Chapter 4 Patient Care and Safety

1. Chapter 4 Patient Care and Safety

2. Duties and Responsibilities of the Radiographer • Safe transfers via wheelchairs and gurneys • Patient assistance with changing into a gown and security of patient belongings • Radiation protection • Preventing injuries to self

3. Patient’s Belongings • Direct the patient to the correct dressing area for gown changing • Give proper dressing instructions • Lockers for clothing or a dressing room to change • Personal items—jewelry, money, wallets, purses

4. Body Mechanics • Injury of the spine is the leading injury to health care personnel due to abuse from moving and/or lifting patients. • Safe body mechanics require good posture—this means that the body should be in alignment with all the parts in balance. • The center of gravity is the point at which the mass of any body is centered. When a person is standing, the center of gravity is at the center of the pelvis.

5. Rules for Correct Posture • Hold chest up and shoulders back. • Hold head erect with chin in. • Stand with feet 4 to 8 inches apart and keep body weight equally distributed on both feet. • Keep knees slightly bent. • Keep the abdomen sucked in. • Keep the buttocks tucked up and in.

6. Rules for Picking Up or Lifting Objects Bend at knees, not at waist

7. Rules for Picking Up or Lifting Objects—(cont.) Pull an object Do not push it

8. Rules for Picking Up or Lifting Objects—(cont.) Keep body aligned Do not twist at the waist

9. Rules for Picking Up or Lifting Objects—(cont.) Keep object close Do not reach

10. Moving and Transferring Patients • Follow these precautions: • Verify the patients’ ability to move and comply with the exam. Request patient information regarding any restrictions or precautions. • Establish the identity of the patient first and introduce yourself. • Obtain adequate help, if necessary. • Move the patient accordingly.

11. Returning the Patient to the Room • Stop at nurses station, return chart, and inform staff that patient has returned. • Return patient to the room, help the patient into bed, make the patient comfortable, lower the bed, and put the side rails up. • Give patient the call button in case patient needs assistance.

12. Assessing the Patient’s Mobility • Deviations from correct body alignment • Immobility or limitations in range of joint motion • The ability to walk • Respiratory, cardiovascular, metabolic, and musculoskeletal problems • Attached equipment such as IV pump, urinary catheter

13. Other Assessment Considerations • The patient’s general condition • Range of motion and weight-bearing ability • Strength and endurance • Balance • Patient understands what is expected during transfer • Patient accepts the transfer • Medication history

14. Legalities of an Incorrect Transfer • Never assume a patient fully understands. • Never assume patients realize their abilities. • The radiographer is the person responsible for the move and the decision on how that is done. • Falling below the standard practice of care may result in the patient being critically injured and the radiographer being held legally liable.

15. Methods of Moving Patients • Gurney • Sheet transfer • Lateral transfer board • Log roll • Wheelchair • Ambulation

16. Sheet Transfer • Roll the top portion of the folded sheet so it is close to the patient’s back • Roll the patient over the roll and facing the opposite direction • Unroll the sheet. It is now ready to use to lift or slide a patient.

17. Log Roll • Similar to a sheet transfer, but one person must maintain alignment of the head and neck. • Two more people roll the patient toward them as one motion. • This will allow a fourth person to place something under the patient, or to check the patient’s back. • The most important aspect of a log roll is to keep the patient’s body in perfect alignment.

18. Lateral Transfer Sliding Board • Roll the patient away from the direction of the move to place the sliding board partly under the patient. • Create a bridge between the table and the gurney. • Roll the patient back onto the board, and slide the patient across the board. • Remove the board by slightly rolling the patient off it.

19. Wheel Chair • Make sure the wheelchair is close to the table and the brakes are on. The foot rests must be up. • Help the patient to sit up. Put nonskid slippers on the patient’s feet. • Lower the table and help the patient stand. Guide them into the wheelchair. Secure a soft security belt around the patient.

20. The Use of Immobilizers • Immobilizers must be ordered by the physician in charge of the patient’s care and applied in compliance with institutional policy. • The Joint Commission states that immobilizers should be used only after less restrictive measures have been attempted and have proved ineffective in protecting the patient. • Immobilizers will most often be necessary only when radiographing pediatric patients.

21. Reasons for Applying Immobilizers • Patient’s behavior presents a danger to self and others. • Control movement when an IV or catheter is in jeopardy of being dislodged • Sedated patients who might forget to remain still • Unconsciousness, confusion, delirious patients. This prevents any possibility of the patients’ falling or hurting themselves. • The most effective method to avoid the use of immobilizers is communication.

22. Type of Immobilizers • Limb holders (4-point restraints) • Ankle or wrist immobilizer • Waist immobilizer

23. Use of Immobilizers • The patient must have the reason for the immobilizer explained. • The knot must be tied so as to be released quickly and easily with one pull. • The immobilizer must not be so tight that the patient has no movement, but it cannot be so loose as to allow the patient to get out of the immobilizer.

24. Positioning the Patient for Diagnostic Imaging Examinations • Supine or dorsal recumbent • Lateral recumbent • Prone • High Fowler • Semi-Fowler • Sims • Trendelenburg

25. Positions High Fowler position Semi-Fowler position

26. Positions(Cont.) Trendelenburg position Sims position

27. Assisting the Patient to Dress and Undress • Disabled patients • Elderly patients • Pathologic conditions • Patient’s with an IV or a disabled patient • Allow enough material to work with by removing the unaffected side first or by placing the gown on the affected side first.

28. Gowning with an IV When placing the clean gown on the patient, put the IV bag through the arm hole as you would the patient’s arm, then put the arm through.

29. Skin Care • Persons who are most prone to skin breakdown are: • Malnourished, elderly, and chronically ill • Immobilizing a patient in one position for an extended period of time creates pressure on the skin that bears weight, causing restriction of capillary blood flow, which can result in tissue necrosis. • Moving a patient to or from a diagnostic imaging table too rapidly or without adequately protecting the patient’s skin may damage the external skin.

30. Skin Care—(cont.) • Moving a patient from the gurney to the x-ray table can cause scraping or bruising. • Movement back and forth on a hard table or uneven surface. • Allowing the patient to lie in wet or soiled sheets for a long period of time.

31. Cast Care and Traction • Compression of a cast may produce pressure on the patient’s skin under the cast, and this, in turn, may lead to the formation of a decubitis ulcer at the site of cast compression. • A cast that becomes too tight may cause circulatory impairment or nerve compression. • A cast must be supported at the joints when moving it. • Have positioning tools available: sponges, sand bags, and pillows for positioning applications. • Work around the patient. Critical thinking is a major component. Remember, images must be 90 degrees from each other.

32. Moving a Splinted Limb Always lift the limb at both joints when moving an injured part

33. Patients in Traction • NEVER move or remove any of the weights from traction. • Consult with the patient’s nurse prior to taking x-ray. • Critical thinking is a must. Move and work around the patient.

34. Departmental Safety • Fire Safety • Fall Prevention • Poisoning and Disposal of Hazardous Waste Materials • Radiation Safety • ALARA • Time: Shortest exposure time • Distance: Increase distance from the source • Shielding: Shield patient and use collimation