Pre‐procedure

ActionRationale

1. 1.Show
   Before treatment begins, ensure the room is set up appropriately. This includes placing a lead pot and long‐handled forceps in the room to hold any dislodged sources.
   To reduce unnecessary time spent in the room once the patient returns from theatre (Hart [25], E).
2. 2.Show
   Switch on a controlled area radiation warning light outside the room and check it is working correctly.
   To warn staff, visitors and other patients of the radiation risk and to ensure only trained personnel enter the room (Hart [25], E).
3. 3.Show
   Place a radiation warning notice outside the patient's room.
   To ensure only authorized personnel enter the room. E

Procedure

1. 4.Show
   A yellow radiation hazard board should accompany the patient back from theatre. This must remain at the bottom of the bed or outside the cubicle until the source is removed.
   To alert everybody that the patient has a radioactive source. E
2. 5.Show
   Place lead shields in position at the door. All staff entering the room should work behind the lead shield when in close contact with the patient.
   To reduce radiation exposure of staff in close contact with the patient (Hart [25], E).
3. 6.Show
   When transferring patients from theatre to ward, the nurse and porter should remain at the head and foot of the bed and at least 120 cm from the centre of the bed in the event of any delay in the transfer.
   To minimize the risk of exposure to radiation. E
4. 7.Show
   Nursing staff must calculate the time allowed with the patient in any 24‐hour period. This time should be written on the yellow warning notice on the bed or cubicle door.
   To minimize exposure to radiation (Hart [25], E).
5. 8.Show
   A contamination monitor should be available on the ward.
   To monitor radioactivity if a dislodged source is suspected, for example in the bedlinen (Hart [25], E).
6. 9.Show
   Although one nurse should be responsible for planning the nursing care of the patient, the time spent with the patient should be shared between all suitably trained nurses and all time spent in performing nursing procedures must be kept to a minimum. Only those staff whose presence is necessary should spend time with the patient.
   To minimize the risk of overexposure to radiation (Hart [25], E).
7. 10.Show
   Every nurse must wear a radiation badge above the level of the lead shield.
   To record the extent of exposure to radiation (Ionising Radiations Regulations [34], C).
8. 11.Show
   All bedlinen and waste materials removed from the patient area should be monitored before being removed from the ward.
   To prevent loss of an accidentally dislodged source (Hart [25], E).
9. 12.Show
   If a source becomes dislodged, use the long‐handled forceps to put the source into a lead pot. Care should be taken not to damage the source. It must never be handled directly with the fingers.
   To minimize the dose of radiation received (Hart [25], E).
10. 13.Show
    Visitors must seek permission each time they wish to enter the room. Visitors must remain at least 120 cm away from the patient. Visitors must always sit behind one of the bed shields. The visit should not last longer than the time shown on the warning notice. No children or pregnant women are allowed to visit.
    To minimize the risk of overexposure to radiation (DH [14], E).
11. 14.Show
    When the patient needs to visit another department, for example X‐ray, the following must be ensured.

    • That the receiving department is aware of the hazard of exposure to radioactivity.
    • One porter and a nurse should accompany a patient in a wheelchair; two porters and a nurse should accompany a patient on a trolley. In the event of any delays, the nurse and porters should remain at the head and foot of the bed and at least 120 cm from the centre of the bed.
    • A radiation warning hazard sign should accompany the patient.
    • Unless the patient is likely to be in the department for a long time, the nurse and porter should stay with the patient.
    • If the source becomes dislodged during transfer, the porter must ring the switchboard, who will send out an emergency call to the physics department. The nurse must ensure the area around the patient is kept clear of other patients, staff and visitors.
    • A member of staff from the ward should take a lead pot, forceps and a monitor to the nurse who will place the source in the lead pot and monitor the area to ensure it is free of radioactivity.
    • The radiation protection adviser and supervisor should be informed of the incident.
    In order that medical care can continue to be provided while the patient is receiving radioactive sealed source therapy. E

    To allow the appointment to be made when the department is quiet, thus ensuring waiting time is kept to a minimum and to minimize exposure to others (Ionising Radiations Regulations [34], C).

    To minimize the risk of exposure of staff to radiation. E

    To warn all staff that the patient has a radioactive source in situ (Ionising Radiations Regulations [34], C).

    To ensure time, distance, shielding and segregation restrictions are maintained. E

    To minimize the risk of exposure to radiation. E

    To contain the radioactive source and minimize the risk of exposure (Hart [25], E).

    To evaluate the incident, and to prevent it recurring (DH [14], C).
12. 15.Show
    In the event of a cardiac arrest, an Ambu‐bag or similar device must be used, and the physics department must be informed immediately.
    To minimize exposure. E
13. 16.Show
    In the event of a fire, the fire policy must be followed. Following evacuation, the appropriate distance between the radioactive patient and other staff should be maintained; help should be sought from the physics department.
    To minimize exposure. E
14. 17.Show
    In the event of a patient's death:

    Either:

    Removable sources: the radiation sources should be removed by the radiotherapist. Inform the physics department.

    Or:

    Non‐removable sources: inform the physics department immediately. The body should be placed in a body bag.

    Transfer of the body should be arranged by the physics department.
    Remove radioactivity to allow Last Offices to be undertaken as normal. E

    In order for the physics department staff to begin making the necessary arrangements for removal of the body to the mortuary. Arrangements would include: segregated refrigerator, warning notices and use of body bag to contain sources if they became dislodged. E

    The physics staff will supervise the transfer of the body. E
15. 18.Show
    In the event of bleeding: in order to stem bleeding in the vicinity of the implant, apply pressure using at least four thickness dressing pads. The padding should only be compressed for 15 minutes by any single person.
    To minimize exposure. E
16. 19.Show
    In the event of a confused or agitated patient, premature removal of sources may be required.
    To prevent overexposure to radiation of the nurses attending the patient, as well as to prevent the patient removing or dislodging sources. E
17. 20.Show
    Only staff who have received training and have been authorized may enter a controlled area. A list of suitably trained staff should be kept by the domestic and catering managers and by the ward's local radiation protection supervisor. A domestic or catering supervisor should undertake tasks if the ward‐based employee is not trained.
    To keep all radiation exposure as low as can be reasonably achieved (Ionising Radiations Regulations [34], C).
18. 21.Show
    Domestic and catering staff should not remove items such as cleaning equipment and crockery until they have been monitored by a nurse and deemed safe.
    To prevent sources being removed from the room before it is safe to do so (Hart [25], E).