AAPM Spring Meeting 4/7/2018
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1 AAPM Spring Meeting 4/7/2018 Joint Commission Update: Diagnostic Imaging Services Standards, Survey Results, Fluoroscopy Objectives: Review of imaging standards Present data for diagnostic imaging services RFIs scored in 2017 Provide examples specific items scored in diagnostic imaging Describe proposed fluoroscopy standards and approval process AAPM 4/7/18-1 AAPM 4/7/18-2 Chapter Human Resources Medical Staff Medication Management Leadership Provision of Care, Treatment and Services Performance Improvement Manages safety & security risks EP8 Controls access security sensitive areas EP11 Responds to product notices and recalls EP14 Manages MRI safety risks (patients/staff) EP 16 Manages MRI safety risks (access control/ signage) AAPM 4/7/18-3 AAPM 4/7/18-4 1
2 Manages risks: hazardous materials and waste EP3 Written procedures (precautions/ppe) response hazardous material, waste spills, exposures EP6 Minimizes risk selecting, handling, storing, transporting, using & disposing RA material EP7 Minimizes risk selecting/using hazardous energy sources (ionizing, nonionizing) Manages risks: hazardous materials and waste EP17 CT, NM, PET, Fluoro dosimetry monitoring results reviewed quarterly EP18 Deemed status orgs periodic check for amount of radiation exposure CMS Operations Manual 141 7/10/15 AAPM 4/7/18-5 AAPM 4/7/ Manages medical equipment risks EP2 Non-deemed: inventory all/selected; deemed: inventory all EP4 ID activities/frequencies (writing) maintaining, inspecting, testing EP5 Deemed status: manufacturer s recommendations (medical lasers, imaging & radiologic) Manages medical equipment risks EP9 Written procedures medical equipment failure (emergency clinical interventions, backup equipment) EP10 IDs QC & maintenance activities (frequency) to maintain image quality (CT, MRI, NM, PET) AAPM 4/7/18-7 AAPM 4/7/18-8 2
3 Inspects, tests, maintains medical equipment EP1 Non-deemed: before initial use (safety, operational, functional checks) Deemed: before initial use & after major repairs or upgrades EP16 Qualified staff inspect, test, calibrate NM equipment annually (documented) Inspects, tests, maintains medical equipment EP18 Maintains quality CT, PET, MRI, NM images produced EP 20 Annually medical physicist measures CTDI 4 protocols; verifies measured/displayed within 20% (systems capable, not dental cone beam, accountable may have assistance) AAPM 4/7/18-9 AAPM 4/7/ Inspects, tests, maintains medical equipment EP 21 Annually diagnostic medical physicist CT tests EP 22 Annually diagnostic MP/MRI scientist MRI tests EP 23 Annually diagnostic MP/NM physicist tests all NM imaging equipment EP 24 Annually diagnostic MP tests PET EP 25 CT, PET, NM, MRI tests acquisition monitors AAPM 4/7/ Manages environment: demolition, renovation, new construction EP 1 Uses state rules/regulations; Guidelines for Design and Construction of Health Care Facilities 2014 (FGI/ASHE) EP 4 CT, PET, NM structural shielding design assessment EP 6 CT, PET, NM after work BEFORE clinical use conducts radiation protection survey AAPM 4/7/
4 Staff/LIP familiar w/ roles/responsibilities relative to EC EP 1 Staff responsible: maintenance, inspection, testing, use medical equipment..safe handling hazardous materials competent, receive continuing education/training EP 2 Staff/LIP describe/demonstrate actions in EC incident Collect information to monitor conditions in environment EP 1 Establish process continually monitor, internally report & investigate Hazardous materials/waste spills & exposures Medical/laboratory equipment management problems, failures, use errors AAPM 4/7/18-13 AAPM 4/7/18-14 January 1, 2018 EC EP 3: The organization has a library of information regarding inspection, testing, and maintenance of its equipment and systems. Note: This library includes manuals, procedures provided by manufacturers, technical bulletins, and other information. Human Resources Ongoing education and training EP 14 Diagnostic CT technologists annual; dose optimization, safe operation equipment used EP 25 MRI technologists annual; patient screening, patient/equipment positioning, classification, procedures urgent/emergent care, system shutdown, hearing protection, patients with claustrophobia, anxiety, emotional distress AAPM 4/7/18-15 AAPM 4/7/
5 Leadership Contractual agreement; care, treatment, services provided safely/effectively EP 4 Monitor: establish expectations EP 5 Communicate expectation in writing EP 6 Evaluate relative to expectations EP 7 Take steps to improve if expectations not met Medication Management Safely administers medication EP 13 Diagnostic RRx verify dose to be administered within 20% prescribed or within prescribed range Contrast AAPM 4/7/18-17 AAPM 4/7/18-18 Medical Staff Oversees quality of care, treatment, services EP 16 Deemed: determine qualifications radiology staff who use equipment & administer procedures (482.26(c)(2) TAG A-0547 EP 17 Deemed: Approves nuclear services doctor qualifications, training, functions, responsibilities NM staff Provision of Care, Treatment and Services (PC) Provides for diagnostic testing EP 5 Documents CTDI, DLP, SSDE every diagnostic CT study (exam specific, summarized series/anatomic area, in retrievable format EP 10 CT, MRI, NM, PET: prior to study verify correct patient, imaging site, positioning, CT protocol, CT scanner parameters EP 12 CT, MRI, PET, NM: consider patient age, prior studies/ most appropriate imaging exam AAPM 4/7/18-19 AAPM 4/7/
6 Provision of Care, Treatment and Services (PC) Plans patient care EP 25 Established/adopts diagnostic CT imaging protocols; current standards of practice; address clinical indication, contrast administration, age (adult or peds), patient size/ body habitus, expected CTDI range EP 26 Review/ keep current diagnostic CT imaging protocols; input interpreting physician, medical physicist, lead imaging technologist (current standards of practice/equipment used); frequency TBD by org Performance Improvement Collects data to monitor performance EP 46 Collects data MRI thermal injuries EP 47 Collects data: unintentional ferromagnetic objects; injuries ferromagnetic objects AAPM 4/7/18-21 AAPM 4/7/18-22 Performance Improvement Compiles and analyzes data EP 6 Reviews/analyzes CTDIvol, DLP, SSDE diagnostic CT exceeded expected range in imaging protocols; compared to external benchmarks Top Standards Compliance Data 2017 AAPM 4/7/18-23 AAPM 4/7/
7 Top Standards Compliance Data 2017 N = 266 AAPM 4/7/18-25 AAPM 4/7/18-26 N = 111 AAPM 4/7/18-27 N = 84 AAPM 4/7/
8 Typical Surveyor Observations EC Access to hot lab; after hours Key code not changed; keys not returned Ferrous fire extinguishers Zone 3. MRI doors unlocked or open w/o staff there Incomplete screening documents or policy Surveyor administrator allowed in Zone 4 w/o screen MRI staff could not articulate emergency procedure EC No badges or not wearing Checking with staff during tracer Policy annual apron inspection; not done Lost apron policy AAPM 4/7/18-29 Typical Surveyor Observations EC CT/ MRI QC not done according to policy Policy: radiographic equipment -not done Looking at both PM and physicist survey Incomplete annuals Maintenance/ testing not meeting manufacturer s recommendations AAPM 4/7/18-30 Typical Surveyor Observations Typical Surveyor Observations PC Siemens CT/ GE protocols Contrast discrepancies; not follow protocol No CT imaging protocols Insufficient contrast guidance Changes in protocols w no verifications, initials etc. No time frame for CT protocol review PI No process for reporting thermal injuries Incident reports; no data collected/analyzed No process for ferromagnetic objects PI No process for CTDI data Collected data but didn t review/ analyze AAPM 4/7/18-31 AAPM 4/7/
9 What s New The Process The Joint Commission develops and updates its standards for health care organizations that seek or maintain accreditation, based on current science to address emerging health care quality issues. These voluntary standards are established after extensive literature review, input from national experts and other stakeholders. The process involves: Extensive research and literature review A technical advisory panel representing imaging leadership and clinicians, researchers and practitioners from leading hospitals and other organizations across the country. A standards review panel to provide real-world practice perspectives and Input on the new and revised standards. AAPM 4/7/18-33 AAPM 4/7/ Hover over Standards; Select Field Review Open until 4/20/2018 AAPM 4/7/18-35 AAPM 4/7/
10 AAPM 4/7/18-37 AAPM 4/7/18-38 AAPM 4/7/18-39 AAPM 4/7/
11 AAPM 4/7/18-41 AAPM 4/7/18-42 AAPM 4/7/18-43 AAPM 4/7/
12 Working Timeline Questions? Thank You! AAPM 4/7/18-45 AAPM 4/7/18-46 The Joint Commission Disclaimer These slides are current as of 3/26/18 The Joint Commission reserves the right to change the content of the information, as appropriate. These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides. These slides are copyrighted and may not be further used, shared or distributed without permission of the original presenter or The Joint Commission. AAPM 4/7/
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