Week 10 Lecture Notes

Week 10 Overview

• This week marks week 10, with four weeks of content remaining before the final exam period.
• Three weeks of instruction from the current instructor, followed by Emma Rush teaching ethics and law from Wagga.
• Resources available on the library site and the Australian Society of Medical Imaging and Radiation Therapists (ASMIRT).

Additional Resources

• ASMIRT has released three videos interviewing clinicians in nuclear medicine, radiation therapy, and radiography.
• These videos offer insights into the daily life and roles within each stream.
• Located under Leganto readings and resources as additional study materials.
• Videos are approximately two and a half minutes long each.

Switching MRS Streams

• Students can switch between Medical Radiation Science (MRS) streams in the first year.
• First-year subjects are transferable, so no time is lost.
• Second year and beyond involve specific clinical placements for the enrolled MRS stream.

Assessment Tasks

• Assessment task due this Wednesday: pre-procedural check.
• Assessment task number four: workplace health and safety, including safe patient handling, hand hygiene, and infection control.
• E-modules and quizzes for assessment four will be available after this week's class.
• These modules recap class content and mirror e-modules used clinically.
• One attempt is allowed for each quiz.
• Grades will automatically populate in the grade center after quiz submission.
• Pre-procedural check is worth 30%, e-modules and quizzes are worth 15%.

Valid Consent Requirements

• Consent is essential for examinations, linking to radiation safety by ensuring the correct patient, side, and procedure.

• Four criteria for valid consent when the patient has mental capacity:

  • Patient must have the ability to make a decision (mental capacity).
  • Consent must be given freely and voluntarily, without coercion or manipulation.
  • Consent must be specific to the proposed procedure or treatment.
  • Consent must be informed, involving two-way communication, education about the examination, risks, and post-examination details.

• The legal responsibility for obtaining consent lies with the medical practitioner delivering the examination.

• Verification checks ensure patient identity.

• Capacity involves two-way communication, time for consideration, and the ability to ask questions.

Forms of Consent

• Consent can be written, verbal, or implied.
• Written consent is essential for procedures/operations like traumatic surgeries, day procedures, cardiac/urology surgeries, anything requiring sedation/anesthesia, blood transfusions, significant/invasive treatments posing health risks, and experimental treatments (clinical trials/research).

Clinical Applications of Consent

• Intravenous Cannula Insertion:

  • Relatively low risk procedure.
  • Written, oral, or implied consent can be obtained.
  • Implied consent: patient rolling out their arm.
  • Verbal consent: patient stating they're happy.
  • Safety questionnaires can also include consent.

• Biopsy of a Lung Nodule:

  • Requires written consent.
  • Higher risks due to the invasive nature (needle in the chest/lungs) and potential for complications.
  • Patients must understand the risks and have a chance to ask questions.

• Open Reduction Internal Fixation (ORIF):

  • Consent lies with the medical practitioner (e.g., orthopedic surgeon).

• Radiation Prostate Therapy:

  • Requires written consent.
  • Major risks and potential damage to healthy cells necessitate informed consent.

Implications

• Written consent can always be obtained if there is doubt.
• Patients must be able to consent (implied, verbal), with written consent for significant procedures.
• If patients lack capacity, consent can be given by a nominated next of kin.

Important Domains

• The content covered contributes to essential domains:

  • Professional and ethical practitioner (consent).
  • Communication and collaboration with interdisciplinary teams, communities, and colleagues.

Workplace Health and Safety

• Medical Radiation Practitioners are exposed to hazards that can affect their health and well-being.

• This includes long hours, changing shifts, and the need to assist patients with mobility.

• Safe work practices are vital for medical radiation practitioners and a consideration of the Medical Radiation Practitioner Board of Australia and AHPRA.

• Three main aspects of workplace health and safety:

  • Safe Patient Handling
  • Infection Control
  • Radiation Safety

• Learning outcome number four includes legal, professional, and regulatory responsibility around health, safety, and hazards.

• The Workplace Health and Safety Act involves taking reasonable care for the health and safety of oneself, others (patients and team members), reporting hazards (e.g., malfunctioning equipment), and following safe manual handling practices.

• Medical Radiation Sciences may act as a bit of a service to a multitude of different specialties.

• Clinicians should also be free from the influence of drugs or alcohol while working, which is a punishable offense.

Hazards vs. Risks

• Hazard: anything with the potential to cause harm to people, equipment, structures, or the environment.
• Risk: the probability of someone being harmed by the identified hazard.

Classifications of Hazards

• Physical Hazards:

  • Lifting with poor posture.
  • Slips and trips due to bodily fluids or leaks.
  • Noise from alarms and equipment.
  • Machinery use.
  • Moving equipment and beds.

• Mental Hazards:

  • Excess workload.
  • Long hours.
  • Dealing with highly anxious patients.

• Chemical Hazards:

  • Cleaning fluids.
  • Cytotoxic chemicals.
  • Radiopharmaceuticals.

• Biological Hazards:

  • Infectious diseases.

Mitigation Strategies

• Infection control procedures.
• Management for sharps exposure.
• Proper disposal of clinical and cytotoxic waste.
• Safe manual handling practices.
• Access to appropriate equipment.
• Addressing slips, trips, and falls.
• Proper disposal of spills and waste.
• Managing exposure to smoking.
• Implementing security measures to address violence and aggression.
• Appropriate use of duress alarms and emergency protocols.

Workplace Health and Safety Issues

• Safe patient handling: Proper staffing to ensure safe transfers.
• Infection control: Includes personal protective equipment (PPE) and hand hygiene.
• Radiation safety: The safe use of ionizing radiation.

Safe Patient Handling

• Purpose: To transfer a patient safely from one place to another.

• Assess patients' capability to transfer by:

  • Checking the referral.
  • Hand-over reports.
  • Talking to the patient.

Hospital Design

• Hospitals and healthcare facilities are designed by an overarching policy of blend of people.
• Work areas are ergonomically designed with tools and flooring that is built into the health care facility to mitigate any of these risks initially anyway.
• Departments' construction, such as lead lining for radiation reduction, aligns with workplace health and safety policies.

Injury Risk Mitigation

• Reduce the size and weight of objects when possible.
• Store items at waist height to eliminate bending and reaching.
• Eliminate clutter to ensure easy access to equipment.
• Maintain floor surfaces.
• Use adjustable height trolleys.
• Lock equipment when transferring patients.
• Provide step platforms or handrails.
• Use non-slip surfaces and identify weight and size instructions.

Reasons for Transfer Assistance

• Cervical spine collar (suspected injury).
• Influence of anesthetics (e.g., epidural).
• Age and mobility limitations.
• Fractures and dislocations.

Musculoskeletal Disorders

• Musculoskeletal disorders result due to prolonged or any sort of acute injury that might be present if clinicians are not practicing and transferring our patients safely, adhering to mandatory kind of policy and safe patient handling practices.
• Sprains, strains, and back injuries are common.

Common Musculoskeletal Disorders (MSD)

• Sprains and strains.
• Back injuries.
• Joint or bone injuries or degeneration.
• Nerve or compression injuries.
• Muscular and vascular disorders.
• Soft tissue injuries, such as hernias.
• Chronic or acute pain.

Mitigating MSDs

• Reducing absenteeism by supporting staff health.
• Maintaining patient and staff safety.
• Rotating staff, particularly in roles with the highest MSD risk.

Assistive Devices

• Slide Sheets: Made of low-friction material; used to reposition and transfer patients.
• Transfer Boards: (e.g., pat slides) - Used to bridge the gap between two beds; made of durable plastic and are used to bridge the gap from a bed to a bed or from a scanner to a bed.
• Air Assisted Transfer Devices: (e.g., hover mats): Inflatable mattresses used to lift and transfer patients.
• Mobile or Standing Hoists: Use a sling mechanism to lift patients safely out of wheelchairs or beds.
• Wheelchairs: Can be positioned to facilitate patient transfers.
• Standing or Pivoting Aids: Can assist with patient transfers.

Using Transfer Equipment

• Slide Sheets: Aid in moving, positioning patients in bed, and safe transferring patients from bed to bed or scanner to scanner.

• Transfer Boards: Provide a rigid surface to bridge gaps between beds, allowing for safer patient movement

  • It's used for supine, completely supine (lying) people with a safe horizontal movement across

• Hover Mats: Reduce friction during transfer; good if you were to have someone from pelvic surgery, since there is significantly less movement involved

  • Utilize restraints to keep patient center from rolling back.

• Ensure a constant flow when going through transfers instead of multiple sporadic shoves.

Common Bed to Bed Transfer Using Transfer Aid

1. Lower adjacent tables and lock brakes.
2. Make sure rail is down.
3. Employ someone to ensure the lateral alignment.
4. Place slid sheet underneath to leverage the pull.
5. Slighty roll towards the two people providing the pull and apply something for rigid support.
6. Afterwards perform a lateral transfer from bed to adjacent surface, using a pat slide to bridge gap.

Weight Balancing

• Utilize legs instead of you extremities when transfers. Ensure a constant flow so not sporadic forces

Infection Control

• Infection prevention aims to prevent harm caused by infection to patients and health workers.

• Healthcare associated infections can lead to long hospital stays.

• Infection control aims to ensure cleanliness from: health care environment, the client and the health worker.

• Infectious diseases have a chain.

  • Causative agent can originate back from sources and transfer through different modes.

• This chain has:

  • Causative agent.
  • Reservoir.
  • Portal of exit.
  • Means of transmission.
  • Portal of Entry.
  • Susceptible Host.

• Infectious agents move through contact transmission, droplet transmission, and airborne transmission.

Standard Precaution

• Standard Proportions implement for every patient every time to interrupt spread route of infection

• They comprise of:

  • Hand Hygiene every patient every time.

  • Appropriate and Correct PPE.

  • Proper Aseptic Technique.

    *What can be done in smaller scale operations

  • Sharp disposals.

  • Routine environmental Cleaning.

    • Infection control comes from cleaning every surface

  • Respiratory Hygiene.

  • Handling and disposing of waste.