HOSPITAL NAME INSTITUTIONAL POLICY AND PROCEDURE (IPP) Department: Radiology/Nursing Manual: Section: TITLE/DESCRIPTION POLICY NUMBER GUIDELINES OF CARE & PRACTICE: RADIOLOGY PATIENTS EFFECTIVE DATE REVIEW DUE REPLACES NUMBER NO. OF PAGES APPROVED BY APPLIES TO PURPOSE The provision of safe and effective care for all patients undergoing diagnostic and interventional radiologic procedures. RESPONSIBILITY CROSS REFERENCES POLICY Defines the minimum guidelines for nursing care for all patients undergoing diagnostic and interventional radiology procedures including during transport to and from Radiology Department and during all Radiology procedures and studies. PROCEDURE PROTOCOL: a. A licensed nurse from the unit will accompany patients during transport to and from Radiology and remain in Radiology if the patient is in ICU monitored bed. Exception: Patient in an ICU with written orders to be transferred to a non-monitored bed. b. A licensed nurse shall accompany all monitored patients not in an ICU. The RN responsible for the patient will determine (in collaboration with the physician) the need to continue or discontinue monitoring during transport and will obtain a physician s order when discontinuation of monitoring for transport and procedure/study time is deemed appropriate. c. A licensed nurse form the unit/floor shall accompany all hemodynamically unstable or potentially high risk patients during transport to and from Radiology Department and remain with the patient during the procedure/study Monitoring includes: SaO2&/or apnea &or cardiac d. When a monitored patient is transported to the Radiology Department without a monitor per MD order, or monitoring has been discontinued within two hours of the transport, the nurse taking care of the patient will communicate report directly to a member of the Radiology nursing staff prior to transport. The unit/floor nurse is to call the Radiology Control Desk who will page the Radiology Charge Nurse or nurse on call for report. This report will include: 1. Patient s related history 2. Hemodynamic Status 3. Potential High Risk Considerations 4. Whether monitoring is to be continued during the procedure/study while in Radiology. 5. Notification if multiple radiologic procedures are ordered. Standards Page 1 of 1
6. Infection Control (Isolation) status (when applicable) e. Assessment parameters will be based on the patient s condition and the specific procedure to be performed. f. All patients will have a brief history obtained prior to administration of any medication and/or contrast media. The history will include, but not limited to, history of prior contrast administration and allergies. g. Pediatric patients will be supervised at all times. h. An RN will monitor all patients undergoing invasive arterial/venous procedures. Monitoring will minimally include the following: 1.Cardia Monitoring 2. Blood Pressure Monitoring 3. Pulse Oximetry 4. Vital signs at least every 15 minutes 5. Neurological assessment during neurovascular studies i. An RN will monitor all patients undergoing procedures requiring moderate sedation according to the guidelines stated in hospital policy (Sedation and Analgesia) j. Patients may receive medication to decrease their anxiety, discomfort, and/or pain during procedures as medically indicated 1. Only a licensed nurse will administer medications. Only an RN or MD may administer IV medication Exception: Radiopharmaceutical and contrast agents may be administered by Radiology Technologists 2. Prior to the administration of medication, the following information must be obtained (per nurse-tonurse report for inpatients or from medical record, patient and/or family members for outpatients), when possible: a. Age b. Weight c. Past Medical History d. History of Sedation e. Allergies f. Length of Study g. Specific ports to be used for administration of medications and/or contrast media. h. Determination of other procedures that may require sedation and/or nursing support. 3. Prior to the administration of any medication for the purpose of moderate sedation, the guidelines listed in the hospital policy Sedation and Analgesia) k. The patient s status, interventions, and any adverse reactions during and after a Radiology procedure/study with Radiology nursing involvement will be communicated verbally to the staff of the unit/floor receiving the patient after the procedure and will be documented in the patient s medical record. l. Pre-procedure preparation for scheduled procedures will be communicated to the patient care units/floors to 1) minimize radiations 2) reduce the need to repeat examinations 3) decrease the hospital stay. m. Whenever possible, multiple Radiology procedures and studies will be coordinated through the Control Desk or the Radiology Charge Nurse in order to minimize the number of required transports off the unit. n. While in the Radiology Department, patients will receive safe, appropriate, efficient, coordinated care in the event of an emergency: 1. All Radiology RNs will be ACLS/PALS certified and have arrhythmia training Standards Page 2 of 2
2. All Radiology nursing staff will be required to attend all mandatory inservices applicable to their role. 3. Emergency drugs, equipment, and supplies will be inventoried daily to assure control, availability and proper functioning. PROCEDURE(S) Considerations: 1. MD/RN need to evaluate appropriateness of each transport. 2. Time required for transport to and from Radiology 3. Staff needed to transport 4. Equipment needed to transport (i.e., O2 cylinder / ventilator, resuscitation bag and mask, cardiac monitoring, emergency drugs, etc.) 5. Clamp any gastric or duodenal tubes for transport time with information given for care during procedure to staff / RN with patient. 6. Appropriate staff available to receive patient and assume responsibility to care OR appropriate staff available to travel and/or stay with patient for time in Radiology. 7. All chest tubes are at least to water-seal drainage with a MD order or per unit standards (suction may need to be applied immediately upon transport to patient care area or procedure room). 8. Schedule multiple tests during a single transport. 9. Need for procedure rescheduling (i.e., conflicts with other procedures, deterioration of condition, patient s ability to tolerate transport and procedure, ventilator adjustments) 10. Patient s need for sedation and/or pain control. 11. Patient s airway needs (i.e., ET Tube, tracheostomy, stomas, ability to maintain own secretions, history of seizure disorder, trauma or surgical intervention). 12. patient s ability to communicate (i.e., artificial airway, language barriers, cultural differences) 13. Security needs for the patient 14. Infection Control needs for the patient 15. Communication needs for technical, transport, physician and nursing staff. PATIENT/FAMILY EDUCATION: a. All radiological procedures and studies will be explained to the patient, including the location of the procedure/study, the approximate length of time for the transport and procedure/study, along with a detailed description of the reasons for the procedure/study. Teaching will be appropriate for age and level of learning. b. Any equipment, possible risks, and the roles of the individuals involved in the procedure/study will be explained to the patient prior to the study/procedure. c. All patient and family questions will be addressed in timely manner. d. Explanations will be given regarding any required sedation/analgesia. e. Any post study/procedure instructions and/or transport needs will be explained to patients, families, and receiving staff on inpatient unit/floor for inpatients, to patients, families and/or responsible caregivers for outpatients prior to discharge (i.e: post arteriogram orders for body positioning requirements) f. All instruction will be provided with appropriate age specific focus including assessment of challenges to learning, previous knowledge/experience, and level of participation in teaching/learning experience. Standards Page 3 of 3
DOCUMENTATION: a. Patient assessments according to level of care (RN involvement only) will be documented. b. All invasive procedures will be documented including but not limited to IV starts and catheter placements. c. All medication administrations including radiopharmaceutical and contrast agents will be documented including patient response. d. Continuing needs of patients post-procedure / transport will be documented. e. Patient and family education will be documented on form Inpatient/Outpatient Radiology Documentation Record. f. Report given prior to procedure and post-procedure will be documented with individual giving and receiving7 report specified in the documentation. FORMS EQUIPMENT If patient has an artificial airway and requires artificial ventilation: a. Full Oxygen (O2) Cylinder (2000psi) with patient specific supplies. b. Resuscitator bag with mask c. Pulse Oximeter d. ETCO2 monitor as deemed necessary by MD, RN, and/or Respiratory Care Personnel e. Cardiac Monitor f. Medications for resuscitation as defined by unit specific standards g. Extra endotracheal tube and/or tracheostomy tube (as deemed needed by RN) h. Portable suction machine and suction kits (as deemed need by RN) i. Transport ventilator for patients who require a Positive End Expiratory Pressure > 15cmH20 (and/or appropriate resuscitator bag with mask & Positive End Expiratory Pressure capability) If patient has an artificial airway, but does not require artificial ventilation: a. Full Oxygen (O2) Cylinder (2000psi) with supplies specific to patient s need. b. Resuscitator bag with mask or tracheostomy adapter c. Obturator for tracheostomy tube d. Portable suction machine and suction kit (as deemed needed by RN) If the patient is on supplemental oxygen, but does not have an artificial airway: a. Full Oxygen (O2) Cylinder (2000psi) with supplies specific to patient s need. b. Supplemental 02 equipment (i.e., nasal cannula, face mask etc ) c. Pulse oximeter (MD, RN or RCP deemed necessary) d. Call Respiratory Care (RCP) for patients with high oxygen requirements. Monitoring (Continuous) a. ECG Monitor (as deemed necessary by MD, RN) b. Pulse oximeter (as deemed necessary by MD, RN) c. Other transport monitoring systems as deemed necessary by MD, RN (i.e.: ICP monitoring, Arterial line monitoring, ETCO2 monitoring for mechanically ventilated patients, etc..) REFERENCES Standards Page 4 of 4
APPROVAL: Prepared by Reviewed by Approved By Approved By Latest Revision Approved By Name Signature Date Standards Page 5 of 5