Improving Nurse Anesthetist Radiation Safety and Dosimetry Badge Compliance in Endoscopy
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Abstract
Problem: Nurse anesthetists in the Endoscopy unit of a large quaternary academic medical center are exposed to radiation throughout their workday, but noncompliance with wearing their radiation dosAimetry badge has been as high as 89.5% - 98.7% of nurse anesthesia staff. Chronic fluoroscopy radiation exposure disproportionately increases the risk of cataracts, unilateral brain cancers, and chromosomal damage of healthcare workers. Dosimetry badge compliance is necessary for fluoroscopy radiation exposure to be properly measured and maintain a safe working environment for nurse anesthetists. Purpose: The purpose of this quality improvement project is to increase nurse anesthesia radiation dosimetry badge compliance with the use of a radiation safety timeout over a 15-week period in the Endoscopy unit. Methods: A project team consisting of a project leader, nurse anesthesia champion, and Endoscopy nurse champion instituted a radiation safety timeout practice change in the Endoscopy unit. Project strategies included electronic and unit-based education to 25 nurse anesthetists and 15 nurses (emails and in-services), collaboration (weekly site visits and project champions), and evaluation (data collection and analysis). Nurse anesthetists completed an anonymous QR code survey tool, evaluating the frequency of fluoroscopy cases in which the radiation safety timeout was performed, and dosimetry badges were correctly worn. Results: Fifteen weeks of data collection showed an average reported compliance of 83.8% with proper display of dosimetry badges and 73% with the radiation safety timeout. Survey response rate was 33.9%. Run charts show a nonrandom increase in dosimetry badge compliance, but the trend showing increased radiation timeout compliance may be due to reminders from nurse anesthesia staff, and not the intervention itself. Re-education through email and an in-person in-service led to increased compliance reporting during week 3. A change in leadership contributed to absence of data in weeks thirteen through fifteen. Conclusion: Dosimetry badge compliance did not reach 100%, but non-significant improvement exists since implementation of the radiation safety timeout and education. Knowledge gaps and opportunities for re-education to increase nurse anesthesia buyin and compliance will be assessed and ongoing.