Akademiska sjukhuset University Hospital Uppsala Revised 2003 10 20 / HJ Version No 16
Example Checklist for description of methods
Parameters to be checked and if appropriate for the respective method, filled in according to local organisation and agreements. More parameters can be included if the local organisation demands. It is also possible to refer to general guidelines in various areas if appropriate. This may be the case for certain methods as CT, Ultrasound, MRI etc However, it is important that there are description of methods for each examination room (equipment, laboratory) Principle: Description of methods for each examination room (equipment,
All description of methods follow the same structure (checklist) which makes it more easy to read. Otherwise there can be free text Present description of methods can be updated according to this structure
Publication should be made on the department´s intranet and printed Available at each examination room
Responsible for this is :……………………
The head of the department is responsible for organising the production including follow- up of description of methods Separate parts of this can be delegated according to ge local organisation, e.g. for CT, MRI, Ultrasound, Interventions etc. Responsible person for each examination room is defined sible for Technique room Suggestion: 1. Responsible nurse for each examination room
2. Responsible for method medical physics medical technique 3. The head nurse confirms the list 4. The head of the department confirms the organisation 5. Group meetings for a particular method, etc 5. One person responsible for typing 6. All methods are documented together 7. Weekly meeting between to follow the work – according to local org. 8. Methods can be written into a database if available
Version No. Replaces No. Valid from Valid until Expedited by (name) Confirmed, signed
Checklist to be locally adapted at the particular hospital and department
PREPARATIONS Medical history and clinical questions to be answered from the procedure to be performed Indications Contraindications Quality control of justification of the examination Necessary patient information from the patient´s physician Is the patient informed by the referring department about any special procedure? Comments Necessary patient information from radiology department. Is the patient informed by the readiology department about any special procedure? Comments Ev. WIPS-journal
-Wellbeein-Intervention-Prevention-Safety
Identification of the patient Preparations to be performed at the examination room or radiology department Preparations to be performed at other institution or departmen Equipment, special utenciles etc Cave
- known allergy - other information of importance Diabetes Creatinin
- procedure if exceeds norm - has increased during the last 6
days ID-marks Catheterization RADIATION PROTECTION See special general information on pages: …
Data only relevant for the particular procedure to be included
PROCEDURE Qualification needed to execute the procedure –
- physician - nurse - other competencies Documentation if relevant - expedition
- exposure data - criterier for correct images - image quality centering - documentation - cleaning - etc Referral to any general methodologica description for examination with/of. Contrast
Creatinin level ? Diabetes ? Metformin administration Decision about the examination procedure if the creatinin level exceeds norm or if on Metformin treatment; when was treatment stopped Type of contrast Amount of contrast Mixture Concentration Administration at the ward Administration at radiology dpt Etc Sequencies / coils / etc. MR Method / CT / Quality control of the examination AFTER THE EXAMINATION PROCEDURE Immediate information to Emergency department, Patient´s physician, Operation theatre or other necessary actions to be performed on an emergency basis, reading from soft copies Image documentation, hard or soft copies, etc Special care procedures after any radiology intervention or examination Information to the receiving department caring for the patient after the radiology department. Responsibilities regarding care for the patient during the procedure transport and after REPORT Special document for report Qualification needed to execute reading of soft or hard copies of any related examination or other procedure Contents of the report
- immediate report to referring department in case of medical emergency
- type of report; Acute, urgent
- form of report; verbal, telephone, RIS, PACS
- Documentation of the report Quality control of the
- second reading by 2:d radiologists
- System to inform referring unit in case of change of report
- System to inform 1:st reader in case of change of report Quality control of RIS and PACS digital function including archiving of examination
Other protocols, e.g. Trauma, Intervention, Angiography etc protocol
RISK EVALUATION Medical complications Risks for mistakes
Incident and accident reports if deviations from normal routines are observed by anyone involved in the procedure
Accident risks Environmental observations
Comments Referenses Appendices Radiation protection General information Use your local recommendations Fertile female At the ages 15 – 45 years shall be asked if they may be pregnant and handled according to the official regulations by …………………………. The request form shall be signed confirming that the patient has been asked about the possibility of being pregnant Shielding of the gonads Men under 50 years of age shall be protected by shielding if the testes are located in the primary beam or less than 5 cm from the margin of the radiated field unless there is a risk that diagnostic information will be lost Compression Shall be used if possible and relevant Effective dose, normal examination The effective dose at a particular examination for a normal patient is calculated to xx mSv (male and female respectively) Reference dose
The reference dose prescribed by the Radiation Protection Authorities for this particular
radiology procedure is xx mSv (KAP = xx Gy*cm²). (The reference dose is the mean dose for male and female) Other radiation protective measures to be taken At this examination, the registered patient dose shall be documented for:
If the skin dose exceeds xx Sv (corresponding KAP-value), the referring physician shall be informed that a skin reaction may occur during the following days as a result of the radiation dose received by the patient during the radiology procedure performed. Rules for approximation
> 5 mSv
approximation to the higher full mSv, ex 5,5 = 6 mSv
approximation to the higher half mSv, ex 3,5 = 4 mSv
0,1 - 2 mSv approximation to the higher 1/10 mSv, ex 0,39 = 0,4 mSv < 0,1 mSv
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