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Prevent accidents and injuries in the MRI suite

Radiology Administrator's Compliance and Reimbursement Insider, May 1, 2008

In 2001, a boy died after a metal oxygen container was drawn into an MRI unit (by the MRI magnet’s extreme power of attraction) at Westchester Community (NY) Medical Center. The ensuing seven-year case heads to trial this spring.

In March, The Joint Commission (formerly JCAHO) issued a Sentinel Event Alert identifying increased accident risks in the MRI environment. The increase is due to several factors, says Tobias Gilk, an architect at MRI-Planning in Kansas City, MO. And because the recent alert identifies these factors, now is the perfect time to conduct a safety audit of your MRI suite.

Safety risks stem from greater attractive forces found in newer magnet systems, more varied uses of MRI technology, and growing numbers of sedation or anesthesia orders for patients.

Although the capabilities of the MRI scanner are well-known, its inherent dangers are not, says Gilk.

“The most important step … is to recognize that MRI safety is a larger-scale issue than originally appreciated,” says Kenneth Powers, media relations manager for The Joint Commission. “You need to proactively educate your staff and patients regarding these issues.”

Be prepared for increased regulation

MRI use has not had significant regulation in the past, says Gilk. There are no current building codes or standardized operational requirements for MRI facility safety, he notes.

But the regulatory landscape is changing. The new Sentinel Event Alert references standards set by the American College of Radiology’s (ACR) White Paper on MR Safety published in 2004, and its recently issued replacement, the ACR Guidance Document for Safe MR Practices: 2007, notes Gilk. The ACR document could soon become the industry’s standard of care, says Gilk, due to its reference in the March alert.

Site surveys will start to focus unprecedented levels of attention on MRI, so staff members should be prepared for questions such as:

Do you adhere to the ACR recommendation for ferromagnetic detection (FMD) screening of patients?

Does your cryogen venting system conform to the MRI manufacturer’s current engineering standards?

How recently have you physically inspected the cryogen venting/exhaust systems?

Is each piece of clinical and incidental equipment appropriately labeled with the current American Society for Testing and Materials standards for MRI safety?

What methods are in place for identifying the safety of patient implants?

What are your provisions for physically screening patients, visitors, and objects entering the suite?

When was your last safety drill?

Does your facility adhere to the ACR standard four-zone safety screening principle?

Is access to your MRI suite effectively controlled for unscreened patients and staff members?

How do you handle medical gasses in the scanner room?

Types of accidents that can occur

The most common types of accidents that occur in the MRI suite and their preventions, says Gilk, are:

Heating: Burns can come from improper positioning of the patient during the exam or incorrect settings on the MRI for a particular scan, says Gilk.

Corrective actions: Provide insulation between the patient and the MRI, ensure proper body positioning, and review scan parameters.

Implants: Active implants, such as pacemakers, and passive implants, such as aneurism clips, can present dangers to patients exposed to static (unchanging) or time-varying magnetic fields, says Gilk. Other implants, such as the leads (wires) used in cardiac devices or nerve stimulators, can become significantly heated as a result of the normal radiofrequency energies used during the MRI examination process.

Corrective actions: Carefully review the patient’s medical record, conduct patient interviews, educate referring physicians, and scrutinize all identified surgical procedures, says Gilk.

Projectiles: Despite the near-universal awareness of an MRI magnet’s extreme power of attraction, patients, and even staff members, still bring objects containing steel into MRI rooms, where they are sucked into the MRI scanner. Often, these objects are small enough to be removed by hand, but larger objects require expensive service calls. However, even small objects, such as bobby pins and nail clippers, can cause injuries if they strike patients or staff members.

Corrective actions. Staff members must increase vigilance in screening patients and objects prior to entering the MRI. The use of contemporary FMD systems specifically designed to find projectile threats in the MRI suite is recommended by the Sentinel Event Alert, says Gilk. (For links to all three manufacturers of FMD systems, see www.MRI-Planning.com/vendor_links.html.)

Liability risks may increase

The Joint Commission Sentinel Event Alert increases the degree of foreseeability of many common accidents and incidents for all MRI facilities, says Gilk. Foreseeability is one legal indicator of the likelihood that an event will occur. It relates to the reasonable precautions your facility needs to take to prevent accidents and injuries, he says.

The presence of The Joint Commission Alert, coupled with best practice standards for patient safety, could increase an MRI facility’s liability exposure in the event of an accident, particularly if it does not take appropriate preventive steps, says Gilk.

Conduct a safety audit

To conduct a safety audit, you’ll first need to set patient safety as a top priority and become better educated on the specific nuances of MRI safety, says Powers.

The staff and leadership should then review, in detail, your current processes of MRI management and compare these practices with accepted standards of practice so that they can establish updated policies and procedures to improve the MRI environment.

Given the importance of MRI safety issues, it behooves you to conduct a safety audit, says Gilk. This allows you to identify, plan, and remediate any safety deficiency prior to your next Joint Commission or state survey.

Conducting a safety audit can also improve your facility’s productivity, says Gilk. Lost throughput from poor practices could cost an MRI facility close to $20 per minute in technical fees alone, he says. For example, if you stop a procedure because a patient hasn’t removed hairpins, this wastes time. Even worse, costs associated with serious incidents start at more than $20,000 in vendor engineering expenses, he says. Accidents involving equipment damage easily reach the six-figure range, he adds.

Thus the return on investment for safety improvements in the MRI suite can be achieved very quickly, Gilk says.

Poor operational practices and accumulated minor safety events can result in large annual lost revenue. Serious accidents might result in multimillion dollar lawsuits and years of litigation, Gilk says. Remember, the Westchester Community case is only now coming to court.

Of course, each facility is different, so each safety audit will focus on different risks and needs. You may either want to hire a professional or have in-house staff members conduct the audit.

Insider sources

Tobias Gilk, architect at MRI-Planning, Imaging Design Specialists, 802 Broadway, 5th Floor, Kansas City, MO 64105, 816/472-7722, Ext. 109; tgilk@MRI-Planning.com, www.MRI-Planning.com.

Kenneth A. Powers, media relations manager for The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181, 630/792-5175; kpowers@jointcommission.org;www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_38.htm.

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