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Design and Implementation of an Emergency Response Team in the Ambulatory Setting
Editor’s Note: Following are abstracts from sessions presented at the American Radiological Nurses Association Annual Educational Meeting held March 31-April 5, 2005, in New Orleans, LA. Design and Implementation of an Emergency Response Team in the Ambulatory Setting David J. Zimmer, RN, PHRN UPMC Presbyterian Shadyside Hillman Cancer Center, Pittsburgh, PA Abstract The advances in care delivery in the ambulatory setting have created the need for emergency interventions prior to the arrival of any organized medical responders such as local EMS providers. This session included the identification of the need for a response team and the process of securing administrative support for such a program. The development and implementation of the emergency response team were outlined, along with the necessary tools for a successful program. The regulatory aspects, both federal and local, that must be considered in the development of the response team were explored.
Contrast Media and Mechanical Power Injection Nancy Costa, BSN, RN, CRNI Methodist Hospital—Clarian Health Partner, Indianapolis, IN Over 10 million radiological exams requiring intravenous (IV) injection of contrast media are performed in the United States each year, and the number is growing. Iodinated contrast media are commonly used to assess venous patency, assist in vascular access, and determine access device position and function. The majority of these procedures are completed without incident; however, IV injection of contrast media is not without risk. Power injection of contrast may accelerate or amplify some adverse effects. The American College of Radiology has published standards and guidelines for intravenous injection of contrast media. Poiseuille’s law of laminar flow was addressed as an important concept in understanding the fluid mechanics involved in contrast media injection. The benefits and potential risks of mechanical power injectors were presented. Published studies of power injection through central venous access devices were summarized and discussed, including risks of ‘‘off label’’ use.
Development of a Breast MRI Service Larraine Chrystal, MS, ANP-C, FNP-C, Barbara Monson, BSN, RN Rutland Regional Medical Center, Rutland, VT Breast MRI has become a useful tool in the screening and early diagnosis of breast cancer. Nationally, breast MRI has been attempted in many institutions. Because of the timing of menses, surgical implications, oncology treatments, and insurance issues, many have not reached their potential in using this technological wonder. Controversy regarding technique, magnet size, and protocol is still occurring. Three years ago, a breast care program was started at Rutland Regional Medical Center (a nonteaching, 188-bed
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rural hospital). This program was developed by a team of multidisciplinary members led by a family nurse practitioner certified in breast health. The team included surgeons, radiologists, oncologists, gynecologists, nurses, technologists, primary care providers, and support staff. The breast care program provides comprehensive information and support resources for women with breast health issues. This specially trained healthcare team works directly with women and their care providers to answer questions regarding breast health screening, diagnosis, and treatment. The presenters reviewed strategies for development and implementation of a breast MRI service within diagnostic imaging. Resolutions to perceived and real barriers were discussed. Development of a coordinated team and financial implications were displayed. Criteria used and protocols established that have proved successful were outlined. Assuring good utilization and strong relationships with insurance carriers is one of the many reasons for the success of this program. Breast MRI is not for everyone. It is not suitable for routine screening and does not take the place of traditional mammography. There are clinical guidelines that are used to determine whether a patient will benefit from breast MRI. The diagnostic nurse screens each potential patient prior to scheduling a breast MRI to ensure that clinical guidelines are met and that the patient is receiving the right service. Patient education and assistance in MRI biopsies is another role for this nurse. We created a patient data database that ensures appropriate follow-up. This database also serves as a mechanism to participate in MRI research. (A team member has recently published a report in the International Archives of Surgery on the subject of breast MRI.) We are also participating with Blue Cross Blue Shield in a 3-year study allowing women who fit the criteria but who otherwise would have been denied to have their breast MRI covered by insurance. The presenters believe this new developing technology should be for every woman. Those at Rutland Regional Medical Center’s Breast Care Program believe they are taking the steps to make this happen. The center has moved from a nonservice to a well-developed program, offering breast MRI throughout Vermont and the neighboring states of New Hampshire, New York, and Massachusetts.
The Development of a Successful PICC Program Ann Earhart, MSN, CRNI Banner Desert Medical Center, Mesa, AZ Obtaining vascular access for patients to receive treatment to expedite discharge is becoming a major issue in health care. Length of stay for patients is down to 3.1 days, making the order for peripheral/central access a challenge for the nursing staff of the hospitals. This issue has become a major concern for the interventional radiology department. As nursing units
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Contrast Media and Mechanical Power Injection Nancy Costa, BSN, RN, CRNI Methodist Hospital—Clarian Health Partner, Indianapolis, IN Over 10 million radiological exams requiring intravenous (IV) injection of contrast media are performed in the United States each year, and the number is growing. Iodinated contrast media are commonly used to assess venous patency, assist in vascular access, and determine access device position and function. The majority of these procedures are completed without incident; however, IV injection of contrast media is not without risk. Power injection of contrast may accelerate or amplify some adverse effects. The American College of Radiology has published standards and guidelines for intravenous injection of contrast media. Poiseuille’s law of laminar flow was addressed as an important concept in understanding the fluid mechanics involved in contrast media injection. The benefits and potential risks of mechanical power injectors were presented. Published studies of power injection through central venous access devices were summarized and discussed, including risks of ‘‘off label’’ use.
Development of a Breast MRI Service Larraine Chrystal, MS, ANP-C, FNP-C, Barbara Monson, BSN, RN Rutland Regional Medical Center, Rutland, VT Breast MRI has become a useful tool in the screening and early diagnosis of breast cancer. Nationally, breast MRI has been attempted in many institutions. Because of the timing of menses, surgical implications, oncology treatments, and insurance issues, many have not reached their potential in using this technological wonder. Controversy regarding technique, magnet size, and protocol is still occurring. Three years ago, a breast care program was started at Rutland Regional Medical Center (a nonteaching, 188-bed
VOLUME 24 ISSUE 2
rural hospital). This program was developed by a team of multidisciplinary members led by a family nurse practitioner certified in breast health. The team included surgeons, radiologists, oncologists, gynecologists, nurses, technologists, primary care providers, and support staff. The breast care program provides comprehensive information and support resources for women with breast health issues. This specially trained healthcare team works directly with women and their care providers to answer questions regarding breast health screening, diagnosis, and treatment. The presenters reviewed strategies for development and implementation of a breast MRI service within diagnostic imaging. Resolutions to perceived and real barriers were discussed. Development of a coordinated team and financial implications were displayed. Criteria used and protocols established that have proved successful were outlined. Assuring good utilization and strong relationships with insurance carriers is one of the many reasons for the success of this program. Breast MRI is not for everyone. It is not suitable for routine screening and does not take the place of traditional mammography. There are clinical guidelines that are used to determine whether a patient will benefit from breast MRI. The diagnostic nurse screens each potential patient prior to scheduling a breast MRI to ensure that clinical guidelines are met and that the patient is receiving the right service. Patient education and assistance in MRI biopsies is another role for this nurse. We created a patient data database that ensures appropriate follow-up. This database also serves as a mechanism to participate in MRI research. (A team member has recently published a report in the International Archives of Surgery on the subject of breast MRI.) We are also participating with Blue Cross Blue Shield in a 3-year study allowing women who fit the criteria but who otherwise would have been denied to have their breast MRI covered by insurance. The presenters believe this new developing technology should be for every woman. Those at Rutland Regional Medical Center’s Breast Care Program believe they are taking the steps to make this happen. The center has moved from a nonservice to a well-developed program, offering breast MRI throughout Vermont and the neighboring states of New Hampshire, New York, and Massachusetts.
The Development of a Successful PICC Program Ann Earhart, MSN, CRNI Banner Desert Medical Center, Mesa, AZ Obtaining vascular access for patients to receive treatment to expedite discharge is becoming a major issue in health care. Length of stay for patients is down to 3.1 days, making the order for peripheral/central access a challenge for the nursing staff of the hospitals. This issue has become a major concern for the interventional radiology department. As nursing units
www.radiologynursing.org
33