has any of the following signs and symptoms:

Yes NoExperienced any complications from a previous irrigationHad a middle ear infection (Otitis Media) in the last 2 months Undergone any form of ear surgeryHas a perforation or there is a history of mucous discharge from the ear in the last 2 yearsA cleft palate (repaired or not)Presence of acute otitis externa (pain, swollen canal and tenderness of the pinna)Profound hearing loss in one ear

Ensure the wax is not too hard when irrigating in the following vulnerable groups

Yes No

Anti-coagulants

Diabetes

Tinnitus

Vertigo

Radiotherapy that has involved the ear canal

Ear preparation

Duration

Ensure irrigator has been decontaminated prior to that day’s use following local guidelines and a new disposable tip is clicked into place for each patient.

After 15 seconds of irrigation stop and ensure the patient is comfortable with no symptoms of water entering the middle ear. Continue irrigation if there are no concerns.

RED FLAG: Stop irrigation if the patient feels the sensation of water in the nose or throat or if they become very dizzy or the procedure becomes painful.

PHYSICAL EXAMINATION OF BOTH EARS

Pinna

Ear canal entrance

Adjacent scalp

Right LeftYes No Yes No

Light reflex present? Handle and lateral process of Malleus visible?Pars flaccida distinguished?

Normal Pars Tensa?

It is recommended that all water is removed from the ear canal on completion of the irrigation procedure and prior to a final ear examination

Any irregularities.

Result of irrigation

Hearing Concern Yes / No

Referral to GP or audiologists for further