Patient safety in radiology field - PIT TORAKS KE

Ethics and Patient
safety in radiology
field
Background
1949, dr Henry Garland :
Errors of perception at
image interpretation
November 1999, the American
Hospital Asosiation (AHA) Board of
Trustees : Patient safety is a
priority strategic
2000, Institute of Medicine, United
States :
3- 16 % adverse event in hospital
PATIENT SAFETY
PRIMUM, NON NOCERE
FIRST, DO NO HARM
HIPPOCRATES’S TENET
(460-335 BC)
Hippocrates
(yunani)
Inhotep
(mesir)
Galenus
(roma)
Pelopor kedokteran kuno
Tradisi dan disiplin  alas etik profesional
Reported overexposed
1980 - 2013
GENERAL ERRORS
2010, Jones et al
1. Patient identification
and events involving the wrong
patient, wrong procedure, or wrong side or site
2. Diagnostic errors, including image perception and
interpretation; failure to transmit, understand, and act on medical
imaging reports; and problems with documentation
3.Communication failure, particularly at times of
patient handover and handoff.
Philosophical Approach to Safety:
Traditional versus Modern View
The traditional view
sees human error as a cause of accidents
The modern view
sees events attributedto human error
as a symptom of trouble deeper inside a system.
PERMASALAHAN ETIKA
Malpraktik
BUDAYA
KESELAMATAN
Kelalaian dalam
penanganan pasien
PASIEN
Diskriminasi
terhadap pasien
BUDAYA
KESELAMATAN
PASIEN
KODE ETIK
PROFESI
KODE ETIK
KEDOKTERAN
PRINSIP ETIKA KEDOKTERAN
1. Autonomy
Kebebasan pribadi untuk suatu tindakan
menunjukkan kemandirian percaya diri,
kebebasan memilih dan kemampuan untuk
membuat keputusan
2. Nonmaleficence
Kewajiban untuk tidak menimbulkan mudharat
3. Beneficence
Kewajiban berbuat baik
4. Justice
Berlaku adil
• ln lndonesia, many problems are not
revealed; cases of suspected malpractice,
negligence in handling of patients,
discriminate against patients and others.
• Medical personnel have an important role
in creating a quality health services
including implementing patient safety
culture.
• Currently patient safety culture does not
exist yet in health careThe evidence are
the persistence reports of malpractice
cases,discrimination, and others.
• Each health profession has a code of
ethics. The existence of a code of
ethics should be an aspect in the
implementation of safety culture
pasien.
• Undang-undang Rumah Sakit No 44 Thn
2009, it was clear to say that patient
safety is a factor that should be
prioritized by health workers compared
to other factors.
• To implement the patient safety
cullture and run code of professional
conduct require good organizational
climate.
• Ethical aspecfs become an imporlant
part of patient service.
RADIATION SAFETY
ALARA (AS LOW AS RESONABLY)
GOALS :
• ELIMINATE DETERMINISTIC EFFECTS (TISSUE REACTION)
• REDUCE INCIDENCE OF STOCHASTIC EFFECTS
(CARCINOGENIC & GENETIC EFFECT)
LIMITING EXPOSURE
• MINIMIZE EXPOSURE TIME
• MAXIMIZE DISTANCE FROM THE X-RAY TUBE
• USE SHIELDING
EFFECTIVE RADIATION
DOSE IN ADULTS
EFFECTS OF RADIATION
EXPOSURE
• EXPERTS SAY EVEN
SMALL RADIATION
DOSES, AS LOW AS
100 MILLISIEVERTS
(mSv), CAN SLIGHTLY
RAISE CANCER RISK
X-RAY & CT CONTRAST
GUIDELINE
• Practical Aspects of Contrast
Administration
• Patient Screening Prior to Administration
of Iodinated Contrast
• Administrative Process for Iodinated
Contrast
• Vascular Access and Use of Central Lines
and Ports in Adults
• Vascular Access and use of Central Lines
and Ports in Pediatrics
• Background Information on Adverse
Effects of Iodinated Contrast
MRI SAFETY GUIDELINES
WHAT CAN GO INTO THE MAGNET
1. ABSOLUTE CONTRAINDICATION
2. RELATIVE CONTRAINDICATION
3. CORONARY STENTS
4. PACEMAKERS, ICDs, PACING WIRES AND
LOOP RECORDERS
5. SCREENING PROCEDURES
CT & MRI DURING
PREGNANCY GUIDELINES
• Signs should be prominently displayed in all
radiology departments asking each patient to
notify a technologist or physician if she is, or
thinks she could be, pregnant.
• All technologists should ask women of
childbearing-age if they might be pregnant
prior to performing a radiologic procedure.
• Radiology requisition forms filled out by
referring physicians should include a section
dealing with the possibility of pregnancy.
• No radiological procedure involving exposure
to the pelvis should be undertaken in a
patient who declares she may be pregnant
without consultation with a radiologist. The
radiologist should discuss risks and benefits
with the patient, and determine if it is
appropriate to proceed, perform an
alternative procedure, or delay the study to
allow performance of a pregnancy test.
OCCUPATIONAL RADIATION
SAFETY IN RADIOLOGICAL
IMAGING
SCATTER RADIATION
RADIATION DOSE
MONITORING
• THERMO-LUMINESCENT DOSIMETERS
• REAL-TIME MONITORING DEVICES
• AREA SURVEILLANCES USING SURVEY
METERS
• Recommended use of at least two dosimeters, one above and
one underneath the lead apron. They allow risk estimation for
the deterministic effects (such as cataract) and the stochastic
effects (such as cancer risks), respectively.
LEGAL ASPECT
• Keputusan Menteri Kesehatan Republik Indonesia Nomor
496/Menkes/Sk/Iv/2005 :Tentang Pedoman Audit Medis Di
Rumah Sakit Menteri Kesehatan Republik Indonesia,
• Peraturan Menteri Kesehatan Republik Indonesia Nomor
1691/Menkes/Per/Viii/2011 : Tentang Keselamatan Pasien
Rumah Sakit
• Undang-undang Rumah Sakit nomor 44 tahun 2009
UU No.23/92 Ttg KESEHATAN
KESEHATAN
SUMBER DAYA
KESEHATAN
TENAGA KES.
▪
▪
▪
▪
DOKTER
BIDAN
PERAWAT
APOTEKER
UPAYA
KESEHATAN
PELAY KES.
SARANA KES.
PEMELIHARAAN KES.
UPAYA
KES.
▪ R.S
▪ PKM
▪ PRAKTEK
DOKTER
▪ POLIKLINIK
INDIVIDU
HUB
TENAGA
KES.
PASIEN
MASYARAKAT
▪ PPM
▪ UKS
▪ KESUNG
R.S
TERBENTUK
HUBUNGAN MEDIK
HUBUNGAN HUKUM
HUB
UPAYA KES.
KURATIF
PREVENTIF
RHTATIP
PROMOTIF
SUBJEK
HUKUM
SUBJEK
HUKUM
Standar
Etika
Input dan Proses
▪ Standar
Pendidikan
Profesi
• Hardware
• Software (al:
kurikulum)
• Brainware
1
Output
Sistem
Pendidikan
Standar
Kompetensi
2
Memberikan
Amanah UUPK:
▪ Standar Pendidikan Profesi (Pasal
26)
▪ Standar Kompetensi (Pasal 27)
Globalisasi & Desentralisasi
Regulasi& Standarisasi
(Pemerintah & Profesi)
Pendidikan
Ijazah (Sekolah)
Standar Profesi
1. Standar Etik
2. Standar
Kompetensi
Dr/Spesialis
Sertifikat Kompetensi
(Profesi)
Registrasi
KompetensiKewenangan
3. Standar
Pendidikan
Profesi
4. Standar
Pelayanan
Medik
*)Tanggung Jwb KKI
Majelis
Kehormatan
Disiplin
Lisensi (Izin Praktek)
(Pemerintah Daerah & Profesi)
Praktek Dokter
Masyarakat
Masalah Disiplin
Masalah Etik
Masalah Hukum
PATIENT SAFETY IN
RADIOLOGY
• Dose limits for professionals and
diagnostic reference levels for
patients
• Dose limits are applied to workers
and to the members of the public.
In Europe, the practical dose limit
for ED in workers is 20 mSv/year.
For the eye lens, a new annual dose
limit for workers of 20 mSv/year
has recently been recommended by
the ICRP instead of the current 150
mSv/year
• Dose limits do not apply to patients
because the priority is always the
clinical benefit, and radiation is
only an ‘instrument’ to diagnose or
to guide the procedure
Conclusion
Safety is a function of operational elements such as
individual skill, processes, technology, and
organizational culture.
Safety is produced when organizations establish
standards for what is expected and implement
systems to
(a)Recognize potential errors early by detecting
deviations from standards,
(b)Quickly and effectively solve specific problems
as they arise before they cause harm, and
(c)Quickly learn from problems and change the
organization accordingly so that problems do not
recur.
Reference
1. Larson D B, Kruskal J B, Krecke K N, Donnelly L F. Key
Concepts of Patient Safety in Radiology. 2015.RSNA
2. Coeytaux k, bey e, christensen d, et all. Reported
radiation overexposure accidents worldwide, 1980 –
2013 : a systematic review. 2015. United states
3. Depkes RI, 2011. Peraturan menteri kesehatan
republik indonesia nomor 1691/menkes/per/viii/2011
4. Depkes RI, 2005. Keputusan menteri kesehatan
republik indonesia nomor 496/menkes/sk/iv/2005
5. Undang-undang rumah sakit nomor 44 tahun 2009
6. Bapeten, 2013. Peraturan kepala badan pengawas
tenaga nuklir nomor 4 tahun 2013.
HATUR NUHUN
Thank you