Ensuring Patient Safety

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Ensuring Patient Safety In Radiology
June 2007 John Thomas
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• Verification Process - STEP 1
• Radiology Request/Consent Form
• Clear legible
• Provision of mandatory information
• Patient Details(preferably Addressograph label)
• Full Name/ DOB/ MRN
• Ward Date Written
• Procedure Requested (including side)
• Relevant Clinical History
• Referring Doctor Contact Details
• Printed Name/ Signature/ Page No.
• Incomplete/Incorrect Request Form Immediately
  notify Referrer or Ward Nurse

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• Verification Process STEP 2
• Correct Patient (Identification)
• Scope All radiology procedures
• Ask the patient
• What is your FULL NAME?
• What is your Date of Birth?
• What is the name of the PROCEDURE you are
  having today?. Also ask SITE/SIDE if required
• Never state patients Name/ DOB/ Site Side
• Do not tell the patient the patient tells
  you
• E.g. Call Mr. Brown, then ask the above
  questions including additional questions related
  to clinical history as outlined on Request Form

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• Verification Process - Cont.
• Correct Patient (Identification) Cont.
• Inpatients
• Ask patient to state Full Name/ DOB/ Procedure
• Check responses against Referral Form Patient
  ID Band (wrist/ankle) including MRN MANDATORY
• Do Not Proceed if
• Patient ID Band is absent. Call Ward Nurse to
  personally ID patient and complete Time Out
  Verification sticker (all personnel sign).
  Complete online IIMS form document into Escort
  Issues book
• Patient can not verbalise identity. Nurse Escort
  must verify patient identity. Complete Time Out
  Verification sticker (all personnel sign).

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• Verification Process - Cont.
• Outpatients
• Ask patient to state Full Name/ DOB/ Procedure
• Check responses against Referral Form
• Do Not Proceed if
• Patient can not verbalise identity.
• Proceed only after
• Identity is verified by accompanying relative,
  family member, friend or healthcare interpreter.

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Reinforcing the Message Displayed
at all imaging consoles
 
Have you checked the Patient ID ? - Prior to the
Procedure -

• Asked patient their
• Name
• DOB
• (Procedure)
• Checked response MRN against ID Band Request
  Form

Are you sure !
 
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• Team Time Out STEP 3
• General X-ray
• (General, Mobiles, Emergency - Resus,
  Mammography, Screening)
• Confirm before procedure
• Correct patient is present (Full Name/DOB/MRN/ID
  Band)
• Clinical history corresponds with Requested exam
• Correct site side is being examined
• Correct right left markers are being used
• Perform diagnostic examination (provided no
  discrepancies exist).

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• Team Time Out STEP 3 Cont.
• Interventional (invasive) Radiology
• (All invasive procedures covering CT / Ultrasound
  / Angiography / Mammography and selective
  Screening procedures)
• In procedure room, with patient present.
• Confirm patient ID, request/consent forms, image
  data all correct.
• Site marked by interventional doctor.
• Team Leader (usually Nursing staff) calls Time
  Out immediately prior to procedure commencement
  (patient draped) to confirm
• Verification of patient identity (Full
  Name/DOB/MRN/ID Band)
• Agreement on the intended procedure
• Verification of correct position i.e level
  side
• Verification of the visible marked site
• Availability of correct implants/equipment/medica
  tion
• TTO discrepancies DO NOT proceed until resolved
  (document)

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• Team Time Out STEP 4
• Post Procedure (all Radiology procedures)
• Ensure that
• Correct details are attached to the image/s
• Patient details side marker/annotations on
  post-processed image/s are correct
• Certified Time Out Verification sticker
• Radiographer/s to complete checklist, procedure,
  date, print name sign
• scanned to PACS, then
• placed in patient medical notes.

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Time Out Verification sticker Scope All
radiology procedures
General vs. Interventional use
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SUMMARY Getting in Right in Radiology
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SUMMARY Getting in Right in Radiology
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• Staff Related Responsibilities
• Patient Transfers
• Radiology staff (Front Desk) are required to
  complete ALL the front section of the Radiology
  Patient Transfer Slip
• Check adequacy of Request Form (completion of
  mandatory information fields). Follow Request
  Form Completion Policy.
• To transcribe procedure patient details from
  Request Form to Patient Transfer Slip.
• Phone Ward Nurse responsible for patient to
  arrange transfer stating
• Your name and department (Radiology)
• I have a Request Form for (Patient Name) to
  have an (Radiology procedure)

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• Patient Transfers Cont.
• The following questions should then be asked
• What is the patient MRN?
• Is the patient ready for their procedure?
• Do they travel in a bed or wheelchair?
• Do they require a Nurse Escort?
• What bed number are they?
• Do they have electrical equipment on the bed
  e.g..IMED?
• Do they need oxygen?
• Does the Orderly need Personal Protective
  Equipment?

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• Patient Transfers Cont.
• For all procedures, especially CT Angiography
• Has the patient consented or are they able to
  consent?
• When was the last time the patient had something
  to eat?
• Does the patient have a cannula?
• Is the patient on anticoagulation therapy?
• When all necessary information has been
  established, complete front side of Radiology
  Patient Transfer Slip.

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Radiology Patient Transfer Slip Front Side
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• Radiology Patient Transfer Slip
• When all information fields are completed,
  patient transfer can proceed. Radiology Orderly
  is given slip.
• Upon arrival on Ward, the Radiology Orderly must
• Identify themselves to Ward staff and
  Department (Radiology)
• State name of patient to be transferred
  procedure (as outlined on accompanying Transfer
  Slip).
• Consult Ward Nurse (or NUM) responsible for
  patient and verify whether
• patient is ready for transfer?
• needs a Nurse Escort?
• requires oxygen /or electrical equipment?
• you need to wear PPE?

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• Radiology Patient Transfer Slip Cont.
• Locate patient as directed by Ward Nurse
• Radiology Orderly MUST
• Verify Patient Identification
• Radiology Orderly to ask patient to state Full
  Name Date of Birth as outlined on Patient
  Transfer Slip. Check
• Check response against ID Band (wrist/ankle).
  This is mandatory. Check MRN against ID Band
  (Patient is not to be transferred without ID Band
  or correct identification)
• Ensure all Patient Notes X-rays accompany
  patient to Radiology
• Radiology Orderly then completes checklist on
  rear side of slip

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Radiology Patient Transfer Slip Rear Side