HIQA finds room for improvement in first inspections of ionising radiation services

There is an opportunity for services to improve governance arrangements to ensure oversight of all areas within a facility that use radiation and incorporate stronger processes to identify the practitioner responsible for justifying individual x-ray exposures, according to HIQA.

The statement was made on HIQA’s publication of the first 10 inspection reports of services that utilise medical exposure to ionising radiation.

Additionally, the Authority said there is a need to ensure the appropriate involvement of key individuals such as medical physics experts to optimise radiation safety processes and incorporate information related to the exposure of patients into the report of the procedure.

Inspectors identified non-compliance with the regulations in two facilities. Inspectors visiting Mercy University Hospital found that there was a lack of comprehensive medical physics involvement in service delivery relevant to the size and scale of the service. In Limerick Clinic, inspectors found non-compliances in the recording of referrals and justification or authorisation for certain medical radiological procedures.

HIQA will continue to engage with and monitor each undertaking’s progress in coming into compliance.

These inspections are HIQA’s first to be carried out within private sector healthcare facilities to ensure compliance with new regulations signed in 2019. The new regulations provide HIQA with enforcement powers in public and private healthcare for the first time in respect of medical exposures.

Mr John Tuffy, Regional Manager for Ionising Radiation, said: “Radiation is used widely in healthcare and new regulations set the minimum standards for the protection of patients when they are being exposed to ionising radiation. These inspections have given us insights into the ionising radiation regulations in practice and while we have seen several areas of good practice, we also identified some areas for improvement which we will be working with services on.”

Inspections were carried out between December 2019 and February 2020 at:

• Aut Even Hospital Ltd, Kilkenny

• Children’s Health Ireland at Crumlin, Dublin

• Global Diagnostics, Our Lady’s Hospital Navan, Meath

• Limerick Clinic (Galway Clinic Doughiska Ltd), Raheen, Limerick

• Mercy University Hospital, Cork

• Merlin Park Imaging Centre, Galway

• Midland Regional Hospital Portlaoise, Laois

• Naas General Hospital, Kildare

• Sligo University Hospital, Sligo

• South Tipperary General Hospital, Clonmel, Tipperary.

Of the 10 inspection reports published, good practice and compliance with the regulations were found in eight services. These services showcased how ionising radiation can be delivered safely, according to HIQA.

The Authority said Children’s Health Ireland demonstrated the importance of considering radiation protection for patient populations. They had selected equipment, dedicated practical techniques and dose tracking systems designed specifically for paediatric patients.

Aut Even Hospital Limited collected and reviewed typical doses received by patients which were reviewed retrospectively on a daily basis as a quality assurance measure. These were then audited and presented twice a year to the Radiation Safety Committee for review.

A number of facilities had comprehensive service level agreements for the sharing of medical physics expertise within hospital groups, showcasing how resources and expertise can be effectively shared for the benefit of all, according to the HIQA.

 Mr Tuffy said: “It is important to bring areas of good practice to light, as it offers an opportunity to share learnings.”