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Images property of Siemens Medical.. ETHICAL & LEGAL PRINCIPLES PATIENT’S BILL OF RIGHTS Every human being of adult years and sound mind has a right to.

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Presentation on theme: "Images property of Siemens Medical.. ETHICAL & LEGAL PRINCIPLES PATIENT’S BILL OF RIGHTS Every human being of adult years and sound mind has a right to."— Presentation transcript:

1 Images property of Siemens Medical.

2 ETHICAL & LEGAL PRINCIPLES PATIENT’S BILL OF RIGHTS Every human being of adult years and sound mind has a right to determine what shall be done with his/her own body. Every human being of adult years and sound mind has a right to determine what shall be done with his/her own body. 1. Privacy- Patient has the right to receive notice of privacy practices. 2. Extend of Care- A patient has the right to consent to or refuse treatment (e.g. DNR) 3. Access Information- A patient has the right to review his medical records 4. Living will- These documents express a patient’s choices about his future care. 5. Research participation- The patient has the right to consent or decline to take part in research.

3 ETHICAL & LEGAL PRINCIPLES LEGAL ASPECTS OF RADIOLOGY 1. Who is authorized to order an examination? MD,DO,PA,ARNP with valid credentials. No Medical Students,Residents,Fellows or Nurses can order an examination. MD,DO,PA,ARNP with valid credentials. No Medical Students,Residents,Fellows or Nurses can order an examination.

4 ETHICAL & LEGAL ASPECTS REQUEST FORM 1. The patient’s name to be examine 2. The exact region to be image (Knee, Liver) 3. The patient’s diagnosis 4. The ordering physician (MD) 5. The date of requisition

5 ETHICAL & LEGAL PRINCIPLES INFORMED CONSENT (WRITTEN OR VERBAL) 1. The patient has a right to information 2. A written consent is required for any procedure that involves substantial risk 3. Consent forms may be signed by the legal guardian in the case of minors or incompetent patients 4. The patient maintains the right to refuse an examination (At any time during the exam)

6 Expressed Consent –Expressed Consent – Involves obtaining a patient’s permission to performed the procedure (can be given orally) Informed ConsentInformed Consent – Is done for invasive procedure and includes the risk, benefits and alternative.They are clearly explained in a language patient fully understand. Patient or Legal Guardian (Alert & Oriented x 3) must sign the informed consent for an invasive procedure For Minors,Parents or Legal Guardian must sign the informed consent. Implied ConsentImplied Consent – Occurs when the patient is in need of immediate medical services,but is unconscious or unable to consent for treatment. Services are rendered with the assumption that the patient would consent if able.

7 ETHICAL & LEGAL PRINCIPLES CONFIDENTIALITY(HIPAA) HIPAA- Means Health Insurance Portability and Accountability Act HIPAA- Means Health Insurance Portability and Accountability Act Health care provider must provide for the privacy and security of patient information in any forms (verbal, written, or electronic). Health care provider must provide for the privacy and security of patient information in any forms (verbal, written, or electronic).

8 ETHICAL & LEGAL PRINCIPLES PROFESSIONAL LIABILITY 1. ASSAULT- The threat of touching in an injurious way. 2. BATTERY- An unlawful touching of a person without consent. 3. FALSE IMPRISONMENT- An unjustifiable detention of a person against his/her will. 4. INVASION OF PRIVACY- When the confidentiality of a patient information is not maintained. 5. NEGLIGENCE- The neglect or omission of reasonable care and caution.

9 ETHICAL & LEGAL PRINCIPLES PATIENT IDENTIFICATION 1. The Technologist has the responsibility for proper patient identification. Wrist band Wrist band Questioning patient (Name & date of birth) Questioning patient (Name & date of birth)

10 INTERPERSONAL COMMUNICATION COMMUNICATION WITH PATIENT 1. Review of patient history 2. Explanation of current procedure 3. Empathy, sensitivity to the needs of the patient 4. Assertiveness, most productive when working with a reluctant patient.

11 INTERPERSONAL COMMUNICATION EQUIPMENT All MRI Equipment Inside the MRI Suite must be MR Safe IV’S- Check frequently, maintain solution bottle/bag ” above the level of the vein. IV’S- Check frequently, maintain solution bottle/bag ” above the level of the vein. MONITORS- Check frequently, plug in units. MONITORS- Check frequently, plug in units. URINARY CATHETERS,CHEST TUBES- Must be kept from superimposition and allowed to maintain operation ( check to see MRI compability ). URINARY CATHETERS,CHEST TUBES- Must be kept from superimposition and allowed to maintain operation ( check to see MRI compability ).

12 INFECTION CONTROL TERMINOLOGY 1. Cleanliness- Avoid transmitting organism by using proper cleaning, dusting, and hand washing techniques. 2. Disinfectants (Germicides)- Refers to the used of hand washing to kill microorganism. 3. Medical Asepsis- Refers to destruction of bacteria through the use of disinfectant/antiseptics. 4. Sterilization (Surgical Asepsis)- The third level of medical asepsis, involves treating items with heat, gas, or chemicals to make them germ free. Destroyed all microorganism and their spores.

13 INFECTION CONTROL ASEPTIC TECHNIQUES 1. Cleanliness- Is our only defense against infection. 2. Hand Washing- Should be performed after every patient, hand washing should last 20 seconds. Alcohol Based is approved by Joint Commission Alcohol Based is approved by Joint Commission 3. Patient Prepping- Betadine destroy microorganism, Alcohol prevents the growth of microorganism.

14 Medical Asepsis – Microorganism are eliminated through soap, water, or alcohol based products. Reduces the number or spread of microorganism Surgical Asepsis – Microorganism and their pores have been destroyed by heat, or chemical process. Sterile Technique – Only the front and above the waist is considered sterile area.

15 PATIENT MONITORING VITAL SIGNS Blood Pressure Blood Pressure Systolic range- Represents the pressure created during contraction of the left ventricle ( Normal) Systolic range- Represents the pressure created during contraction of the left ventricle ( Normal) Diastolic range- Represent the pressure within the vascular system with the heart at rest (60-80 Normal) Diastolic range- Represent the pressure within the vascular system with the heart at rest (60-80 Normal) Temperature Temperature Oral 98.6, Rectal 99.6, Axillary 97.6 Oral 98.6, Rectal 99.6, Axillary 97.6 Respiration Respiration Adults per minutes, Children per minutes Adults per minutes, Children per minutes Pulse Pulse Normal Range beats/minute for adults, for infants/children. Normal Range beats/minute for adults, for infants/children.

16 CONTRAST MEDIA INDICATIONS & CONTRAINDICATIONS 1. The best predictor of possible reaction to contrast media is a history of a previous reaction. 2. About 5% of patient experience some reaction; of this population only 5% experience a severe or life- threatening reaction (5% Rule)

17 Idiosyncratic Reactions Adverse Reaction - Adverse Reaction - Can be caused by anything other than contrast.It happens with the release of Histatmine due to injection, anxiety. Histamine- Histamine- Can cause muscle constraction,accelarated heart rate,lower blood pressure,localized edema. Pre-Meds for allergy are anti-histamine(Benadryl) and Steroids(Medrol)

18 Use for those at risk of reactions Use for those at risk of reactions  90% of reactions are associated with the release of histamine  Prednisone is used to reduce the release of histamine (high osmality contrast stimulates release of histamine).  Breakthrough reactions  Most likely similar to initial,however there is a chance it could be more severe. No Premedication could replace state of being ready to treat a reaction

19  SIGNED INFORMED CONSENT  Allergies  Pregnancy  Kidney Functions  SELECTION OF VEINS  Anticubital Veins (Best)  TYPE & SIZE OF NEEDLE  18/20 Angiocatheter Gauge for MRA,Perfusion, Dynamic Studies

20 1. Always wear gloves. 2. Follow OSHA standard precaution and dispose of all materials. DO NOT RECAP NEEDLES 3. Place needle and syringe in sharp containers ( DO NOT RECAP NEEDLES ). 4. Use new needle, and site for second attempt. 5. Document injection and all complication. Also time and amount of contrast injected

21 1. Wash hands and put on gloves. 2. Select site and apply tourniquet. 3. Confirm puncture site and cleanse(Surgical Asepsis. 4. Initiate puncture (35-45 degrees angle). 5. Secure needle and confirm access (drawback blood) 6. Flush line and confirm no pain or extravasation. 7. Proceed with injection.

22 CONTRAST MEDIA INTRAVENOUS INJECTION IV drugs are injected directly into the circulatory system, reaction can be instantaneous. IV drugs are injected directly into the circulatory system, reaction can be instantaneous. Technologist must not leave the patient receiving a contrast agent alone. Technologist must not leave the patient receiving a contrast agent alone. Patient pulse rate and blood pressure should be taken before and after exam (Depending on the Hospital Policy). Patient pulse rate and blood pressure should be taken before and after exam (Depending on the Hospital Policy). If patient experiences any changes in their vital signs contact physician immediately. If patient experiences any changes in their vital signs contact physician immediately.

23 Is used to improve the sensitivity and specificity of clinical diagnoses. Reactions to IV Contrast Agents Higher injection rates,larger total volume are all associated with increase of adverse reactions MinorModerateSevere NauseaHivesAnaphalaxys VomitingWheezingCardiac Arrest HeadachesBronchospasmRespiratory Arrest ItchingFacial Edema Moderate reactions may require treatment and close observation Severe reactions are rare,but are required immediate attention.

24 CONTRAST MEDIA ADVERSE REACTIONS Assessment of Patient : Assessment of Patient : How do they look,sound(voice),breathing ? How do they look,sound(voice),breathing ? If needed, stop exam immediately and remove patient from Zone 4 If needed, stop exam immediately and remove patient from Zone 4 Call for Help Call for Help Code or Radiologist/MD (Follow your Hospital Policy) Code or Radiologist/MD (Follow your Hospital Policy) Vital Signs: Get Baseline Vital Signs: Get Baseline Heart Rate – Less than 40 bpm or greater than 130 bpm (except Pedi) Heart Rate – Less than 40 bpm or greater than 130 bpm (except Pedi) Systolic Pressure – Less than 90 Systolic Pressure – Less than 90 Respiration Rate – Less than 8 per minute Respiration Rate – Less than 8 per minute Oxygen Saturation – Less than 90 Oxygen Saturation – Less than 90

25 CONTRAST MEDIA ADVERSE REACTIONS Mild Reaction- Nausea and vomiting, Hives, Itching, Sneezing. Mild Reaction- Nausea and vomiting, Hives, Itching, Sneezing. Monitor and comfort patient (Document reaction). Monitor and comfort patient (Document reaction). Moderate Reaction- Excessive hives, tachycardia, excessive vomiting. Moderate Reaction- Excessive hives, tachycardia, excessive vomiting. Call for medical assistance, monitor & comfort patient (Document reaction) Call for medical assistance, monitor & comfort patient (Document reaction) Severe Reaction (Anaphylactic)- Very low blood pressure, cardiac or respiratory arrest, convulsion, cyanosis. Severe Reaction (Anaphylactic)- Very low blood pressure, cardiac or respiratory arrest, convulsion, cyanosis. Call for immediate assistance, prepare for CPR, prepare for antihistamine (EPINEPHRINE). Call for immediate assistance, prepare for CPR, prepare for antihistamine (EPINEPHRINE).

26 MEDICATIONS: Benadryl (Diphenhydramine)– Relieve allergic symptoms,can be given IV or PO. Epinephrine - Use for management of severe allergic reaction,can be given IM (Epi Pen) or IV(MD). Atropine Sulfate– Is use to increase heart rate (IV) Albuterol (Inhalers) – Is a bronchodilator, increases air flow to the lungs Nitroglycerin – Use for chest pain, blood vessel dilator, increases blood flow.

27 MEDICATIONS: Dextrose 5% - Is injected into a vein through an IV to replace lost fluids(helps increase BP) and provide carbohydrates to the body. Nifedipine – Is a type of calcium blockers,is use to decrease blood pressure.

28 Cardiac Arrest CPR should be started on any patient demonstrating cardiac failure Seizure Can cause a patient to demonstrate convulsive moments or period of unconsciousness Stroke Lack of blood flow to the brain. Could result in inability to speak, facial numbness,limb paralysis. Shock Can result due to blood loss(trauma) or massive vasodilation can occur due to allergy to iodine contrast

29 CONTRAST MEDIA LOCAL ADVERSE REACTIONS Extravasations- Escape contrast media into the interstitial tissues at the site of injection Extravasations- Escape contrast media into the interstitial tissues at the site of injection Symptoms-Pain, swelling and redness. Care by applying warm/cold compress and elevating the effecting extremity. Symptoms-Pain, swelling and redness. Care by applying warm/cold compress and elevating the effecting extremity.

30  Most Extravasation are limited to adjacent soft tissue(skin).Usually no permanent damage  Most Extravasation are limited to adjacent soft tissue(skin).Usually no permanent damage (Less than 100ml)  All extravasation should have a close clinical follow.  Always have a Radiologist examine patient and provide discharge instruction  Compartment Syndrome – Is a severe injury from large amount of extravasation. Causing result of mechanical compression.  Do not inject more than 20 ml saline flush with power injector. Most common experience is pain, swelling or tightness/burning at the site

31  Elevation of affected extremity  Keeping the extremity above the level of the Heart, decrease capillary pressure and promotes reabsorption of extravasated fluids.  Apply Cold or Warm compresses  No evidence of favoring warm versus cold compress.  Cold help relieved pain at the site  Warm/Heat helps improving absorption of extravasation, improving blood flow. TREATMENTS  Surgical Consultation  For severe extravasation.  Progressive swelling or pain  Altered tissue perfusion,blistered,and/or ulcer skin  Increase Patient Risk  Patient who cannot communicate (Elderly/Pediatrics)  Hand,Wrist,Foot and Ankle are more likely site for extravasation  IV longer than 24 hours and multiple punctures in the same vein,also increase risk for extravasation.

32  Contrast on Pregnancy – Placenta transfer contrast (Gad) to Fetal Circulation.  Lactation– Recommended 24 – 48 hours after contrast injection, babies not to be fed.  Excreted milk has shown very low levels of Iodine. Need to be medically necessary and approved by ordering physician and OB-GYN Pregnancy Test is required for Child Bearing age female patients

33 CONTRAST MEDIA LONG TERM EFFECTS Nephrogenic Systemic Fibrosis (NSF)- Mostly seen in patient with decrease renal function. It causes fibrosis over tissues, including joints,lungs,kidney,diaphragm. Nephrogenic Systemic Fibrosis (NSF)- Mostly seen in patient with decrease renal function. It causes fibrosis over tissues, including joints,lungs,kidney,diaphragm. Symptoms-Swelling,tighness,and redness of the skin. Patient must contact Referring physician if seen are seem. Symptoms-Swelling,tighness,and redness of the skin. Patient must contact Referring physician if seen are seem.

34 Chloral Hydrate– Is a sedative, is used in the short-term treatment of insomnia(oral).Usually given for pediatric cases in CT. Versed - Belongs to a class of drugs called benzodiazepines.Is given intravenous and has a short term effect. Morphine– Is a narcotic used for severe pain Valium – Is used as an anti-anxiety medication

35 Joint Commission (JC) – Joint Commission (JC) – Accredits and certifies more than 20,500 health care organizations and programs in the United States. Every Three Years Every Three Years Improve Patient Safety Improve Patient Safety Improve Health Care Quality Improve Health Care Quality

36 MRI SAFETY MRI Safety Officer- Every department needs an MRI Safety Officer. MRI Safety Officer- Every department needs an MRI Safety Officer. Recommended a dedicated MRI Safety Committee Recommended a dedicated MRI Safety Committee Yearly In-Service/Training for entire Hospital Staff Yearly In-Service/Training for entire Hospital Staff Dedicated In-Service for MRI Technologist Dedicated In-Service for MRI Technologist Meet Yearly with local Fire Department & Police Department Meet Yearly with local Fire Department & Police Department MRI Zones must be label throughout the department MRI Zones must be label throughout the department Restrict access to Zone III, Only MR Personnel Level 2 Zone IV Restrict access to Zone III, Only MR Personnel Level 2 Zone IV 5 Gauss Line,must be marked/visible on the room/floor. 5 Gauss Line,must be marked/visible on the room/floor.

37 MRI SAFETY(Cont…) MRI Safety Officer- Every department needs an MRI Safety Officer. MRI Safety Officer- Every department needs an MRI Safety Officer. Patient Identifiers(Two),name and date of birth or MR# Patient Identifiers(Two),name and date of birth or MR# MRI Screening forms to anyone entering the MRI Suite MRI Screening forms to anyone entering the MRI Suite Have two different MRI Personnel review the forms Have two different MRI Personnel review the forms All Equipment must be mark for MRI Safety within the department. All Equipment must be mark for MRI Safety within the department. Stickers with MR Safe or UnSafe Stickers with MR Safe or UnSafe Fire Estiguisher,Wheelchairs,Stretchers,IV Pole,Vital Sign Machine Fire Estiguisher,Wheelchairs,Stretchers,IV Pole,Vital Sign Machine Hand Held Magnet (Exclusion Criteria Equipment) Hand Held Magnet (Exclusion Criteria Equipment)

38 INFECTION CONTROL Hand Washing- Needs to be followed per guidelines below. Hand Washing- Needs to be followed per guidelines below. Before touching patients Before touching patients After touching patient After touching patient After touching patient room equipment After touching patient room equipment After exposure to body fluids After exposure to body fluids After removal of gloves After removal of gloves Soap & Water is required if exposure to body fluids(Blood). Alcohol Gel can be used if no soap & water available Alcohol Gel can be used if no soap & water available.(Unless Body Fluid Exposure)

39 INFECTION CONTROL Infection Control Policy - Dedicated policy for MRI Department. Infection Control Policy - Dedicated policy for MRI Department. Cleaning Pads and Coils after each use Cleaning Pads and Coils after each use Have PPE ready in every room. Have PPE ready in every room. Cleaning MRI Safety Equipment routinely(even if not used) Cleaning MRI Safety Equipment routinely(even if not used) MR Vital Signs, Anesthesia Machine,etc MR Vital Signs, Anesthesia Machine,etc Using correct cleaning solution for infection control Using correct cleaning solution for infection control Requires two minutes(wet) to destroy microorganism Requires two minutes(wet) to destroy microorganism Check for specific brand for your Hospital Check for specific brand for your Hospital Have sticker for date and check expiration dates Have sticker for date and check expiration dates Inspect Pads routinely, replaced if needed Inspect Pads routinely, replaced if needed MRSA can grow in old/tear pads MRSA can grow in old/tear pads

40 Hospital Policies & Procedures Policies – Everyone should know where to locate Hospital and Departmental specific policies. Policies – Everyone should know where to locate Hospital and Departmental specific policies. Chemical Spills & Material Safety Data Sheet (MSDS) Chemical Spills & Material Safety Data Sheet (MSDS) Code Red(FIRE) Code Red(FIRE) MRI Safe Fire Extinguishers MRI Safe Fire Extinguishers Pull Station & Fire Exits Pull Station & Fire Exits Fire Evacuation Routes must be posted throughout the department. Fire Evacuation Routes must be posted throughout the department. Hallways should be clear by at least 36 inches Hallways should be clear by at least 36 inches Informed Consent Forms. Informed Consent Forms. Sedation (Claustrophobia) needs to provide patient/family with a copy. Sedation (Claustrophobia) needs to provide patient/family with a copy. MR Conditional (Programmable Shunts,DBS,Pacemarker,etc) MR Conditional (Programmable Shunts,DBS,Pacemarker,etc) “Time Out” for Invasive Procedures (Biopsies,Wire Placement) “Time Out” for Invasive Procedures (Biopsies,Wire Placement)

41 Hospital Policies & Procedures Policies – Everyone should know where to locate Hospital and Departmental specific policy. Policies – Everyone should know where to locate Hospital and Departmental specific policy. Emergencies or Code Blue/Cardiac Arrest Emergencies or Code Blue/Cardiac Arrest Know the Policy & Who to contact Know the Policy & Who to contact Know your ABCD Know your ABCD Never performed in Zone IV Never performed in Zone IV Mock Code should be performed every quarter with entire staff. Mock Code should be performed every quarter with entire staff. Maintained Log/Inventory for AED,Refrigarator,Contrast Warmer,Eye Wash Station. Maintained Log/Inventory for AED,Refrigarator,Contrast Warmer,Eye Wash Station. Do not store anything in carton boxes Do not store anything in carton boxes Nothing under sinks Nothing under sinks

42 MEDICINE MEDICINES – All medicines need to be store and locked. MEDICINES – All medicines need to be store and locked. Do monthly checks for expired medication Do monthly checks for expired medication Check biopsy supplies monthly for expiration Check biopsy supplies monthly for expiration Keep a log Keep a log All medications should be label,including contrast All medications should be label,including contrast Power Injector, label syringes with contrast and saline Power Injector, label syringes with contrast and saline Label needs to include medicine,dose,time,date,and initials Label needs to include medicine,dose,time,date,and initials

43 PRIVACY HIPPA – Privacy must be maintained by all Hospital Personnel HIPPA – Privacy must be maintained by all Hospital Personnel Employees should only have access to information needed. Employees should only have access to information needed. No cameras in Private Patient areas No cameras in Private Patient areas Changing rooms, Bathrooms Changing rooms, Bathrooms Patient Chart should have a cover/folder(No papers). Patient Chart should have a cover/folder(No papers). All computers Screen must be close when not in used. All computers Screen must be close when not in used. Always log off medical records,PACS,RIS. Always log off medical records,PACS,RIS. All CPU must have a privacy protector screen. All CPU must have a privacy protector screen.


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