Bushur Katherine

Final Pr. ID: Poster #: EDU-005 (T)

In 2016, we focused on MRI safety and the inherent cultural barriers to reduce the risk of undetected or misplaced metal objects causing MRI accidents. We successfully addressed this opportunity using a coordinated approach with Patient Safety, Performance Improvement and Radiology Leadership to provide a multi-faceted solution.
Despite implementation of ferromagnetic detection systems (FMDS) technology, numerous gaps in screening effectiveness were identified. Three primary improvement objectives were established involving place, people and process leading to 42 new practice changes that were implemented, and 68 existing process improvements instituted. Alarm fatigue was one among many identified risks. Variables included the physical location of the projectile on the transport person, as well as the horizontal or vertical orientation of potential hazard while being carried were identified during a series of nine standardized PDSA testing sessions that were completed in the clinical setting. Read More

Authors:  Bushur Katherine

Keywords:  MRI Safety, Ferromagnetic detection, projectile hazards