par John R. Fischer
, Staff Reporter | October 11, 2019
Point-of-care ultrasound (POCUS) has found a place in the annual Top 10 Health Technology Hazards for 2020 report produced by ECRI Institute.
The imaging modality was listed as the number two cause of hazards, behind surgical stapler misuse. Its presence on the list was credited to the rate of adoption outpacing policies and procedures for preventing misuse and diagnosis.
“The forces driving adoption are the low cost of scanners, ease of use and the clinical trend to utilize POCUS more often and for more indications and applications,” Daniel A. Merton, diagnostic ultrasound specialist and principal project officer at ECRI Institute, told HCB News. “The reason many facilities cannot keep up with the pace of adoption is that many clinicians or even departments choose to utilize POCUS independently from the institution, and the policy makers may not be aware of the prevalence of those users.”
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Merton says that clinicians are concerned about what is best for a patient and less so about policies, procedures and other aspects of appropriate use, such as properly documenting exams or communicating results in a timely manner.
At the same time, an issue that can put patient safety in jeopardy is when a facility does not perform a POCUS exam when the need for one is indicated. This has lead to several legal cases, with reasons for not performing exams varying, from not having a skilled clinician or the technology readily available, to not making it a priority.
“Our recommendation is for institutions to have a POCUS committee composed of imaging specialists and stakeholders that provides oversight on the use of POCUS, including establishing training and credentialing processes, competency assessments, continuing education, scope of practice, ensuring the service is available when necessary, exam documentation, and generation of reports / communicating the results to the appropriate individuals involved in a given patient's care,” said Merton, who reiterated that “the lack of formal policies and procedures creates the potential for safety issues.”
Other issues listed in the report include sterile processing errors in medical and dental offices; central venous catheter (CVC) risk in at-home hemodialysis; unproven surgical robotic procedures; alarm, alert, and notification overload; connected home healthcare security risks; missing implant data and MRs; medication timing errors in EHRs; and loose nuts and bolts in devices.