Patient safety is such an important topic that when I received an e-mail from James Teixeira, a sonographer from Tennessee, asking to submit an editorial on the topic; I honestly wished I had thought of it myself. The truth is, many laboratories are working extensively to incorporate a culture that embraces the patients safety above all else. Please enjoy the following editorial by James Teixeira, BA, RDCS, (AE, PE), RCS. –Marti L. McCollough, BS, MBA, RDCS, FASE
More often than not, sonographers are inundated with literature regarding their safety and the measures that must be taken to stay protected. Both the Society of Diagnostic Medical Sonographers (SDMS) and the American Institute of Ultrasound Medicine (AIUM) provide documents which describe the topic of sonographer safety: wearing protective gear, ensuring proper ergonomics, and even tasks such as washing your hands. Obviously, appropriate hand hygiene benefits the sonographer as well as the patients. While protecting oneself is necessary and in most cases mandatory, it is also the responsibility of all caretakers, including sonographers, to properly care for our patients and their safety.
Debatably, one of the most important features of an echocardiogram is answering clinical questions, thereby confirming a diagnosis or managing the progression of a prior diagnosis. The ASE has published a plethora of guidelines with respect to appropriateness criteria. The creation of appropriateness criteria is an effort to reduce unnecessary examinations, thereby minimizing costly medical bills and improving efficiency. It is the duty of each and every sonographer to ensure that the proper diagnosis is presented, but also that the criteria for each examination, whether it is a TEE, contrast study, or routine echocardiogram, have been met.
Regardless of the setting (inpatient vs. outpatient), the care we give our patients extends beyond the realm of scanning and broadens into the daily management of patient care. Sonographers are faced with patient safety in both outpatient laboratories and inpatient settings. Assessing two patient identifiers (i.e. arm band, driver’s license, or verbal confirmation), as well as confirming the order and indication for the test, is mandatory. In addition, in the inpatient setting, lowering the bed, raising the side rails, removing obstacles, and leaving a patient with a call bell are all simple measures a sonographer can take to keep his or her patients free of harm. The facility where I work gives each new employee a thorough orientation which goes over the care a practitioner must follow in order to remain competent. Proper education and orientation is excellent practice and reiterates the fact that patient safety is a top priority, as well as the vision for providing the highest quality of care.
Patient safety issues are challenging in any setting but are particularly so when working in a large general hospital. The sonographer working in a hospital facility has to be especially adaptable as he/she applies patient safety measures to circumstances that vary according to each patient. For instance, a premature infant is significantly different from a full-term infant. The complexity of care then continues through pediatrics, adults, and into geriatric patients.
Pediatric echocardiography has a myriad of technical challenges. The physical pressure applied during scanning can cause problems such as a pneumothorax, bruising, dyspnea and even, in extreme cases, cardiorespiratory arrest. In addition, neonates are extremely vulnerable to handling and sonographers/echocardiographers must always be aware of how firmly pressure is applied with our probes onto the patients’ chest walls.
Sonographers, nurses, and physicians all become health care providers to positively impact the lives of others. We need to be the front line that protects and guards the safety of the patients so that their health conditions can be accurately diagnosed and their care properly delivered. By spending a few moments before each exam to tidy a room, remove hazards, or arrange patients so that they are out of harm’s way, we can greatly decrease the chances of an untoward incident. Always keep in the mind the motto of health care: “Primum non nocere.”