Radiology issues, conditions, and circumstances that may predispose patients to errors:

Below are some of the issues, conditions, and circumstances pertaining to radiology areas that may predispose patients to suffer medication (or other) errors:

1. Patients often need to wait for tests or wait for transport back to their unit of origin.
   We have seen numerous examples of patients deteriorating while waiting for a procedure or waiting to be transported back after a procedure.
   
   
2. Nursing care differs from ICU.
   While most radiology departments in large hospitals do have nursing staff dedicated to the radiology area, they may not have the same expertise or skill set that a nurse from an ICU might have. The nurse:patient ratio is usually not what one would have in the ICU. And even when a nurse from the ICU accompanies the patient to the radiology suite, that nurse may be unfamiliar with where medications or equipment are stored in the radiology department.
   
   
3. Lack of access to current medication lists, allergy lists, etc.
   While the patient’s chart usually accompanies him/her to the radiology suite, some important documents (eg. the MAR or medication administration record) may not.
   
   
4. The patient may be unable to give information and those who could answer questions are not available.
   The patient may have impaired cognition or impaired level of consciousness. He/she may have been pre-medicated prior to coming to radiology or may have received conscious sedation for a procedure. Typically (at least for an inpatient) a family member or caregiver or the housestaff, individuals who could provide vital information about a patient, may not be present in the radiology suite or otherwise readily available.
   
   
5. The patients may be incredibly sick and have very complex medical problems, both of which are known to be associated with an increased likelihood of errors
   
   
6. Sedation of patients for some procedures may have an additive effect to other medications (eg. narcotic analgesics) that a patient may be receiving.
   
   
7. Some of the hi-tech patient safety technologies available elsewhere in a hospital may be unavailable or underutilized in radiology.
   This might include things like and electronic medical record (EMR), barcoding, electronic MAR, etc.
   
   
8. Patients may arrive with multiple lines and tubes.
   Not only does this predispose to the rare occurrence of catheter misconnections, but often an IV must be temporarily discontinued and then there may be confusion as to how to restart that IV (especially for medications like anticoagulants).
   
   
9. Diabetic patients may represent specific problems.
   Particularly when a patient needs to spend a prolonged time in radiology, there may be confusion about insulin administration, meals, etc.
   
   
10. Medications, supplies, equipment may have come from somewhere else.
    Particularly when medications have been brought with the patient from some other area of the hospital, there is often suboptimal documentation of dosage, time given, etc.
    
    
11. Personnel in radiology may be unfamiliar with equipment.
    This may apply to items like infusion pumps. Often a hospital has pumps made by different manufacturers or different models used in different units of the hospital. Personnel in the radiology suite may not have experience with that particular model.
    
    
12. Inadequate clinical information.
    The bane of the radiologist’s existence is the requisition lacking sufficient clinical information. How often does a requisition for an X-ray of the hip come down with “stroke” as the only clinical information! The radiologist needs to know what specifically is being looked for and other clinical information so that he/she knows what is the most appropriate study and can better interpret the result of the study.
    
    
13. Key people to communicate results to may not be readily available.
    The communication problem on the back end is as important as on the front end. We have talked in previous Tips of the Week about communication of critical reports back to physicians responsible for the care of the patient.
    
    
14. Time pressures.
    The time pressures to move patients through the radiology suite and accommodate not only inpatients but also outpatients and unscheduled cases can be enormous. Add to this staffing issues, particularly around nights and weekends and holidays. And financial pressures (eg. cost issues that lead to use of less expensive contrast agents in many patients).