|
The IAC Standards
and Guidelines |
4.1A Written
policies and procedures must exist to ensure patient and personnel safety.
Safety policies must be enforced, reviewed and documented annually by the
Quality Improvement Committee or the Medical Director.
4.1.1A Patient
Identification Policy – For all clinical procedures there must be a current
process that assures accurate patient identification immediately prior to
initiating the procedure.
(See Guidelines below for further
recommendations.)
4.1.2A Environmental
Safety Policy – A policy must be established to educate, train and screen
all MRI facility staff members and personnel that may be required to enter the
MRI environment. It is mandatory that all individuals who may potentially enter
the MRI environment be aware of the potential hazards and appropriate safeguards necessary with
regard to the force of the magnet on ferromagnetic objects (i.e., oxygen tanks,
tools, etc.).
4.1.2.1A A
mechanism must be in place to identify those patients/staff members/visitors at
high risk for untoward effects or complications from entering the MRI
environment (e.g., individuals or patients with cardiac pacemakers, implantable
cardioverter defibrillators and certain ferromagnetic implants).
4.1.2.2A A
method for continuous visual, verbal and/or physiologic monitoring of the
patient during the examination must be present.
4.1.2.3A A
procedure must exist for identification of a patient or individual (i.e.,
visitor, staff member) who suffers an incident or complication from the MRI examination
or exposure to the MRI environment. Any incident or complication must be immediately documented. This documentation must be stored and retrievable upon request.
4.1.2.4A Protective ear devices must be
available and offered to every patient and all other individuals present in the
scan room during the procedure.
4.1.2.5A To
avoid radio frequency burns caused by the combination of electrical and
magnetic fields, proper patient setup is necessary when utilizing electrical
conductors such as RF coils, ECG leads, monitoring equipment, etc.
4.1.2.6A MRI
safety policies must address possible contraindications and appropriate safeguards to ensure patient and personnel safety with regard to the presence of electrical, mechanical or magnetically-activated
devices including cardiac pacemakers, implantable cardioverter defibrillators,
certain neuro stimulators, certain cochlear implants and other similar devices
that may malfunction or have altered operation under conditions used for MRI
procedures.
4.1.2.7A MRI
safety policies must address possible contraindications to MRI procedures that
include implants made from ferromagnetic or electrically conductive materials
such as certain clips, stents, ocular implants, otologic implants,
cardiovascular catheters and other similar devices that may be moved, dislodged
or heat excessively during the MRI procedures.
4.1.2.8A The
facility must meet the standards set forth by the Occupational Safety and
Health Administration and other
applicable agencies.
4.1.3A Infection
Control Policy – Procedures and policies must exist to control the spread
of infectious diseases and blood borne pathogens to patients and personnel. The
policy must include equipment cleaning, hand washing, glove use and universal
precautions that are implemented in the facility.
4.1.4A
Contrast Administration and Supervision Policy – MRI safety procedures
must address possible contraindications and/or risk factors including (but not limited to): Nephrogenic Systemic Fibrosis (NSF), diabetes, liver/kidney disease, hypertension, contrast material sensitivity, history of reactions to contrast media, age and
allergies to medications. Patient management must address these
possible contraindications prior to the MRI procedure and must be
listed on the screening questionnaire.
4.1.4.1A The
administration of contrast agents, medication and/or sedation must be performed
by licensed or qualified trained personnel, under the direct supervision of a
licensed physician and in compliance with applicable federal, state and local laws.
(See Guidelines below for further recommendations.)
4.1.5A
Acute Medical Emergency Policy – In the event of an MRI
procedure-related emergency (i.e., respiratory arrest, cardiac arrest,
severe agent reaction, quench, etc.), there must be a written policy
for patient management that includes rapid recognition of the symptoms, immediate and appropriate, response and safe removal of the patient from the magnet room and administration of emergency medical care.
4.1.5.1A For
medical emergencies, proper MR safe and MR conditional equipment and supplies (i.e.,
defibrillator, oxygen tank, suction, monitoring device, etc.) must be accessible and used, as
needed.
4.1.5.2A Appropriate
(i.e., MR safe and MR conditional) equipment, supplies and licensed and/or
qualified and trained personnel (i.e., BLS or ACLS certified) must be available
to manage medical emergencies and handle critically ill or high-risk patients.
4.1.5.3A In
the event of a superconducting magnet quench, the patient must be removed from the scan room as
quickly as possible to avoid risks such as potential life-threatening injuries and/or death.
4.1.6A Incident
Report/Adverse Events Policy – A policy for documentation of adverse
events (i.e., contrast reactions, patient incidents, patient falls, etc.) must
be in place.
4.1.7A
Patient Pregnancy Screening Policy – For all clinical procedures
there must be a process that assures that patients who could be pregnant are
identified. This must be documented and contain the signature/initials of the
patient and/or technologist verifying the information. This procedure must
include an explanation of the proper steps to be taken if a patient may be or
is pregnant.
4.1.8A Cardiac
Procedures: MRI safety policies in a cardiovascular facility must include a
detailed description of graded protocols and/or infusion protocols used; timing
of assessing symptoms, heart rate, blood pressure and electrocardiographic
tracings; exercise testing end points; pharmaceutical injection criteria; post
stress monitoring.
4.1.1A
Two independent patient-specific identifiers must be used. Examples of
patient-specific identifiers include the patient’s identification
bracelet, hospital identification card, driver’s license, or asking the
patient to state his or her full name or birth date avoiding procedures in
which the patient can answer “yes” or “no.”
4.1.4A
Documentation of contrast should include contrast type, amount, lot number and
should be communicated to the manufacturer.