Prepare for the JCAHO's visit to your radiology department

"They don't call you up and set up an appointment," she said.

"They come in and want to make sure you know your stuff." Getting a radiology team up to JCAHO standards doesn't need to be a harrowing experience, however. Belanger suggested involving the entire team because more people mean more ideas and better outcomes. The more the merrier

Staff in Belanger's radiology department cross-train to provide care in CT, diagnostics (adult and pediatric x-ray), breast imaging, ultrasound, nuclear medicine, magnetic resonance imaging, endovascular clinic, and vascular/ neuro interventional radiology.

"The nurses work independently to provide specialized care to a diverse population of patients," she said. Their duties include administering medications, monitoring and managing patient crisis, and educating patients about the department. Radiology nurses oversee patient care in a technically oriented environment. It is this type of training and teamwork that makes her department so successful, she said.

"All these ideas come from my team," Belanger told RACRI.

"They are so creative and talented." She'd like to increase the number of opportunities for staff to communicate their ideas for improvement.

"They have so many ideas. If you just ask, you'll be amazed at what they can come up with," Belanger said.

"It's a good team effort," Belanger said of her own group.

"That's what JCAHO is looking for within the whole institute."

Right meds for the right patients

For example, the team resolved one JCAHO goal--improving accuracy of drug administration--by using a simple tool from elementary school. Her team started carrying around colored pencil boxes. Each box contained a specific patient's medication to ensure that patients receive the correct doses.

"Everyone has an example of a problem like this," Belanger said.

"It's an issue for nursing and the radiology technologists. By labeling the medications and keeping them in the right box, we can be sure the syringe doesn't get mixed up with any other meds."

Handwashing--no water!

To comply with the HAI safety goal, JCAHO recommends following the Centers for Disease Control & Prevention guidelines. Simply put, wash your hands at every opportunity. But Belanger's staff complained that there simply weren't the facilities to keep handwashing within arms' reach. So they recommended putting antibacterial dispensers at high traffic areas throughout the department. Within days, the number of staff who washed their hands doubled, she said.

"It's amazing what you can come up with. And these simple solutions solve life-threatening problems."

Reconciliation of pharmaceuticals

Despite her 21 years of experience and the collective experience of her crew, certain JCAHO safety goals still cause Belanger concern. Improving drug documentation throughout the continuum of care perhaps causes the most consternation.

"The reconciliation of medication across departments is the biggest deal," Belanger said.

"We're a 700-bed hospital. I have 150 CT scans scheduled on any given day. How are we going to keep track of all that?" Belanger and her team have so far resolved to document medications within the radiology department. They'll add medications to a patient's list if they are administered within the department. But it's not a suitable system for outpatient services, she said.

"We have patients who come to us with enough medications to fill a garbage bag. How are we ever going to be able to track that in a radiology department?" Belanger asked. Reduction of falls

Preventing falls is also an issue of concern for Belanger and her team.

"How many of us have had a patient fall off the table?" Belanger asked the audience during the RSNA Chicago conference.

"We all know that despite our best efforts, some of these patients just want to get up and go for a walk rather than sit still." A radiology nurse or technologist's job makes it difficult to remain at the patient's bedside constantly, so Belanger's hospital established a falls committee to investigate best practices for keeping patients safe.

"Do we use restraints to reduce this risk, or don't we?" she asked.

"If we use them, they may work, but there's also evidence that patients find a way around the restraint and possibly injure themselves worse." JCAHO recommends the following tips for preventing falls:

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