Establishing a Patient Safety Program in Radiation Oncology

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Arthur Sanders
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1 Establishing a Patient Safety Program in Radiation Oncology : John E. Bayouth, PhD Professor and Chief of Physics Department of Human Oncology University of Wisconsin

2 ! none Disclosures

3 Introduction! Modern radiation therapy is complex and rapidly evolving! Patient safety and quality care are inseparable

4 Pathway to Improve Safety is Clear

5 AAPM Practice Guidelines! AAPM Task Group 100 Report! ASTRO's Practice Accreditation Program

6 ASTRO's Practice Accreditation Program! Standard 1: Patient Evaluation and Follow up: The Radiation Oncologist is accountable for patient evaluation, ongoing assessment, and follow up.! Comprehensive evaluation prior to therapy! Ongoing evaluation during therapy! Post treatment evaluation and assessment of side effects

accountable for patient evaluation, ongoing assessment, and follow up.

7 ASTRO's Practice Accreditation Program! Standard 2: Treatment Planning: The radiation oncology practice uses a written treatment planning directive resulting in comprehensive written patientspecific treatment plan.

9 ASTRO's Practice Accreditation Program! Standard 3: Safe Practices in Treatment Preparation and Delivery: The radiation oncology team conducts checks of safety and accuracy of treatment prescriptions prior to and during therapy.

Delivery: The radiation oncology team conducts checks of

10 Example: Treatment Planning

11 Treatment Planning, cont.

12 ASTRO's Practice Accreditation Program! Standard 4: Staff Roles and Responsibilities: The radiation oncology practice defines the roles and responsibilities of each member of the team and consistently implements procedures according to these definitions.

oncology practice defines the roles and responsibilities of

13 Multidisciplinary Effort to Establish Safety in Radiation Therapy

15 ASTRO's Practice Accreditation Program! Standard 5: Qualifications and Ongoing Training of Staff: The radiation oncology practice establishes and monitors qualifications and training requirements for all personnel to ensure initial and continuous competency in job requirements.

radiation oncology practice establishes and monitors qualifications

16 Improve Safety Culture Through Education

17 AAPM Training: Establish Quality and Safety in Radiation Therapy! Understand safety, quality and their relationship.! Understand how quality and safety work within a system and a culture.! Understand how actions fail and how and why errors and events happen.! Understand how to use risk assessment to identify potentially hazardous parts of procedures and how to reduce the likelihood of errors and mistakes.

! Understand how quality and safety work within a system and a culture.

18 AAPM Training: Establish Quality and Safety in Radiation Therapy! Understand the principles of quality assurance, quality control and quality management and how to develop an effective program for an individual facility.! Learn how to establish an error reporting system for a facility and how national reporting databases help prevent future events.! Understand how to perform root cause analysis.! Learn the tools for addressing safety and quality problems.

effective program for an individual facility.

19 ASTRO's Practice Accreditation Program! Standard 6: Safe Staffing Plan: The radiation oncology practice establishes, measures, and maintains staffing requirements for safe operations in clinical radiation therapy.

21 ASTRO's Practice Accreditation Program! Standard 7: Culture of Safety: The radiation oncology practice fosters a culture of safety in which all team members participate in assuring safety; the practice capitalizes on opportunities to improve safety; and no reprisals are taken for staff that report safety concerns.

24 ASTRO's Practice Accreditation Program! Standard 8: Patient-specific Safety Interventions: The radiation oncology practice adopts and implements protocols to ensure patient-specific safety reviews at key junctures of the treatment planning and delivery process.

25 Isodose Distribution Review

26 Dose Volume Histogram Review

29 ASTRO's Practice Accreditation Program! Standard 11: Quality Management Committee: The radiation oncology practice has an interdisciplinary quality management committee (QMC) accountable for quality oversight and improvement of the radiation oncology practice.

31 Dose review with in-vivo dosimetry

32 ASTRO's Practice Accreditation Program! Standard 12: Facility and Equipment: The radiation oncology practice maintains a facility that supports delivery of safe, high quality care and this is compliant with state and federal requirements.

33 AAPM TG 142

34 ASTRO's Practice Accreditation Program! Standard 13: Information Management and Integration of Systems: The radiation oncology practice maintains information management systems to support patient care, planning, and documentation, and assures safety and interoperability of the systems. Pages 43-62

35 Export from TPS and into R&V

38 Independent MU Check

39 ASTRO's Practice Accreditation Program! Standard 14: Quality Management of Treatment Procedures and Modalities: The radiation oncology practice demonstrates the capability to provide quality management and safe practices for each treatment procedure and modality.

40 AAPM Practice Guidelines! TG-226 MPPG Therapy #1! Evaluation and quality assurance of x-ray based image guided radiotherapy system! recommendations for minimum commissioning and quality assurance practices! description of the treatment team and their responsibilities in IGRT system use and management! staffing estimates and resource requirements needed for IGRT system management

42 Responsibilities of Radiation Oncologist

43 Responsibilities of Medical Physicist

44 Responsibilities of Dosimetrist

45 Responsibilities of Radiation Therapy Tech

46 ASTRO's Practice Accreditation Program! Standard 15: Peer Review of Clinical Processes: The radiation oncology practice implements a robust program to provide peer to peer learning that promotes continuous quality improvement in treatment practices.

47 ASTRO's Practice Accreditation Program! Standard 19: Performance Measurement and Outcomes Reporting: The radiation oncology practice measures its performance using standard, non-standard and patient experience measures, and takes action to improve care.

48 Questions we should be asking! How frequently were the goals of therapy met?! How frequently were acute and/or chronic toxicities beyond expected values?! Have newly implemented technologies changed outcomes in a measurable way?

49 Conclusions! Modern radiation therapy is complex and rapidly evolving! Patient safety and quality care are inseparable! Practice Guidelines and Practice Accreditation are powerful tools of improvement! Regulators have a challenging yet critical role to play

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Quality Reports With. PlanIQ. *Export only. 510(k) pending. Patent pending. Your Most Valuable QA and Dosimetry Tools Quality Reports With PlanIQ * *Export only. 510(k) pending. Patent pending. Your Most Valuable QA and Dosimetry Tools Objective Plan Assessment? How good are my treatment plans? Quality assurance of radiation