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Abstract
Aim Guided by the ALARA - "As Low As Reasonably Achievable" principle in radiation safety, a quality improvement project to optimise the bedside diagnostic imaging process to the best standards of care was conducted over a six month period. The goal was too reduce the radiation hazard opportunities in the neonatal intensive care unit by at least 75% from the existing level at Q2/2015, within 6 months.
Methods The existing bedside imaging process was critically analysed and the following quality improvement initiatives were implemented namely , mandatory lead protective gear to healthcare staff, gonadal shield for neonates, guidelines for optimal collimation of X-ray beam and optimal positioning of neonates. Radiation dosimetry results, regular staff awareness sessions and strong collaboration between neonatologists, radiologists, radiographers and neonatal nurses helped to ensure compliance to the revised imaging process. Radiation hazard opportunities were measured by analysing all radiographs done during the period under baby exposure and healthcare staff exposure categories.
Summary of results Radiation hazard opportunities were reduced by 100% to healthcare staff and 75% to neonates, and the overall reduction was 83%. The rate of discordance between radiograph request forms and images taken was measured as a surrogate marker for compliance to the project initiatives and it declined by 77%. Mandatory orientation of staff to the revised policy on the standardised diagnostic imaging process, regular radiation awareness talks and staff feedback sessions are among several measures taken to sustain the project.
- radiation safet
- preterm infants
- ALARA
- radiation dosimetry
- cumulative radiation exposure
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Footnotes
Contributors The authors were in the six-member QIP team involved hence in the design, study, brainstorming and implementation of the proposed initiatives. PE: project lead, involved in concept, design, data analysis, conducting radiation awareness sessions to the multidisciplinary team and scripted the department policy on bedside radiography in neonates and writing the manuscript. PSC: involved in data analysis, providing orientation of the QIP to nursing staff, monitoring compliance and conducting preproject and postproject survey, contributed to the run charts, and final approval of the manuscript. VAS: mentored the QIP and contributed to administrative details of the project and revised the critical content of the manuscript. SKS: provided expertise and literature search on radiation studies in neonatal units, and contributed to the radiation dosimetry study and relevant sections of the manuscript. GHT and LNL: conceptualised and conducted the radiation dosimetry study in the neonatal unit and played a role in enlisting the radiographers' commitment to the QIP, compiled the dosimetry results and revised relevant sections in the manuscript.
Disclaimer All the views expressed in this paper are reflective of the project team and are not the official statement of the institution.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.