Jesse Speedy
DOS 516 Fund. of Rad. Safety
October 25, 2016
Patient Reassurance and Radiation Safety
The topic of safety in radiation therapy can be a cause for concern among patients and their families. Patients may realize the great importance of safety in radiation therapy if they are educated on studies and academic discussions relating to this topic. A study done at the largest cancer treatment center in Toronto Canada examined error rates over the course of several years and has presented optimistic findings for those concerned about the safety.(1) In addition, the International Journal of Medical Physics Research and Practice (2) shared the results of a meeting in which 400 professionals in the field of radiation therapy met and released 20 recommendations to increase patient safety. Understanding and education is the key to making patients feel comfortable with radiation therapy. By examining clinical studies on the topic of radiation safety it may be possible to educate patients and thus alleviate some concerns about the safety of radiation treatment.(1,2)
Medical procedures can be scary and intimidating for patients. One of a patient’s greatest fears may be the occurrence of a medical error. Examination of medical error rates can educate patients and help to reduce some of their fears. A study done at the Princess Margaret Hospital, the largest Cancer treatment facility in Canada, examined error rates from 1997 to 2002.(1) The study identified trends in treatment errors and identified solutions to reduce error rates. The definition of errors in this study were cited as “unintended deviation from the prescribed treatment.” Over the course of this study 555 treatment errors were identified among 28,136 treatments showing an error rate of 1.97% per patient. When looking at treatment volumes, of the 43,302 volumes treated the error rate per volume was 1.28%. One of the most comforting findings of the study states, “The clinical severity scores for the 555 errors, as graded by the radiation oncologist, were as follows: none, 44.1%; minor, 50.3%; moderate, 5.2%; and severe, 0.4%. Overall, 94.4% of the errors were judged to be of little or no clinical significance.” At one point in the ongoing study a trend was noticed in increased error rates for head and neck cancers. An analysis determined causes for the increased error rates were related to the varying methods in head and neck treatments. The differences in head and neck treatments were due to simulation method, patient transfer to different treatment machines in the event their primary treatment machine required service, therapist staff changing between machines, and differing charting techniques such as paper or electronic charting. The analysis resulted in several proposed solutions which standardized patient treatments from simulation. Patient simulations were standardized using one CT simulator and standard immobilization devices. Patient treatment machines were paired so that in the event of a transfer the patient would travel to an identical machine. Charting techniques were standardized using electronic charting. The adoption of new standardized head and neck treatments resulted in a 6.7% drop in errors. The observed reduction in treatment errors shows that careful analysis of department procedures can increase patient safety. One of the most positive findings of this study suggests that severe medical treatment errors are an uncommon occurrence. Errors in radiation therapy will always be a possibility due to human nature. By examining the data of error rates and how to reduce errors patients may be able to gain some confidence that radiation therapy is a safe process with minimal risks to health.(1)
It is important for patients to realize that their safety is of utmost concern to radiation therapy staff. A review of the Januaury 2010 conference entitled “Safey in Radiation Therapy: A Call to Action”2 will educate patients on the importance placed on safety in radiation therapy. The International Journal of Medical Physics Research and Practice (2) explained the importance of this conference and the twenty recommendations presented to make radiation therapy safer for patients. This 2010 conference included 400 professionals from 14 different organizations involved in the radiation oncology industry. At the American Association of Physicists in Medicine (AAPM) and American Society for Radiation Oncology (ASTRO) sponsored meeting physicians, therapists, nurses, physicists, and product manufacturers discussed common treatment errors, their causes, and proposed solutions to reduce the frequency of errors. Potentials for error were identified at all steps of the treatment process and it was determined that a multidisciplinary approach was the best method to reduce treatment errors. Areas of concern were addressed such as cluttered work areas, outside distractions, lack of empowerment to question superiors, lack of policies and procedures to handle adverse events, and inadequate education training on new products. These issues reveal that problems can occur at every level ranging from the therapist who directly interacts with the patient, to treatment planning, to equipment manufacturer issues, to department management. The conference concluded with the issuance of twenty recommendations covering areas for improvement among all staff and modalities related to radiation therapy. Examples of the recommendations presented were listed as the following: “18) safety champions should be present,” “14) audits should be performed,” “11) a covenant and commitment to safety should be expected of the treatment team.” Some of these recommendations are already common practice but may not yet be a nationwide standard. For example, recommendation thirteen states “checklists should be employed,” many sites employ checklists at several levels of staffing from physician to therapist. These checklists must be completed by each team member before a new treatment plan is allowed to be administered. Another example states “12) any member of the treatment team can declare a time out,” this is another common practice among patient treatments. A mandatory time out is often required on a daily basis prior to beginning a treatment to identify the patient, treatment area, and treatment parameters. Patient safety is a topic that is constantly researched, updated, and improved upon. This conference is evidence that safety is a responsibility every member of the radiation therapy industry. Patients and their families can be assured that safety is the top priority in radiation therapy.(2)
Education is the key to ensure patients and their families that radiation therapy is safe. Concerned individuals may realize the effort put into making treatment safe for patients by observing studies and scholarly discussions on the topic of safety in radiation therapy. The large scale study done at Princess Margaret hospital examined error rates and produced some optimistic findings. This study found that although medical errors cannot be completely eliminated they can be reduced through analysis and resulting policy changes.(1) The Princess Margaret study also found that severe medical errors are rare and that most errors that occur are of little clinical significance to the patient. The review published in The International Journal of Medical Physics Research and Practice showed the commitment of the radiation therapy industry to increase patient safety.(2) The cited meeting of 400 professionals examined every portion of radiation therapy and concluded with the establishment of twenty concise recommendations that could be enacted to make radiation therapy safer for patients. It may be reassuring to patients that many of these recommendations are already commonly adopted nationwide. It is natural for patients to fear processes that are unfamiliar to them. Patients and their families may find they have less to fear concerning radiation therapy through education and familiarization with studies related to patient safety.(1,2)
References:
DOS 516 Fund. of Rad. Safety
October 25, 2016
Patient Reassurance and Radiation Safety
The topic of safety in radiation therapy can be a cause for concern among patients and their families. Patients may realize the great importance of safety in radiation therapy if they are educated on studies and academic discussions relating to this topic. A study done at the largest cancer treatment center in Toronto Canada examined error rates over the course of several years and has presented optimistic findings for those concerned about the safety.(1) In addition, the International Journal of Medical Physics Research and Practice (2) shared the results of a meeting in which 400 professionals in the field of radiation therapy met and released 20 recommendations to increase patient safety. Understanding and education is the key to making patients feel comfortable with radiation therapy. By examining clinical studies on the topic of radiation safety it may be possible to educate patients and thus alleviate some concerns about the safety of radiation treatment.(1,2)
Medical procedures can be scary and intimidating for patients. One of a patient’s greatest fears may be the occurrence of a medical error. Examination of medical error rates can educate patients and help to reduce some of their fears. A study done at the Princess Margaret Hospital, the largest Cancer treatment facility in Canada, examined error rates from 1997 to 2002.(1) The study identified trends in treatment errors and identified solutions to reduce error rates. The definition of errors in this study were cited as “unintended deviation from the prescribed treatment.” Over the course of this study 555 treatment errors were identified among 28,136 treatments showing an error rate of 1.97% per patient. When looking at treatment volumes, of the 43,302 volumes treated the error rate per volume was 1.28%. One of the most comforting findings of the study states, “The clinical severity scores for the 555 errors, as graded by the radiation oncologist, were as follows: none, 44.1%; minor, 50.3%; moderate, 5.2%; and severe, 0.4%. Overall, 94.4% of the errors were judged to be of little or no clinical significance.” At one point in the ongoing study a trend was noticed in increased error rates for head and neck cancers. An analysis determined causes for the increased error rates were related to the varying methods in head and neck treatments. The differences in head and neck treatments were due to simulation method, patient transfer to different treatment machines in the event their primary treatment machine required service, therapist staff changing between machines, and differing charting techniques such as paper or electronic charting. The analysis resulted in several proposed solutions which standardized patient treatments from simulation. Patient simulations were standardized using one CT simulator and standard immobilization devices. Patient treatment machines were paired so that in the event of a transfer the patient would travel to an identical machine. Charting techniques were standardized using electronic charting. The adoption of new standardized head and neck treatments resulted in a 6.7% drop in errors. The observed reduction in treatment errors shows that careful analysis of department procedures can increase patient safety. One of the most positive findings of this study suggests that severe medical treatment errors are an uncommon occurrence. Errors in radiation therapy will always be a possibility due to human nature. By examining the data of error rates and how to reduce errors patients may be able to gain some confidence that radiation therapy is a safe process with minimal risks to health.(1)
It is important for patients to realize that their safety is of utmost concern to radiation therapy staff. A review of the Januaury 2010 conference entitled “Safey in Radiation Therapy: A Call to Action”2 will educate patients on the importance placed on safety in radiation therapy. The International Journal of Medical Physics Research and Practice (2) explained the importance of this conference and the twenty recommendations presented to make radiation therapy safer for patients. This 2010 conference included 400 professionals from 14 different organizations involved in the radiation oncology industry. At the American Association of Physicists in Medicine (AAPM) and American Society for Radiation Oncology (ASTRO) sponsored meeting physicians, therapists, nurses, physicists, and product manufacturers discussed common treatment errors, their causes, and proposed solutions to reduce the frequency of errors. Potentials for error were identified at all steps of the treatment process and it was determined that a multidisciplinary approach was the best method to reduce treatment errors. Areas of concern were addressed such as cluttered work areas, outside distractions, lack of empowerment to question superiors, lack of policies and procedures to handle adverse events, and inadequate education training on new products. These issues reveal that problems can occur at every level ranging from the therapist who directly interacts with the patient, to treatment planning, to equipment manufacturer issues, to department management. The conference concluded with the issuance of twenty recommendations covering areas for improvement among all staff and modalities related to radiation therapy. Examples of the recommendations presented were listed as the following: “18) safety champions should be present,” “14) audits should be performed,” “11) a covenant and commitment to safety should be expected of the treatment team.” Some of these recommendations are already common practice but may not yet be a nationwide standard. For example, recommendation thirteen states “checklists should be employed,” many sites employ checklists at several levels of staffing from physician to therapist. These checklists must be completed by each team member before a new treatment plan is allowed to be administered. Another example states “12) any member of the treatment team can declare a time out,” this is another common practice among patient treatments. A mandatory time out is often required on a daily basis prior to beginning a treatment to identify the patient, treatment area, and treatment parameters. Patient safety is a topic that is constantly researched, updated, and improved upon. This conference is evidence that safety is a responsibility every member of the radiation therapy industry. Patients and their families can be assured that safety is the top priority in radiation therapy.(2)
Education is the key to ensure patients and their families that radiation therapy is safe. Concerned individuals may realize the effort put into making treatment safe for patients by observing studies and scholarly discussions on the topic of safety in radiation therapy. The large scale study done at Princess Margaret hospital examined error rates and produced some optimistic findings. This study found that although medical errors cannot be completely eliminated they can be reduced through analysis and resulting policy changes.(1) The Princess Margaret study also found that severe medical errors are rare and that most errors that occur are of little clinical significance to the patient. The review published in The International Journal of Medical Physics Research and Practice showed the commitment of the radiation therapy industry to increase patient safety.(2) The cited meeting of 400 professionals examined every portion of radiation therapy and concluded with the establishment of twenty concise recommendations that could be enacted to make radiation therapy safer for patients. It may be reassuring to patients that many of these recommendations are already commonly adopted nationwide. It is natural for patients to fear processes that are unfamiliar to them. Patients and their families may find they have less to fear concerning radiation therapy through education and familiarization with studies related to patient safety.(1,2)
References:
- Huang G, Medlam G, Lee J et al. Error in the delivery of radiation therapy: Results of a quality assurance review. Int J Radiat Oncol Biol Phys. 2005;61(5):1590-1595. http://libweb.uwlax.edu:2093/science/article/pii/S036030160402807X?np=y. Accessed on October 23, 2016.
- Hendee W, Herman M. Improving patient safety in radiation oncology. Int J Med Phys Res Pract. 2011;38(1):78-85. http://scitation.aip.org/content/aapm/journal/medphys/38/1/10.1118/1.3522875. Accessed on October 24, 2016.