Factors Contributing to Adverse Events Occurring in the Radiology Suite
Below are some of the issues, conditions, and circumstances
pertaining to radiology areas that may predispose patients to suffer medication
(or other) errors:
often need to wait for tests or wait for transport back to their unit of
We have seen numerous examples of patients deteriorating while waiting for
a procedure or waiting to be transported back after a procedure.
care differs from ICU.
While most radiology departments in large hospitals do have nursing staff
dedicated to the radiology area, they may not have the same expertise or
skill set that a nurse from an ICU might have. The nurse:patient ratio is
usually not what one would have in the ICU. And even when a nurse from the
ICU accompanies the patient to the radiology suite, that nurse may be
unfamiliar with where medications or equipment are stored in the radiology
of access to current medication lists, allergy lists, etc.
While the patient’s chart usually accompanies him/her to the radiology
suite, some important documents (eg. the MAR or medication administration
record) may not.
patient may be unable to give information and those who could answer
questions are not available.
The patient may have impaired cognition or impaired level of
consciousness. He/she may have been pre-medicated prior to coming to
radiology or may have received conscious sedation for a procedure.
Typically (at least for an inpatient) a family member or caregiver or the
housestaff, individuals who could provide vital information about a
patient, may not be present in the radiology suite or otherwise readily
patients may be incredibly sick and have very complex medical problems,
both of which are known to be associated with an increased likelihood of
of patients for some procedures
may have an additive effect to other medications (eg. narcotic analgesics)
that a patient may be receiving.
of the hi-tech patient safety technologies available elsewhere in a
hospital may be unavailable or underutilized in radiology.
This might include things like and electronic medical record (EMR),
barcoding, electronic MAR, etc.
may arrive with multiple lines and tubes.
Not only does this predispose to the rare occurrence of catheter
misconnections, but often an IV must be temporarily discontinued and then
there may be confusion as to how to restart that IV (especially for
medications like anticoagulants).
patients may represent specific problems.
Particularly when a patient needs to spend a prolonged time in radiology,
there may be confusion about insulin administration, meals, etc.
supplies, equipment may have come from somewhere else.
Particularly when medications have been brought with the patient from some
other area of the hospital, there is often suboptimal documentation of
dosage, time given, etc.
in radiology may be unfamiliar with equipment.
This may apply to items like infusion pumps. Often a hospital has pumps
made by different manufacturers or different models used in different
units of the hospital. Personnel in the radiology suite may not have
experience with that particular model.
The bane of the radiologist’s existence is the requisition lacking
sufficient clinical information. How often does a requisition for an X-ray
of the hip come down with “stroke” as the only clinical information! The
radiologist needs to know what specifically is being looked for and other
clinical information so that he/she knows what is the most appropriate
study and can better interpret the result of the study.
people to communicate results to may not be readily available.
The communication problem on the back end is as important as on the front
end. We have talked in previous Tips of the Week about communication of
critical reports back to physicians responsible for the care of the
The time pressures to move patients through the radiology suite and
accommodate not only inpatients but also outpatients and unscheduled cases
can be enormous. Add to this staffing issues, particularly around nights
and weekends and holidays. And financial pressures (eg. cost issues that
lead to use of less expensive contrast agents in many patients).
See also our August 11, 2009 Patient Safety Tip of the Week
Radiology Suite…Again!” for even more contributing factors.
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