Safety in Radiology

1. Safety in Radiology UCSF Medical Center

2. Safety in Radiology National Patient Safety Goals are important • Protect our staff and our patients • Safety Committee self identifies risks • Prevent needle related injuries • Administer medications safely • Ensure quality of care in Radiology

3. General Hand Hygiene • Handwashing with either an antimicrobial or plain soap and water, or use of an antiseptic hand rub • Wash for 10 seconds • Before and after patient contact • Before and after performing invasive procedures

4. Surgical Hand Antiseptic • Performed before donning sterile attire preoperatively • Antiseptic hand prep with brushless waterless alcohol based product in IR/NIR

5. Personal Protective Equipment • Gloves – practice task oriented glove use • Gowns – moisture resistant, sterile from chest to table level, back is not considered sterile • Face protection – prevents exposure by using masks, goggles or a face shield

6. Needle Safety • Do Not recap needles for later use! • Do not slip sharps under the tray, covered by towel, or left exposed on the table. • All needles and other sharp instruments should be disposed of directly into a needle container after use.

7. Safety Devices • Safety shield locks in place to prevent needle injury

8. Safety IV devices Retractable needle Avoid the risk of injury while securing IV line

9. Sharps Containers • Position container for direct disposal while maintaining sterile technique. • Emptied routinely when 2/3 full

10. If Exposure Occurs If splash with blood or body fluid should occur, wash the exposed skin with soap and water, and profusely flush exposed mucous membranes with water. Contact the infectious disease “HOT LINE” at 719-3898 Patient history should be reviewed. Patient permission for hepatitis and HIV serostatus is necessary.

11. Radiologists in dark rooms • Radiologists need to be in compliance with needle safety precautions! • 800,000 needlesticks occur annually in the United States • The risk of HIV infection with a single sharp injury is 0.3% • 99.7% of exposures will not result in infection

12. Medication Labeling • Proper medication labeling prevents med errors and adequate communication between health care workers • 2007 JACHO requirement

13. WHEN do we label medications? • Any time medications are prepared but are not administered immediately • Anytime medications are transferred from the original packaging to another container • Pre-labeling of containers is not acceptable.

14. HOW should we label medications ? DRUG NAME, CONCENTRATON, AMOUNT(if not apparent) • EXPIRATION DATE when not used within 24 hours

15. Medication Labeling • 1.WHAT should we label? All Medications, including: • vSterile Water • vNormal Saline • vContrast dyes • vHeparin • vLidocaine

16. Medication Label Verification • All labels are verified both verbally and visually by 2 qualified individuals when the person preparing the medication is not the person administering the medication.

17. Maintenance of Original Containers • All original containers from medications or solutions remain available for reference until the conclusion of the procedure.

19. Medication Management • Do NOT use Abbreviations includes: U, IU, HS, QD, QOD, MS, MS04, MGS04, trailing zero (1.0), lack of leading zero (.1)

20. Administering Contrast • Contrast is now considered a medication • Check for Allergy or contraindications • Don’t forget the Patient Rights: right patient, two identifiers right drug right dose right route

21. High Risk Medications High risk medications are defined as medications that bear a heightened risk of causing significant patient harm when they are used in error. Narcotics Neuromuscular blocking Insulin Anticoagulants- Heparin Chemo Conc Electrolytes

22. High Risk Medications What safeguards do we have in place? • Independent Double check before administration • Standardized drug concentrations • Preprinted order forms • Proper labeling/packaging

24. 2 Independent Checks • Mistakes happen even when doing our best. • It‘s not intended to question the practitioner’s skills or competence. Rather, it is to acknowledge the high risk and complexity of the work and the fact that every practitioner is only human and therefore fallible. • Research has shown that ~95% of mistakes are found when someone’s work is checked by others.

26. Administering medications • Bring order to obtain medications from nurses who have access to the medication Pyxis machine. MD must indicate medication allergies on the form. • Obtain medication, compare, and confirm the drug, dose, time, and route against the MD’s order. Verify the five rights.

27. Administering Medication • Visually examine the medication for stability, expiration date, and tampering. • Keep medication in the original wrapper or container or label according to policy until administered. • If interrupted or distracted while completing this process, repeat the above steps.

28. Administering Medication • Use aseptic technique when preparing all parenteral medications. • Correctly identify the patient using two-patient identifiers. • Educate the patient and/or family as appropriate about the purpose of the drug

29. Alaris Infusion Pump

30. Communication bet caregivers • Some medication drips cannot be interrupted. • This would be a medication error requiring communication to MD and an incident report. • Communication between the patient’s caregivers is critical to ensure patient safety.

31. Effective Communications • Communicate your plan of care to the patient’s nurse. • The nurse communicates special precautions to you regarding the care of the patient • Opportunity to ask and answer questions • Communicate before and after care

32. Falls Prevention • All patients, whether identified as being at risk for falls or not, must have the following safety precautions taken: • Orient patient to environment. • Gurney in low position when patient is unattended, brakes on. • Determine safest position for siderails.

33. Falls Prevention • Eyeglasses, hearing aids, etc, accessible to patient. • Assistive devices (e.g.walker, crutches, etc.) within easy reach, if appropriate. • Fitted, non-slip, non-skid footwear. • Environment clear of hazards. • Evaluation of medications that predispose patient to falls. • Educate patient and family regarding fall prevention strategies.

34. Falls Prevention From the policy, ”Do not leave a patient who is at risk for falling unattended on a commode or in the bathroom.”

35. FALLS CATEGORIES • Anticipated physiological/intrinsic: patient diagnosis or characteristics that may predict patient’s likelihood of falling. • Unanticipated physiological/intrinsic: unpredictable if no previous history is present and no risk factors identified from assessment. • Extrinsic/Accidental: environmental risk factors.

36. ASSESSING FOR FALLS RISK • Mobility- use assistive devices, weakness, dizziness, poor balance • Mentation- alter level of consciousness • Elimination- frequency and urgency • History of Falls-fallen in the past year • Current Medications- analgesics, diuretics,

37. Falls Prevention • Identify the patient's risk status by: Placing a yellow arm band on patient’s wrist • Yellow slippers if ambulatory, bedrest is not falls prevention • TAILORING INTERVENTIONS TO INDIVIDUAL PATIENT’S FALL RISK BEHAVIOR

38. SEDATION …ZZZ …ZZZ In IR procedures For Biopsies In MRI For pain control In Radiology

39. SEDATION • The physician will have primary responsibility for the patient requiring sedation. • All sedation shall be ordered and supervised by the physician privileged for the specific procedure and the administration of sedation and analgesia.

40. UCSF Admin. Policy 6.07.01

41. Emergency Stop Buttons

42. Patient Identification What’s the Problem? Images misidentified and sent to PACS

43. How many are wrong? One is too many!

44. Category 2008 ID band issue + 1 Acc No. issue + + Image ID issue + + Identification issues are tracked 2007

45. What is the cause of errors? • Not checking the patient’s ID band, DOB • Tech selects wrong accession number • Tech begins multiple accession numbers Tech scans on prior patient, wrong name! • Not doing time out at the computer console

46. What can we do to prevent errors? • Use proper two patient identification techniques for patient and image identification. • Do a time out and double check the images before sending to PACS. • Check patient ID “two times every time at two locations”

47. Medication Reconciliation • A complete list of patients’ current medications is obtained • Patient allergies are verified • The list is reviewed by MD prior to contrast or medication administration • Communication of medication changes is provided to next caregiver

48. Hand-off communications • Interactive, allowing the opportunity for questioning between the giver and the receiver of patient information. • Includes communications between: Radiologists, fellows, residents, RNs, technologists, Hospital Assistants, floor nurses.