A NUMBER OF hospitals, including Temple Street Children’s Hospital and Beaumont Hospital in Dublin, have been found to be non-compliant in relation to some of their ionising radiation policies and practices. 

One private hospital in Munster was also found to be non-compliant in a total of six areas of its radiation, including protection during pregnancy and breastfeeding.

They form part of a batch of 20 new inspection reports by the Health Information and Quality Authority (HIQA) assessing compliance with medical exposure to ionising radiation regulations in medical facilities.

These include three dental facilities, six private medical facilities and 11 public medical facilities. 

The inspections, carried out between May and August 2022, assessed compliance with the European Union regulations.

Medical exposure

Medical exposure to ionising radiation happens in a number of instances, such as for X-rays or CT scans, or in radiotherapy as part of cancer treatment.

It also includes radiation received for medical research purposes, radiation received by carers and comforters while attending to a patient and a dental X-ray.

Since 2019, HIQA has been the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland. 

The inspections examine the undertaking for each medical facility, which is a person or body who has the legal responsibility for carrying out, or engaging others to carry out, a medical radiological practice or procedure.

Notification of ‘significant events’

Inspectors visiting Beaumont Hospital in Dublin found that initial notification of a “number of accidental and unintended exposures and significant events relating to high patient skin doses were not reported to HIQA within three working days” as required.

The watchdog found the hospital largely complaint with regulations but it also reported that “a single staff member was responsible for the reporting of all incidents” to HIQA, which it highlighted as an area for potential improvement as it created a single point of failure for the timely reporting of incidents.

“Despite these regulatory issues, further communications with the undertaking and their representatives as well as information gained through the inspection process assured inspectors that these issues did not represent a current safety concern,” HIQA said in its report. 

There is, however, a need to ensure consistent regulatory compliance in the future reporting and investigation of all accidental and unintended exposures and significant events,” inspectors said, adding that this was brought to the attention of senior hospital management.

Breastfeeding

For Bon Secours in Tralee, Co Kerry, inspectors were satisfied on a number of measures but found a total of six aspects were not compliant. 

Among these were that the hospital had not ensured its undertaking to check whether a patient was pregnant or breastfeeding at the time of the medical exposure.

The report said that the “gaps in documentation” outlined in the report “did not represent a radiation safety risk to the service user but did impact on compliance with regulations”. 

Inspectors also found that the hospital should ensure that all clinical staff involved in the delivery of medical exposures at the hospital should avail of radiation protection training updates offered to provide greater assurance for the radiation protection of service users.

“While inspectors were satisfied overall, that the right professionals were involved in the conduct of medical exposures delivered by the hospital, some areas for improvement were identified,” the HIQA report continued.

“For example, inspectors found that documentation viewed did not delineate practitioner and radiographer responsibilities for medical radiological procedures undertaken in the interventional cardiology suite and therefore should be reviewed to reflect day-to-day practices as described to inspectors.”

In addition, the hospital needs to ensure that a referrer and or a practitioner are involved “in enquiring and documenting pregnancy status of service users undergoing medical exposure” at the hospital.

Retention of records 

In its report on Temple Street Children’s Hospital, the watchdog found there to be noncompliance regarding retention of records. 

Inspectors also found that established governance arrangement for the radiology service could be improved and strengthened to ensure greater oversight of all services providing medical exposures at the hospital.

The report added: “Overall, inspectors noted several examples of good practice during the inspection and were satisfied that CHI at Temple Street demonstrated that systems and processes were in place to ensure the safe delivery of medical radiological exposures to service users.”

Inspectors found evidence of good levels of compliance or full compliance with the regulations in dental undertakings.

They also found varying levels of compliance following inspections of the medical facilities. Two of the 20 inspections were conducted to follow up on the outcomes of previous inspections.

Others, such as Rowe Creavin Medical Practice in Waterford, was found to be fully compliant with the assessed regulations. 

An area that requires additional attention in most undertakings inspected involves the requirement to include information relating to radiation dose in the report of the procedure, HIQA said. 

As part of its inspections, they talk with staff and management to find out how they plan, deliver and monitor the services that are provided, and where possible they speak to service users.

They also observe practice “to see if it reflects what people tell us”, while reviewing documents to see if appropriate records are kept and that they reflect practice.