Inpatient Radioactive Iodine -131 Therapy Clinical …€¦ · Web viewThe NM Medical Physicists will return 20 minutes after administration, to conduct the first radiation survey

CHHS17/019

Canberra Hospital and Health ServicesClinical Procedure Inpatient Radioactive Iodine-131 Therapy: Care and Discharge Contents

Contents...................................................................................................................................1

Purpose.................................................................................................................................... 2

Scope........................................................................................................................................2

Section 1 - Procedure...............................................................................................................2

1. Room Preparation.........................................................................................................2

2. Administration...............................................................................................................2

3. Isolation.........................................................................................................................3

4. Visitors...........................................................................................................................3

5. Nursing Care..................................................................................................................3

6. Emergency Medical Care...............................................................................................4

7. Discharge.......................................................................................................................4

Discharge to another facility..........................................................................................5

8. Incidents........................................................................................................................5

Bodily Fluids / Radioactive Spills....................................................................................5

Section 2 - Contact Details....................................................................................................... 6

Implementation........................................................................................................................6

Related Policies, Procedures, Guidelines and Legislation.........................................................6

References................................................................................................................................7

Definitions, Acronyms & Abbreviations....................................................................................8

Search Terms............................................................................................................................8

Doc Number Version Issued Review Date Area Responsible PageCHHS17/019 1 21/02/2017 01/02/2022 DDG Clinical –

Medical Imaging1 of 8

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/019

Purpose

The purpose of this procedure is to outline the process to be followed when providing care to a patient admitted to the Canberra Hospital and Health Services (CHHS) for radioactive Iodine-131 therapy.

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Scope This document applies to all Administration Officers, Medical Officers, Medical Physicists, Medical Physics Registrars, Nuclear Medicine Scientists (NMS), Nuclear Medicine Science Students, Nurses and Student Nurses under direct supervision, who are involved in the care of patients requiring an admission for the duration of Radioactive Iodine-131 therapy (all patients receiving more than 600MBq [15mCi] of Radioactive Iodine-131).


Section 1 - Procedure

1. Room Preparationi. The patient will present to Ward 14B by 9am on Friday. The nursing staff and

Endocrinology registrar will follow routine admission procedures to admit the patient to room 1 or 2 only1 (the ‘therapy room’). The room will need to be supplied with the following: At least 4 red-lined garbage bins Ample 600ml water bottles Sufficient linen for 3-4 days Small, medium and large gloves

ii. Excess furniture should be removed from the therapy room. Only a bed, chair, phone and over-bed trolley are required.

iii. Radiation signage 2 must be displayed in the door display frame at all times.

2. Administration i. Nursing staff will notify the NMS by phone (ext 44 345) once admission is complete.

The NMS will liaise directly with the Team Leader in 14B if there are any delays in this process.

ii. The NMS will liaise with the NM Specialist and NM Medical Physicist, ensure the radioactive Iodine-131 dose has been checked by at least two members of the NM Team and is ready for administration3 and the required pathology (including β-HCG) results are available.

iii. The Nuclear Medicine team (NM Specialist, NMS and NM Medical Physicist) will attend the ward when the admission is complete. The team will meet with the patient in the therapy room.




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iv. The Nuclear Medicine Specialist will explain the Radioactive Iodine-131 therapy to the patient, including any risks and side effects4. The Nuclear Medicine team will answer any questions that the patient may have and ask the patient to sign a ‘Consent to Treatment’ form accessible from the Clinical Forms Register prior to swallowing the capsule/s.

v. The patient swallows the capsule with a drink of water and remains fasting for a further two (2) hours5.

vi. The NMS will complete the Administration Checklist, scan to RIS (Radiology Information System) and place the Checklist in the patient chart.

vii. Radiation warning signage will be placed on the door of the patient’s room immediately prior to administration, and must remain in place for the duration of admission.

viii. The NM Medical Physicists will return 20 minutes after administration, to conduct the first radiation survey. The patient should not void their bladder prior to this survey. Survey results are recorded in the ‘Internal Radionuclide Therapy Treatment Sheet’, accessible from the Clinical Forms Register.

3. Isolation i. The patient remains in the therapy room for the duration of the weekend.ii. Radiation Signage must remain in place on the door at all times.i. It is important to keep ‘close contact’ to a minimum 6 after the therapy dose has

been administered. No one – staff, family or other patients – should spend more than 15 minutes per day within 1 metre of the patient. A distance of more than 2 metres should be maintained whenever possible. Where possible, consultation with the NM Specialist, RSO or NM Medical Physicist (all via switch) should occur prior to visitors attending the treatment room.

4. Visitors i. Visitors should be discouraged. However, they may be allowed for brief periods7. The

maximum period of time for any visitor is 15 minutes per day, and they should stay more than 2 metres from the patient. A brief period of close contact is allowed, for example a hug.

ii. Pregnant women and children under the age of 10 are not permitted to visit.

5. Nursing Care i. Essential nursing procedures should still be done, as quickly as practical8. Gloves

should be worn for any patient contact, or contact with isolation room surfaces. ii. Communication should be via the room phone where possible / practical. Time spent

in the room with the patient should be minimised as far as possible. Radiation monitoring equipment provided near the door to the therapy room should be used.

iii. Medications- Patients are discouraged from bringing and taking their own medications, as per CHHS Medication Management Policy available from the Policy Register. Regular medications should be recorded in the patient’s medication chart and provided by CHHS.




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iv. Meals 9 are provided on disposable cups, plates and cutlery, which are not to leave the room without a radiation contamination survey being completed by Medical Physics. If necessary, patients may bring their own meals, which are to be stored in the general access fridge (NOT in the patient’s room fridge) for reheating and delivery by the nursing staff. Food which is stored in the patient’s room after the time of therapy dose administration cannot be removed from the room without a radiation contamination survey being completed by Medical Physics.

6. Emergency Medical Care “In life-threatening situations, the patient’s medical management will always take precedence over radiation safety considerations” (see clause 4.5, Safety Guide) i. During an emergency medical situation, only essential staff should be involved. All

other staff should remain more than 2 metres away from the patient. 10 ii. If possible and practical, staff should not spend more than 15 minutes within 1 metre

of the patient. If other staff are available to take over, this may be a feasible option. iii. Gloves and gowns should be worn, and staff should be aware that the patient’s

bodily fluids are potential radioactive contaminants. iv. If an emergency situation arises, or the medical condition of the patient deteriorates,

the Nuclear Medicine Specialist and Radiation Safety Officer must be contacted (via the switchboard) as soon as possible.

v. Non-urgent investigations or interventions should be postponed wherever possible, until the Medical Physics team has cleared the patient for discharge.

7. Discharge i. A Medical Physicist will return to Ward 14B on Monday morning to measure and

document the amount of radiation being emitted from the patient. If it is below the legal limits (36uSv/hr at 1m, equivalent to 600MBq) the patient may be discharged home. The Medical Physicist will complete the ‘Internal Radionuclide Therapy Treatment Sheet’ 11.

ii. The Medical Physicist will fax the form to Nuclear Medicine to be scanned into RIS, then file the form in the patient chart.

iii. The Medical Physicist will inform the nursing staff when the patient is ready to be discharged, ensure the patient has a copy of the Radiation Precautions (sent with the Patient Information Letter), and provide the patient with a ‘Radioactive Iodine-131 Discharge Information’ card 12.

iv. Normal discharge procedures can be followed at this time by the nursing staff and endocrinology team.

v. The NMS will visit or contact the patient by phone to confirm the follow-up scan date and time (if required).

vi. After the patient has been discharged, the NM Medical Physicist will return to monitor the room for radioactive contamination prior to cleaning 13. Once the room is considered safe to clean, the Medical Physicist will remove the radiation warning signage, replace it with a notice for the cleaning staff, and inform the nursing staff that the room is available for general use.




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vii. The ‘Early Discharge of a Radioactive Iodine-131 Patient’ procedure available from the Policy Register outlines the procedure to be followed if the patient wishes to be discharged early, against medical advice 14.

Discharge to another facilityIf the patient is being transferred to another care institution, details of the patient’s radioactive status must accompany them, and must include the following details 15: Date, time and activity of radioactive Iodine-131 administration Nursing precautions to be followed when caring for the patient Contact details for the hospital for further questions, specifying that the NM

Specialist (on duty or on call) should be contacted in the first instance, via the Canberra hospital switchboard. The NM Specialist may then refer the query to the RSO (on duty or on call), the NMS (on duty or on call), or to the NM Medical Physicist (during business hours, available through the RSO after hours), as necessary.

A copy of this procedure and the Discharge Information Card completed by Medical Physics would be sufficient to meet this requirement.

8. Incidentsi. Because the patient’s bodily fluids are all radioactive, any unexpected spill of bodily

fluids is a radioactive spill (see below). All spills from these patients are considered major spills, and require an incident report 16.

ii. ‘Early Discharge’ of a Radioactive Iodine-131 Patient’ and ‘Death of a Radioactive Iodine-131 Patient’ 17 Procedures will be available on the Policy Register.

iii. In all instances, the NM Specialist on call is available 24/7 through the switchboard as the first contact 18. The RSO (Radiation Safety Officer) must also be notified (through switch) in the event of an emergency.

Bodily Fluids / Radioactive SpillsPregnant or breastfeeding staff should not be involved in dealing with a major spill, due to the likelihood of increased exposure.

The following steps should be followed:i. Remove all unnecessary people from the area of the spillii. If anyone requires medical attention, attend to their needs, calling a MET call if

requirediii. Contact the NM Specialist on duty or on call and the RSO (both via switch) for

immediate assessment and advice, via the switchboard. They will provide initial advice and arrange to attend if necessary. They may also contact the NMS on duty or on call, and/or the NM Medical Physicist, as required.

iv. The NMS Manager, NM Specialist and the RSO must be notified of the incident.v. A RIskMan report should be completed.

If a surface, substance, or material is contaminated with more than 100 times the exemption level for that radioactive material, ARPANSA must be notified by the RSO.




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Refer to the Radiation Safety Manual – Nuclear Medicine on the Policy Register for further information.


Section 2 - Contact Details

Nuclear Medicine Specialist on duty ext 45 757Nuclear Medicine Specialist on call via switchRadiation Safety Officer (24hrs) via switchNM Medical Physicist (business hours) ext 45 300NM Medical Physicist (out of hours, via RSO) via switchNuclear Medicine Scientists on duty ext 44 345Nuclear Medicine Scientists on call via switch


Implementation

The procedure will be implemented using the following: Discussion at team meetings, including Medical Physics, Nuclear Medicine and ward 14B Inclusion in staff orientation processes Dissemination through the CACHS Clinical Governance Committee


Related Policies, Procedures, Guidelines and Legislation

Legislation and Standards ARPANSA 2014 – Fundamentals - Protection against Ionising Radiation. Available at

http://arpansa.gov.au/publications/codes/rpsF-1.cfm RPS 4 - Discharge of patients undergoing treatment with radioactive substances. Code of Practice for Radiation Protection in the Medical Applications of Ionizing

Radiation (2008) – ARPANSA (referred to as ‘The Code’). Available at http://arpansa.gov.au/publications/codes/rps14.cfm

Recommendations for the Discharge of Patients Undergoing Treatment with Radioactive Substances (2002) – ARPANSA

Safety Guide for Radiation Protection in Nuclear Medicine (2008) – ARPANSA (referred to as the ‘Safety Guide’. Available at http://arpansa.gov.au/publications/codes/rps14_2.cfm

National Safety and Quality Health Service (NSQHS) Standards, available at https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/ o Governance for Safety and Quality in Health Service Organisationso Partnering with Consumerso Patient Identification and Procedure Matching




https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/

https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/

http://arpansa.gov.au/publications/codes/rps14_2.cfm

http://arpansa.gov.au/publications/codes/rps14.cfm

http://arpansa.gov.au/publications/codes/rpsF-1.cfm

CHHS17/019

Radiation Act 2006 (Australian Capital Territory). Available at http://www.legislation.act.gov.au/a/2006-33/

Manuals CHHS Radiation Safety Manual – Nuclear Medicine

Policies and Procedures CHHS Operational Procedure Inpatient Radioactive Iodine-131 Therapy Consent and Treatment Policy Consent and Treatment SOP Consent and Treatment: Children or Young People SOP Consent and Treatment: Capacity and Substitute Decision Makers SOP TCH Clinical Handover Policy TCH Clinical Record Management Policy TCH Discharge Planning Policy TCH SOP - Discharge Summary Completion TCH SOP - Clinical Record Documentation TCH SOP - Medical Officer Clearance TCH SOP - Medication Supply on Discharge TCH SOP - Patient – Ward admission, Discharge and Transfer


References

1. Safety Guide, clause 4.4.42. Safety Guide, clause 4.4.103. Safety Guide, clause 4.34. Safety Guide, clause 4.4.25. EANM Guidelines for radioiodine therapy of differentiated thyroid cancer6. Safety Guide, clause 4.4.87. Safety Guide, clause 4.4.108. Safety Guide, clause 4.4.109. Safety Guide, clause 4.4.1010. Safety Guide, clause 4.511. Recommendations for discharge (RPS4), clause 2.412. Recommendations for discharge (RPS4), clause 2.213. 12. Recommendations for discharge (RPS4), clause 314. Safety Guide, clause 4.4.1015. Safety Guide, clause 4.4.1016. Recommendations for discharge (RPS4), clause 2.817. The Code, clause 3.1.1118. The Code, clause 3.1.3219. Safety Guide, clause 4.5




http://www.legislation.act.gov.au/a/2006-33/

CHHS17/019


Definitions, Acronyms & Abbreviations

NM – Nuclear Medicine NMS – Nuclear Medicine Scientist NM MP – Nuclear Medicine Medical Physicist NM Team – consists of a Nuclear Medicine Specialist, a Nuclear Medicine Scientist and a

Nuclear Medicine Medical Physicist RFA- Request for Admission PIL – Patient Information Letter ‘Safety Guide’ - Safety Guide for Radiation Protection in Nuclear Medicine (2008) –

ARPANSA ‘The Code’ - Code of Practice for Radiation Protection in the Medical Applications of

Ionizing Radiation (2008) – ARPANSA


Search Terms

Radioiodine, I131, Nuclear Medicine, RAI, Iodine, Radioactive, I-131, Iodine-131, Iodine 131

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair




Documents

Inpatient Radioactive Iodine -131 Therapy Clinical …€¦ · Web viewThe NM Medical Physicists will return 20 minutes after administration, to conduct the first radiation survey