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Taisa Polishchuk
DOS 516 Radiation Safety in Radiation Oncology
October 20, 2014

Patient Safety in Radiation Oncology Department

In recent years, there have been significant developments in radiation therapy treatments.
Modern radiation therapy is becoming complex and more efficient due to the advancement in
technological equipment and diagnostic radiology.
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Despite a computer-controlled technological
advancement, Hendee and Herman
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indicated that according to the Committee on Quality of
Health care in America between 44 000 and 98 000 patients died in the United States in 1997 as
a consequence of medical errors. Such events captured and continue to capture publics
attention. It is important to assure public in their safety, and therefore crucial to recognize and
implement factors that can facilitate safety in the radiation oncology departments.
There is a list of recommendations that was provided at an international meeting Safety
in Radiation Therapy a Call to Action, sponsored by the American Association of Physicists
in Medicine (AAPM) and the American Society of Radiation Oncology (ASTRO). This meeting
was held in June 2010 and was attended by professional organizations, as well as public interest
groups in order to discuss improvement in the safety of patients undergoing radiation therapy.
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Hendee and Herman listed the twenty recommendations provided at the international meeting
and discussed main concepts of each of the recommendations. The authors stated the importance
of simplifying the control over treatment devices despite its increase in the complexity. In order
to achieve this recommendation, Hendee and Herman suggested organizing the workstations in a
clutter-free and a distraction free environment. The monitor screens and keyboards used for daily
treatments should be limited to a number that will help therapists work efficiently. Therapists
should not be interrupted with noise and non-related to work conversations while treating
patients. The authors mentioned the importance in following warning systems and not overriding
the treatment unless the problem has been corrected. Multitasking should be limited while the
therapist is focused on the patient treatment. This involves not handling billing forms while
patients are being treated. Any member of the oncology team should have the right to question
procedure and ask for clarification of a certain aspect of a treatment.
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Some other recommendations included utilizing checklists of quality control and
treatment delivery, developing error reporting system in the department, treating patient safety as
a competency, performing periodical audits, establishing nationally recognized consistent team
qualifications, and developing written standard policies and procedures in radiation oncology.
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Hendee and Herman discussed the highlights of improving patients safety through three main
areas. The first area highlighted the importance of safety being emphasized and supported by the
institutions board of directors and management. The second point to improve safety was closely
connected to making sure patients safety is everyones responsibility. And the last area
emphasized the importance of the collaboration of everyone in the department and working as a
team to increase safety of patients.
Marks et al discussed the correlation between the safety and the efficiency of the
department.
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The authors stated that staff frustration and being rushed during work are outcomes
of an inefficient system utilized by the radiation oncology team. Efficiency is essential in
providing a good quality of service, and will help normalize the workflow of the medical staff.
By demonstrating the efficient work at the department patients can feel secure about their safety
and build the trust towards the oncology team. Increasing efficiency and therefore increasing
patients safety could also be achieved through improving workspaces of the radiation therapy
team. Reducing noise, interruptions and visual clutter, in addition to improving lighting,
temperature and desk height are just some of the steps the department can take to positively
affect treatment delivery performance.
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Another aspect of perfecting patients safety lies in communication between all team
members.
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Marks et al emphasized the significance in creating such a system by using well-
defined communication pathway between workers in order to properly deliver and receive
information about every patients treatment. Many departments create daily morning meetings to
review the clinical activities for the day, in addition to discussing some of the events that might
cause daily challenges. Such meetings bring the department closer together and emphasize the
importance of working as a team. The authors suggested publicly acknowledging and celebrating
achievements of staff in reporting the outcomes of safety rounds. Demonstrating the leaderships
commitment to improvement can create an environment where patients and staff will be willing
to speak openly about safety concerns.
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Eatmon provided a list of mitigating factors that could reduce the risk of error occurrence
in the department, and ensure patients safety.
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Some of those factors included reading the
patients chart prior to treatment delivery, performing time-outs to answer any questions
therapists might have about the treatment, utilizing barcodes to match a patient with the correct
beam modifiers and accessories, and conducting redundancy of checks.
The nature of radiation oncology is rapidly evolving and moving forward, and with its
evolvement comes the need for the advances in patients safety.
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Communicating with the patient
prior and during his treatment, and answering all of his questions can help him feel confident in
the hospital staff and trust the team with the treatment process. Explaining some of the steps of
the treatment and talking about certain quality assurance checks performed by the department
can help the patient see that his safety is the priority for the radiation oncology team. By utilizing
the above listed factors, radiation oncology department will increase its involvement in reducing
errors and reassure patients in their safety.
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References
1. Marks LB, Pavord D, Burns RA, et al. Safety is no accident. ASTRO web site.
https://www.astro.org/uploadedFiles/Main_Site/Clinical_Practice/Patient_Safety/Blue_Book/Saf
etyisnoAccident.pdf. 2012. Accessed October 19, 2014.
2. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Medical Physics.
2011; 38(1): 78-82.
3. Eatmon S. Error prevention in radiation therapy. Radiation Therapist. 2012; 21(1): 59-74.