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Every time you come for radiotherapy, even on the last day and even when the staff know you well, they will ask you to say your full name, date of birth and often your address, rather than asking you to confirm them. They also check that the plan on the machine is yours and that the right side is being treated. This is one of the most important safety checks in radiotherapy.
In the UK the check is a legal requirement: IR(ME)R 2017 Schedule 2 requires the employer's written procedures to include procedures to identify correctly the individual to be exposed. Towards Safer Radiotherapy (RCR, SCoR, IPEM, NPSA, BIR, 2008) sets the method: open questions that elicit an active response (full name, date of birth, address), never closed yes/no questions; formal identification for every procedure even when the patient is well known, because mistakes are more likely later in treatment than at the beginning; a specified procedure for patients who cannot identify themselves; and confirmation of the correct side at set-up for each fraction. It recommends exploring technology such as bar codes, photographs in the record and verify system and biometrics. The WHO Radiotherapy Risk Profile (2008) rates incorrect patient identification as a high-impact risk at every stage and lists open questions with an active response, a minimum of three points of identification, photo identification and a unique identifier as solutions.
The time-out is less settled. AAPM TG-100 (2016) includes two forms of identification and a time-out in its example day-1 checklist, notes that the Joint Commission requires a time-out for procedures, and says there is no specific guidance requiring one at every treatment session, though it is a good idea; at day 1, it suggests the radiation oncologist take part. ASTRO's Safety is No Accident (2019) could not be read.
Why: In the UK this is the law, and a written procedure means every member of staff does the check the same way.
“to identify correctly the individual to be exposed to ionising radiation;”
UK Government (SI 2017/1322) 2017 · Statutory requirement (IR(ME)R 2017, Schedule 2, 1(a))
Why: A person who is nervous, hard of hearing or expecting to be called can easily say yes to someone else's name; saying their own details out loud avoids that.
“It is vital that identification verification is performed by asking open questions, which elicit a positive response from the patient (see Table 5.1).”
The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 · Recommendation (consensus of RCR, SCoR, IPEM, NPSA and BIR)
Why: Checking several details against the record, not just the name, catches two patients with similar names and records opened in error.
“ID check open questions, eliciting an active response”
World Health Organization 2008 · Listed solution to a high-impact risk
Why: Familiarity makes people skip the check, and errors are more likely later in a course than at the start.
“Formal identification must be carried out for all procedures even when the patient is well known.”
The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 · Recommendation (consensus)
Why: Treating the wrong side is one of the errors a patient can help prevent.
“Treatment of the correct side should also be confirmed at the set-up for each fraction during a course of treatment.”
The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 · Recommendation (consensus)
Why: A short shared check before the first fraction catches the wrong plan or an unsigned change before any dose is given.
“Patient and treatment plan to be used are identified correctly using two forms of identification check and time-out procedure”
American Association of Physicists in Medicine (Medical Physics; Huq et al.) 2016 · Example checklist item (TG-100 is a method, not a standard)
Why: The same errors can happen on any day; no standard read requires it, but the AAPM report calls it a good idea.
“Although there is no specific guidance that a time out should be required for each treatment session, it is a good idea.”
American Association of Physicists in Medicine (Medical Physics; Huq et al.) 2016 · Suggestion in a task group report
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
Positive identification by open questions eliciting an active response (name, date of birth, address) against the record on the machine, at every attendance including when the patient is well known, with a written alternative for patients who cannot identify themselves, and confirmation of the treated side at each fraction (Towards Safer Radiotherapy 2008; a legal requirement in the UK under IR(ME)R 2017; WHO 2008 adds a minimum of three identifiers, photo identification and a unique identifier). A time-out before the first fraction is in the AAPM TG-100 example checklist; whether one is needed at every fraction is not settled by any source read, TG-100 calling it a good idea without a requirement. The sources do not disagree; they differ in how much they specify.
The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 · UK Government (SI 2017/1322) 2017 · World Health Organization 2008 · American Association of Physicists in Medicine (Medical Physics; Huq et al.) 2016
Where it differs: A fingerprint, bar-coded wristband or card calls up the patient's record and confirms the match at the room door.
Evidence: Towards Safer Radiotherapy describes one department using fingerprint identification at the department entrance and the room entrance, and bar-coded wristbands in two UK departments, and recommends that such technology be explored; it notes that these systems compel the identification step. No comparative study was read.
Where it differs: The set-up screen shows a photograph of the patient taken at planning, checked against the person on the couch.
Evidence: Named by Towards Safer Radiotherapy as a feature of some record and verify systems and by WHO 2008 as a solution (photo ID); no study of its effect was read.
The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 · World Health Organization 2008
Where it differs: The doctor joins the radiographers at the machine for the first treatment to confirm the plan matches their intent.
Evidence: Suggested by AAPM TG-100 as a guard against deviations from physician intent; not required by any source read.
American Association of Physicists in Medicine (Medical Physics; Huq et al.) 2016
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Correct patient identification at every step, with procedures eliciting an active response; explore new technology “Correct patient identification is essential at every step. Procedures eliciting an active response from the patient must be used. The use of new technology to assist patient identification should be explored.” | Recommendation (consensus) | The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 |
| Errors are more likely later in treatment than at the beginning “Mistakes are more likely later in treatment than at the beginning.” | Observation from UK incident data | The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 |
| The employer must specify the steps for patients who cannot identify themselves “Patients who cannot identify themselves pose particular problems and the employer must specify the steps to be taken in these circumstances.” | Recommendation (consensus) | The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency and British Institute of Radiology 2008 |
| Written procedures to identify correctly the individual to be exposed | Statutory requirement | UK Government (SI 2017/1322) 2017 |
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