Safety Challenges and Concerns

Magnetic resonance imaging (MRI) is a widely used diagnostic modality. Both hospitals and standalone imaging centers offer the services. According to the FDA, while MRI is considered a safe modality, there is an underlying potential for injury to patients due to the strong electromagnetic (EM) fields used in MR scanning (Sunder Rajan, 2018). When any medical procedure is preformed there is always the potential of risk to the patient; however the magnetic resonance (MR) environment poses potential risks to patients, technologist, accompanying family members, other health care professionals and basically anyone that could somehow gain entry to a magnet room.
There are both regulatory and accreditation requirements that must be met to preform MRI exams. The Center for Devices and Radiologic Health (CDRH) is the branch of the United States Food and Drug Administration responsible for the premarket approval of all medical devices and well as overseeing the manufacturing, performance and safety of these devices (Sunder Rajan, 2018). The American College of Radiology (ACR) is responsible for the MRI Accreditation Program which evaluates staff qualifications, quality control, MR safety policies and image quality (American College of Radiology, 2018). The safety policies are set in place, but fail when employees or patients are noncompliant.

Safety challenges and concerns

The challenge with MRI safety is that a complete and efficient screening procedure has yet to be implemented. A strong MRI safety program requires that radiology, patient safety, facilities management and biomedical engineering collaborate to enforce the safety procedures put in place are followed. Understanding of the potential risk involved with a giant magnet is vital to preventing accidents, training of all employees, even if they do not work in the magnet environment is required and that training needs to be annually reviewed. The technology today is always changing and it is important that the updates are shared as soon as available.

MRI safety is a constant concern, despite annual training videos and reminders; there are still accidents or incidents involving the MRI magnet. Implanted devices, ferris metal, non MRI safe equipment, patient screening, noncompliance and ignorance are all human or pilot error. There are numerous incidents reported every time something enters the magnetic field that should not have made it through the screening process. Following review of the incident reports, emails and updated policy information is sent out to the entire company. Yearly documented and updated training is provided in groups and requires all employees' compliance. The violations included are the fault of both patients and employees as written and posted protocols were not followed or were ignored. It is important that every individual that enters the MRI zones are properly screened for contraindications i.e. pacemaker, hearing aids, aneurism clips, anyone in the MRI suite is at risk as the magnet is never turned off.

Besides attracting metal objects that can fly inside the scanners and injure patients, they can disrupt the functioning of some cardiac pacemakers and other implanted electronic devices, even those made of metal that is not attracted to magnets (Mcneil, 2005). The Joint Commission is an independent group in the United States that administers voluntary accreditation programs for hospitals and other healthcare organizations. The Joint Commission standards function as the foundation for healthcare organizations to gauge and enhance their performance (The Joint Commission, 2017). Items are tested and classified with a rating of MR Safe, MR Conditional and MR Unsafe, and then all items are labeled with specific stickers stating their classification. The area leading up to a magnet room is divided into safe zones. Since the magnet is never turned off, the magnetic field extends into three dimensions and then classified into zones based on their purpose and distance from the magnet. Signs are also posted to alert everyone of what zone they are in, but most of the doors leading to each zone are secure and require a qualified person to enter the area.

Proposed initiative for MRI Safety

The challenge with MRI safety is that a foolproof, complete and efficient screening procedure has yet to be developed. A strong MRI safety program requires that radiology, patient safety, facilities management and biomedical engineering collaborate to enforce the safety procedures put in place are followed. Addressing MRI safety issues and requirements pre-service and developing protocols and procedures to support the safe use of MRI will prevent adverse outcomes or incidents at time of service.

Current protocol and procedure

?An important aspect of protecting patients and individuals from MR system-related accidents and injuries involves an understanding of the risks associated with the various implants, devices, accessories, and other objects that may cause problems in this setting(Shellock R & D Services, 2017). There is a procedure that the staff follows that seems quite simple. Preliminary interview of patient, change patient into MRI safe attire, screen patient with metal detector or with hand held detector in the case of stretcher bound patients. The number of times a foreign body makes it into the magnet itself is a case that needs to be reported.

Reports generated from the data submitted from the incident reports can help to narrow down where there is a breakdown in the process. Those reports can also provide continuous data that can shed light on when the incidents occur, if it's the same personnel involved, time of day or even the staffing numbers at the time of the incident. The control limits set are rigid and not negotiable; something is safe or unsafe so the result will be easily traced to a root cause. I think by having all individuals that are allowed into the MRI suite wearing the gender neutral green scrubs signals go to the technologist that initial screening has been completed and all safety protocols have been met. As is always the case the technologist is the last line of defense before entering the magnet room (Trudeau, 2018).

Proposed initiative

The initiative I propose would work along with the MRI screening sheets that are already in use today. Putting focus on communication in the hospital setting and on the MRI screening form that is completed by every single individual prior to entering the MRI suite, I purpose that every person be provided with a set of ferromagnetic free scrubs, green in color. By the time a person is provided the green scrubs, it would be known that the patient has passed at least 2 screenings. The documentation that is recorded on every patient and ensures all the safety questions have been asked and any implant documentation has been researched and documented as safe would be available in the patients' medical record (Trudeau, 2018).

By giving consumers a sense of a health care provider's processes and commitment to providing safe and high-quality care. Structural measures would be indicative of a quality outcome. The standard in providing practice policies is more effective with clear concise direction to all departments in the form of documentation; to be reviewed and signed off would ensure the information is shared. Installing software that sets alerts during the preliminary scheduling portion would create a time out before being allowed to continue with the registration for the appointment. The scrubs would not be issued until all screenings have been completed and reviewed.

Following the patients study, they are provided with a quality survey. Analysis of the qualitative data obtained from the patient surveys would give information on the level of quality care received. Patients would express their feeling of safety and how they were treated.

Provided all steps are completed and compliance is documented, there should be an uneventful experience. The organization performance should be both effective and efficient. In the event that an incident occurs, then those results would be recorded on the detailed incident reports submitted after the occurrence. Quantitative data obtained from the reports provides connected data that concludes with results and recommendations on how to prevent the safety incident from occurring again.

Health Information Technology is important to support the patient's history and their electronic medical record. In today's healthcare market, where patients have a choice on where to have their medical services performed, it is critical to have access to the patient's records no matter where they choose to have their care. Medical history in regard past surgeries or implants is critical when screening for an MRI procedure.

Success of Initiative

Should this initiative be successful, the financial implications would be sector specific so the initial investment would be required from the department and organization. The organization would require an initial investment in the purchase of the ferromagnetic free specialty scrubs and then maintenance in the form of providing laundry service and replacement scrubs when necessary. The cost would benefit the organization with the decrease in the risk of safety incidents occurring in the MRI environment.

The existing information management system already contributes to success of the proposal by assuring there is a minimum knowledge base for people charged with the responsibility of patient safety in the MRI environment. Safety in an MRI environment requires both proactive and reactive safety measures. Current data that is being gathered in the form of the incident reports provide a view of where the weakness in the followed protocol. Being proactive comes down to two things: training and risk assessment.

Organizational processes that will permit continued viability of the performance improvement include continued risk management. Benchmarking is not a one-time review of operations but a continuous process (Ross, 2014). Safety is something that not easily benchmarked because of new discoveries and improved processes. By disregarding even one safety measure that is in place, could be detrimental to the patients' health. Inefficient communication in health care is just unacceptable. Providing the minimum safety training to all personnel, screening of the patient, controlled access to the MRI suite and identifying higher risk patients all are included in the current safety procedures and help to prevent mistakes in decision making. There needs to be objective indicators of performance to assess the initiative. Detailed continued reporting of incidents that occur after the initiative begins and then compared to the data pre-initiative over time would show if there is improvement or worsening.

Conclusion

Interdepartmental communication is vital to the success of the initiative. We need to ask the right questions to assess the risks. Are we correctly identifying the risks? Are we correctly responding to the risks? What part does each staff member play in assuring the quality care and safety for every patient? Practice policies are preformed recommendations on treatment based on the level of information known about medical outcomes and patient preferences (Ross, 2014).

It is important to raise the awareness of the safety risks and risk response actions. MRI incidents include more than the obvious projectile force on ferromagnetic objects. There are other risks involved like peripheral nerve stimulation, acoustic noise and thermal effects. Implementing utilization of the ferromagnetic free protocol would require that all parties find the new dress code easy to follow and beneficial (The Workspace Advantage, 2018). Providing and enforcing clear and concise policies and procedures and increased training to anyone that is involved with the patients care would be shared between the organization and the MRI department. Patient safety is everyone's responsibility so communicating with MRI staff is vital if there is any question about the safety of entering the MRI environment.

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