Ch 19 Quality Improvement in Rad Onc
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"An approach to the continuous study and improvement of the processes of health services to meet the needs of patients and others
Synonyms for QI
- CQI....continuous quality improvementTQM...total quality management
a non profit organization dedicated to improving the quality of care in health care settings
- TJC the Joint Commission Officeformerly JCAHO
- Joint Commission on the Accreditation of Healthcare Organization
Focuses on performance measurement
-based on the comparison of processes with outcomes to quality indicators, the measurable dimension of quality that defines what is to be monitored
Quality assurance (aka quality assessment, quality improvement by the TJC)
stresses the control and assessment of performance, providing standards of measurement
Involves the systematic collection of and review of quality assurance data
integrates quality assurance, quality control and assessment into a complex system wide improvement program revolving around the healthcare organization's mission and goals
eliminates duplication of quality assurance and and quality improvement efforts but still provides assurance that services are of high quality
QI in rad onc, involves ongoing activities encompassing administrative, clinical, physical and technical aspects of processes in rad one
ACR American College of Radiology and the AAPM American Association of Physicists in Medicine
What is an integral part of the QI plan in the ACR AND AAPM?
a peer review and audit mechanism
Responsible for oversight of patient care, established in 1917
American College of Surgeons (ACS)
Established Hospital Standardization Program which developed the concept of "minimum standards" in 1919
The Joint Commission on Accreditation of Hospitals (JCOAH)was formed through the efforts of what 5 establishments?
- ACP American College of Physicians
- ACS American College of Surgeons
- AHA American Hospital Association
- AMA American Medical Association
- CMA Canadian Medical Association
Which Commission , was created in 1974
"to ensure adequate protection oof the public health and safety, the common defense and security, and the environment in the use of radioactive materials in the US."
Nuclear Regulatory Commission
Commission which managed nations atomic energy program 1954-1974
Atomic Energy Commission
What did the Atomic Energy commission divide into in 1974
Energy Research and Development and the National Regulatory Commission.
What is the NRC's scope of responsibility?
- -regulation of commercial nuclear power reactors
- -nonpower research, test, and training reactors
- -fuel cycle facilities
- -medical, academic and industrial uses of nuclear materials
- -transport, storage, and disposal of materials and waste
Use of radioisotopes in brachytherapy and cobalt for external treatment falls under which Agency?
National Regulatory Commission
The federal agency, established in 1970, to assist NRC whose mission is" to protect human health and safeguard the natural environment -air,land and water- upon which life depends"
Environmental Protection Agency EPA
Involved in the regulation of the disposal, the storage, and handling of nuclear waste materials as it relates to the enviromental issues
Regulates the transportation of hazardous materials
Department of transportation DOT
Responsible for overseeing the national safety program for transporting hazardous materials by air, rail, highway and water
Office of Hazardous Matrials
"To ensure safe and healthful working conditions for working men and women"
-developed in 1970
Occupational Health and Safety Act (OSHA)
"to save lives and prevent injuries and protect the health of America's workers"
-Developed in 1970
Mid 1980's,________ mandated a policy on bloodborne pathogens stating an exposure control plan must be in place for all industries in which workers may come in contact with blood or other infectious materials
______ set standards fir exposure to lead and cadmium, which would apply to mold rooms in Rad Onc facilities, where Cerrobend (Lipowitz metal)
What is Lipowitz alloy?
What provides the basis for the NRC to relinquish portions of its regulatory authority to licensing and regulating;
by-product materials (radioisotopes),
source materials (uranium, thorium)
certain quantities of nuclear materials
the the individual states...
Section 274B of the Atomic Energy Act of 1954
When was the first agreement state established?
How many agreement are there?
In the agreements, what does the NRC provide assistance for?
- -reviewing agreement request
- -conducting training courses and workshops
- -evaluating technical licensing and inspection issues
A professional organization for the medical physicists, a forerunner in the development of minimum standards to guide medical physicists in the development of a quality assurance program as it relates to treatment planning and delivery
American Association of Physicists in Medicine
Which professional association developed practice standards for radiation therapists
American Society for Radiologic Technologists
What are the three sections the practice standards for the ASRT
- Clinical performance- activities related to the patient care and delivery of procedures and treatments
- Quality performance_-activities of practitioner in the technical areas of equipment safety and TQM (total quality management)
- Professional Performance- defines activities in the areas of education, interpersonal relationships, personal and professional assessment and ethical behavior
What is Quality as defined in reference to Rad Onc?
the totality of features ad characteristics if a radiation therapy process that bear on its ability to satisfy stated or implied needs of the patients
"All those planned or systemic actions necessary to provide adequate confidence that a product or service will satisfy given requirements for quality"
The term used to refer to the planned or systemic actions to ensure an RT facility consistently delivers high quality care in the treatment of patients leading to the best outcomes with the least side effects
Quality Assurance (also referred to as quality assessment, quality improvement by TJC)
A review of all aspects of radiation therapy, routinely and continuously measured, results analyzed and corrective measures taken to ensure quality patient care is
a quality audit
Defined as " the operational techniques and activities used to fulfill the requirements for quality"
The term typically used to refer to those procedures and techniques used to monitor or test and maintain the components of RT quality improvement program
Who requires measurement of patient outcomes including morbidity, mortality, recurrence of disease, and survival rates , patient satisfaction and quality of life
who provides a continuous evaluation of performance as part of the accreditation process to help healthcare organizations measure and improve their quality of care through the use of common ______ _______.
What is the IM System?
Joint Commissions Indicator Measurement System
What are measured as Quality Indicators?
- disease recurrence
- survival rates
- patient satisfaction
- quality of life
Because emphasis of quality is now an ongoing evaluations the program is often refferred to as
- CQI or TQM
- Continuous Quality Improvement
- TOTAL QUALITY MANAGEMENT
Who is responsible for improvement quality?
Rad Onc Team
What is a pictorial representation of the steps necessary in a process
A simplistic and easy to implement, improvement methodology, consisting of A system wide set of methods and tools for improving a process by emphasizing speed and efficiency
The Lean Technique
A process improvement method focusing on precision and accuracy, with the elimination of defects in the process
What is the tolerance for QA Tolerance of Simulators?
- Everything is +/- 2 for daily monthly or annually Except
- GANTRY/COLLIMATOR ANGLE INDICATORS which is 1 DEGREE
TOLERANCES FOR THE CT SIMULATOR
DAILY, MONTHLY SEMI ANNUALLY AND ANNUALLY CHECKS WITHIN 2MM
EXCEPT TABLE VERTICAL AND LONGITUDINAL MOTION WHICH IS 1MM
What is the QA tolerance for gantry /collimator angle indicators?
Which QA of Medical Accelerators tolerance is 3%
- xray and electron output constancy
- Electron Beam flatness constancy
- xray and electron symmetry
Which QA are 1 degree?
Gantry/collimator angle indicator
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