February 19, 2008 - The Joint Commission issued a Sentinel Event Alert, encouraging hospitals and ambulatory care centers to focus on preventing accidents and injuries that can occur during MRI scans.

The alert stated the Food and Drug Administration (FDA) has received nearly 400 reports of MRI-related accidents over the past decade. Over 70 percent of accidents were burns, while 10 percent of injuries occurred when metal objects such as ink pens, cleaning equipment and oxygen canisters have become harmful when pulled into the magnetic field of the scanner.

To reduce the risk for MRI injuries to patients, The Sentinel Event Alert newsletter recommends that healthcare organizations:

-- Restrict access to all MRI sites by creating safe zones recommended by the American College of Radiology (ACR);

-- Use trained screeners to perform double checks of patients for items such as metal objects, implanted or other devices, drug delivery patches and tattoos;

-- Ensure that the MRI technologist has the patient's complete and accurate medical history to ensure that the patient can be safely scanned;

-- Have a specially trained staff person accompany any patients, visitors and staff into the MRI suite at all times;

-- Annually educate all medical and ancillary staff who may accompany patients into the MRI suite about the risk of accidents;

-- Take precautions to prevent patient burns during scanning;

-- Only use fire extinguishers, oxygen tanks and other equipment that have been tested and approved for use during MRI scans (equipment that will not be attracted to the magnet);

-- Manage critically ill patients who require monitoring and life-sustaining drugs to assure that their care needs are continuously met while in the MRI suite;

-- Provide all MRI patients with ear plugs to diminish the loud "knocking" noise emanating from the equipment; and

--Never run a cardio-pulmonary arrest code or resuscitate a patient in the MRI room.

For more information: http://www.jointcommission.org


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