by Bryan Williams, MHA, RT(R), RDMS, RVT, RDCS, LAS, Ultrasound Specialist, Tammy Stearns, MS, RDMS, RVT, RT(R), FSDMS, FAIUM, LAS, Ultrasound Specialist, and Christa Brown BSN, RN, LAS, Senior Director of Medical Impact
Even after your primary training is complete and the initial ultrasound skills are mastered, there remains the question of how to retain competency. To best help the women and families we serve, our skills must remain up-to-date to provide relevant information, clear images, and accurate reports. This leads to several areas of discussion regarding the specific requirements needed to maintain competency. Given that each imager is different, each pregnancy help medical clinic (PHMC) has its own number of scans per day and that leads each of them to have their own guidelines for what is necessary to remain competent. It is no surprise that there are varying opinions on what should be required to maintain competency.
We live in a world where medical professionals are constantly running up against new “rules” and recommendations. Different organizations working to improve quality often set arbitrary rules on how to retain skills and remain competent in the field. This is likely done with good intentions and oftentimes leads to a variation of many different ideas and suggestions dependent on the focus of that specific organization.
Training and teaching people is one of the most dynamic activities that occurs in this world. As with any user-dependent learned skill, ultrasound requires continual practice and education throughout an imagers career. These vary greatly dependent on the natural ability of the imager and the foundational level of education specific to ultrasound, making it difficult to set a required number. Heartbeat International recommends the policies set by the Medical Director of that specific PHMC regarding the requirements to maintain competency in conjunction with any federal or state licensure or legal requirements.
Heartbeat International recommends quarterly or bi-annual peer reviews. In a peer review, all staff performing ultrasounds have a quarterly peer review which assesses the quality of an exam provided by experienced nurses and sonographers. The cases are chosen randomly and are reviewed blindly. A peer review includes an assessment ensuring that all required forms are being completed thoroughly and properly and all protocols of imaging and measurements are being followed. Any issues revealed in a peer review are corrected with feedback, goals set, and continued education.
The minimum requirement for continued education differs dependent on several factors. Registered Nurses are governed by their licensing board which is dependent on the state in which the board oversees. Registered Diagnostic Medical Sonographers' requirements are dependent on the requirements of the organization that has awarded their credentials, along with state licensure laws dependent on their state.
However, these are specific to the credentials of the professional, not necessarily specific to imaging limited obstetrical ultrasounds. Because each medical professional has a different skill set and frequency of scans in their clinic, some may be experiencing very few scans. Because of this, less pathology is being seen and less diversity of images and gestational ages. This makes it challenging to maintain proficiency. Policies need to be set within each PHMC to ensure that competency within the level of imaging being seen is maintained.
Heartbeat International recommends that only licensed or credentialed medical personnel trained in limited obstetrical ultrasounds (nurses, registered diagnostic medical sonographers, nurse practitioners, midwives, physicians, and physician assistants) perform scans within PHMCs.
Just as when you started your training, continued education should be a combination of didactic and clinical learning. Maintaining skills ensures you remain competent and confident in your ultrasound skill to image life most effectively.
If your PHMC has a team of medical professionals who have experience in ultrasound scanning, periodic group training may be helpful. This could be a time to review didactic material, share difficult cases, and perhaps perform a few practice scans. Consider scheduling a time for group training, overseen by experienced nurses and sonographers within your PHMC or even with a few clinics combined, who can provide feedback, support, and insight. Personal and dependent growth continues far beyond the initial training period.
For those that have a smaller or newly developed medical department, Heartbeat International offers a didactic ultrasound refresher course that allows continued education online. The course is reissued every two years to allow for a continual source of learning for the more experienced imagers. In addition to the didactic components, there is a clinical component that requires ten exams to be completed along with an assessment completed by an experienced observer. For those without an experienced observer, personal arrangements may be made.
Another more in-depth option would be to attend the clinical training, L.O.V.E. Approach Ultrasound Clinical, which is available to all levels of ultrasound proficiency. These events are also great for those who have been scanning for many years and have proven to be a time of encouragement while fine-tuning existing skills.
At times, it can be difficult to navigate all the legal requirements for the services PHMCs offer. However, it may be more difficult to navigate the areas that are not legally governed. These gray areas are often met with suggestions from organizations that do not govern ultrasound or medical services but rather have an opinion on what is best for all. That can add to the confusion of what is actually a requirement and what is a guideline or recommendation. As you discern what is best for your PHMC and the community you serve, it can be helpful to consider a few things:
Together, these things can guide policy for your PHMC in light of the purpose of the scan…to image life.
Thank you for all you do for your communities. You put your heart into your work and want the very best for the women, babies, and families you serve. You are making a difference.
While there are various ultrasound trainings available for nurses and sonographers who work within the pregnancy help movement, Heartbeat International has championed a new form of training that connects the technical needs and the spiritual needs for those working in pregnancy help. The training is held in two parts: First, students complete an online ultrasound training* through Heartbeat International’s Academy which meets the Association of Women's Health Obstetric and Neonatal Nurses (AWHONN) guidelines for didactic training, as well as completing 25 OB prerequisite scans** to prepare for the in-person training. Next, students come on-site to participate in an in-person scan lab experience with one-on-one instruction from educators that are also sonographers credentialed in RDMS (OB/GYN) and RNs that have multiple years' experience imaging in Pregnancy Help Clinics.
By combining the technical, the practical, and the spiritual elements into one pregnancy help medical training, trainees will work towards becoming equipped, qualified, and ready to scan within their center. (Looking for training for other Pregnancy Help staff? Click here!)
*Heartbeat International will offer 28 Continuing Education Contact Hours for nurses for the didactic portion of training and 10 Continuing Education Contact Hours for nurses for the clinical portion of training. Heartbeat International is an approved provider through the California Board of Nursing, Provider Number 16061.
The focus of the clinical event is on repetition and volume, along with spiritual encouragement and reinforcement of techniques and knowledge gained from the didactic training. The ideal participant is someone who is self-motivated, confident and is in need of a high volume of scans for training. This event is fast-paced and filled with drills, techniques and one-on-one instruction from educators that are also sonographers credentialed in RDMS (OB/GYN) and RNs that have multiple years' experience imaging in Pregnancy Help Clinics. Each participant receives a skill evaluation by our instructors, however, Heartbeat International does not certify nor credential any medical professional. Final determination of when a nurse can scan in a clinic is made by individual Medical Directors.
The LOVE Approach Ultrasound Clinical includes 28 hours of didactic training (28 CEUs) and 20 hours of clinical training (10 CEUs).
*Completion of Heartbeat's Online Ultrasound Didactic Training is a prerequisite to the LOVE Approach Ultrasound Clinical and is included in the cost of the training.
**Nurses attending the LOVE Approach Ultrasound Clinical have found many ways to obtain the prerequisite of 25 OB scans. Here are a few ways to fulfill this requirement.
Our completely updated training will be available in early March for medical professionals offering Limited Obstetric Diagnostic Ultrasound in Pregnancy Help Clinics. We are thrilled to offer ten new modules on topics such as ultrasound physics, first trimester scanning, legal and ethical questions, knobology, and more.
We invite imagers around the world that perform limited obstetric diagnostic ultrasounds to our updated Online Ultrasound Training. The purpose of scanning in the Pregnancy Help Clinics is to shed His Light on the reality of life by showing a mom the first image of her baby. Designed with the medical professional in Pregnancy Help Clinics in mind, this training is rooted in the LOVE Approach for all who serve and all who are served in Pregnancy Help Clinics.
Available to you:
Training topics includes:
You will not walk the journey alone but rather will be guided by those of us who have walked the journey before you. Each member of the Medical Impact team has been a part of creating this training and providing support for you as you learn.
Gathered from around the world, we are dedicated to assisting and encouraging while you learn not only the technique of performing a Limited Obstetric Ultrasound Diagnostic Exam but also as you forge through the spiritual warfare that will accompany it.
Our team is composed of sonographers that are multicredentialed to include RDMS(OB/GYN) and recognized nationally for their accomplishments and Registered Nurses that have performed ultrasounds in Pregnancy Help Clinics throughout the nation. You will also hear from Heartbeat International General Counsel, HBI President Jor-El Godsey, Vice-President of Ministry Services Betty McDowell, and Vice-President of Development Cindi Boston-Bilotta and others from the HBI team. Each member of this team brings with them experiences that will enhance your learning experience.
This course was created for medical professionals who are called to perform ultrasound in Pregnancy Help Clinics. It is not essential for you to obtain the RDMS credential to effectively perform Limited Obstetric Diagnostic Ultrasound. It is essential that you become competent. This course is designed with you in mind. We fully believe that God equips who He calls!
This training is self-paced and can fit in any schedule. Participants complete modules when convenient to their them. There are no required log-in times but we would expect the course to completed within six months from start date. Recognizing that each person will progress at his or her own time frame, the clinical section of this course can be completed while one is completing the didactic portion of the program or may be completed following the completion of the program.
Module I The Power of Seeing This module explores a basic overview of the history of Ultrasound and its unique utilization in Pregnancy Care Centers.
Module II: Limited Obstetrical Ultrasound for the Registered Nurse These presentations provide guidance on patient assessment & education, documentation, and nursing professional practical guidelines for those that scan in Pregnancy Help Clinics.
Module III: The Physics of Ultrasound These presentations will help you become more familiar with you machine along with teaching basic physics principles that will enhance your scanning effectiveness.
Module IV: Pelvic and Obstetrical Anatomy This module will briefly review basic embryology along with the female reproductive system and basic first trimeter obstetrical anatomy in order to prepare the participant for First Trimester Obstetrical Ultrasound.
Module V: Obstetrical Ultrasound These presentations focus on the basics of scanning in the first trimester starting from basic transducer manipulation to basic measurements along with presentation techniques.
Module VI: Normal Variants and Atypical Findings These presentations focus on scanning beyond the typical first trimester scan concentrating on the second and third trimester basic measurements, presentation techniques, commonly encountered first trimester abnormalities and scanning multiple gestations.
Module VII: Abortion Pill Reversal and Ultrasound These presentations will help you to care for the abortion pill reversal client in your clinic.
Module VIII: Legal and Ethical Issues This module concentrates on quality analysis of exams along with legal and ethical issues.
Module IX: Self-Care and the Imager This presentation explores the personal role of the imager and the care that is involved in those who serve on the front lines.
Module X: Clinical Competencies The clinical component of your training includes two elements, an experience log and competency evaluation. Clinical portion of training is completed in your clinic under the supervision of a qualified RDMS OB/GYN Sonographer, qualified RN who has completed ultrasound training, or a Physician of your choice.
Each module of this course consists of presentations, discussion questions, and assignments. This course is designed to be completed in its entirety with each section developed to specifically prepare students for the task ahead. After each section, a small quiz assesses understanding of the topic. Questions are encouraged in the discussion forum or in email to our ultrasound instructors.
Cost is $495 for non-affiliates/$395 with HBI affiliate discount.
Assistance is available to centers who qualify through the Option Ultrasound Program (OUP) which provides grants to qualifying pregnancy medical clinics for 80% of the cost of an ultrasound machine or sonography training for medical personnel.
We are excited for those that will join us on this endeavor to image life. We can assure you, this will be a life changing experiencing for you and those for who you scan!
Provider approved by the California Board of Registered Nursing, Provider Number CEP 16061 for eight contact hours.
At the end of Pregnancy Help Institute, we invite our attendees to write a letter to the Board of a pregnancy center who might be trying to decide whether to send staff for training or not. Every year, we are inspired by their reactions to working with other like-minded individuals as they sharpen their skills to continue serving on the front lines of pregnancy help. Here's what a few of our 2017 Pregnancy Help Institute graduates had to say.
Dear Board Member,
If you are looking for one single thing that you can do to grow the ministry that you are a part of, please consider sending your director to Pregnancy Help Institute. I know when the budget is tight it is hard to spend money and allow your director to be out of the office. But it is worth every penny. Equipping your director to do his/her job better is a huge part of Pregnancy Help Institute, but the encouragement they will find there, you cannot put a price tag on.
Sincerely,2017 Pregnancy Help Institute GraduateNew Director Track
If you are considering sending your medical staff for ultrasound training at Pregnancy Help Institute, please do it! It will equip your staff to not only learn/be able to perform basic ultrasound exams, but to give that mother a chance to view LIFE! Not only will they learn the skill of ultrasound, but they will also be encouraged spiritually to effectively help a mother see her unborn. Your staff will leave blessed when they go in, and blessed when they leave (Deuteronomy 28:6).
Sincerely,2017 Pregnancy Help Institute GraduateUltrasound Training Track
What I have discovered is how important it is to take some time away to refresh and rediscover our purpose and energize our soul for the work we do. Being a part of the Pregnancy Help Institute training in development has helped me not only affirm much of what I have been focused on, but also to discover new ways to take our ministry to the next level. Development involves everyone on the team, and I have taken away so many ideas that I can present to our team to help us be the best we can be.
This week, I have been challenged, affirmed, and inspired to take what we do for God to the next level. I can take my skill set and use it for so much good. I have met amazing people who I will keep in touch with and bounce new ideas off of. It is so important to value the resources we have through Heartbeat International and to allow your team to participate so that they are more equipped to serve women and their families and affect generations to come and most importantly, be able to put on the armor of God to do the work we have been called to do. It’s an investment for God.
Sincerely,2017 Pregnancy Help Institute GraduateDevelopment Track
The investment for the heartbeat International training is not only faith-filled, but full of amazing information that can and will be incorporated into our plans for the home. I firmly believe this is something new members, as we add them to our team, need to attend. Not only has it been an amazing and information-filled week, but it has renewed my fire and excitement for our ministry.
Thank you,2017 Pregnancy Help Institute GraduateLeadership Track
The 2017 Pregnancy Help Institute Ultrasound Track was a great success!
Heartbeat International was incredibly blessed to have Tammy Stearns, RDMS and Bryan Williams, RDMS facilitate the ultrasound training portion of PHI. Tammy and Bryan, along with several other volunteer sonographers, spent the week training ten participants, including nurses, an RDMS, a Nurse Practitioner and a physician, from Pregnancy Centers around the country. Trisonics and Preferred Medical Systems, in a joint collaboration, provided ultrasound machines for use during the week of training.
The ultrasound training not only contained a didactic portion and scan labs, but a spiritual component as well. Tammy opened each day reminding the class that this is a ministry, not just a skill, and that this ministry is something that can only come out of God’s overflowing presence in our lives, and not from within our own selves. Each day, Tammy’s devotions emphasized how the spiritual side of things was a big part of the ultrasound ministry.
“I appreciate that this training was tailored to working in a CPC. I learned not only technical training but the spiritual aspect of giving these babies a voice for the first time.”
Each morning there was a classroom-style teaching which covered topics from physics and QA in the ultrasound setting, to anatomy of mom and baby, and abnormal findings while performing ultrasounds. For many of the participants, this was the first time they had undergone such a training, and the curriculum was designed to be real and applicable.
The afternoon scan labs were a huge success. There were 7 instructors who were involved in the hands-on training, and about 40 “models” from the community who volunteered their time (and bellies) for the students to take turns scanning. In total, about 200 scans were performed by the class (about 20 per student) which went towards the recommended 50-75 training scans that is recommended for Limited OB Ultrasound training. The students learned the basics of scanning a typical client that may present in the PRC, as well as the unique instruction on how to dialogue with the abortion-minded client during a scan.
“This was a very informative training. Each sonographer had a helpful hint to give, each one gave critical information for getting good ultrasounds. The didactic information was explained fully and in a helpful way. I believe I got way more than my money’s worth.”
The overall success of this year's ultrasound training will prove to be a huge tool in the PRC tool-belt as more qualified medical professionals are learning the ultrasound skills they need to be successful in the collective quest for life.
Recognizing the great service your Medical Directors give to your centers, Heartbeat International also wants to support them in their mission. Please pass on the information below about a great opportunity to your Medical Director.
The AIUM American Institute of Ultrasound in Medicine is presenting
Register today for Gynecologic and Early Obstetric Ultrasound---- Solving Problems With Imaging. This course is brimming with essential, illuminating sessions such as:
Join Course Chair Beryl Benacerraf, MD, FAIUM, AIUM president, and other esteemed faculty September 25-26, 2015, in Las Vegas, Nevada. This course offers up to 11 AMA PRA Category 1 Credits™ (accepted by the ARDMS) or ARRT Category A Credits. Learn more here.
By Susan Dammann RN
The FDA has issued a warning. While the FDA's main focus in the warning is to advise pregnant women to avoid commercial sonogram services for nonmedical purposes that could pose a danger to the developing fetus, emphasizing that these are prescription medical devices, are to be used only by trained health care professional and only with a prescription, included within the warning are guidelines/recommendations which we in the pregnancy help medical clinics should be aware of.
Below are three excerpts from the 12/16/14 FDA Consumer Update which may pertain to the use of ultrasound imaging in the PMC, and a question for you to consider.
"Fetal ultrasound imaging provides real-time images of the fetus. Doppler fetal ultrasound heartbeat monitors are hand-held ultrasound devices that let you listen to the heartbeat of the fetus. Both are prescription devices designed to be used by trained health care professionals. They are not intended for over-the-counter (OTC) sale or use, and the FDA strongly discourages their use for creating fetal keepsake images and videos."
Question: Are the sonograms in your center being performed by trained health care professionals?
"The long-term effects of tissue heating and cavitation are not known. Therefore, ultrasound scans should be done only when there is a medical need, based on a prescription, and performed by appropriately-trained operators."
Question: Are the sonograms performed in your center based on a prescription for a medical need?
"Similar concerns surround the OTC sale and use of Doppler ultrasound heartbeat monitors. These devices, which are used for listening to the heartbeat of a fetus, are legally marketed as "prescription devices," and should only be used by, or under the supervision of, a health care professional."
Question: If your center uses Doppler, is it being used under the supervision of a health care professional?
As you consider the above FDA recommendations in relation to the ultrasound services performed in your PMC keep in mind also that one of the points in the Commitment of Care and Competence to which all Heartbeat Affiliates sign in agreement is:
Medical services are provided in accordance with all applicable laws, and in accordance with pertinent medical standards, under the supervision and direction of a licensed physician.
To read the full FDA Consumer Update click here.
by Kevin T. Rooker, RT(R), RDMS, RVT, Sonography Consultants
Is ultrasound safe? Will it hurt my baby? These are questions we sometimes hear from our clients. We need to be able to answer those questions with confidence for several reasons. First, because our patients deserve an honest answer, and second because we never know who is listening. We know that there are some that think you should not be performing limited OB ultrasound and will always be looking for reasons to justify their position. Let's not give them that opportunity on the issue of ultrasound safety. Unfortunately, we, the medical community, have not done as well as we can at educating ourselves on the safety of ultrasound1.
Ultrasound is a wave of mechanical energy that penetrates human tissue as an oscillating (alternating) wave of high and low pressure. As it does so, there are two potential types of biological effects; Mechanical and Thermal. In 1993, the FDA allowed ultrasound manufacturers to significantly increase the amount of ultrasound energy created in diagnostic ultrasound systems, as long as they displayed the MI (Mechanical Index) and TI (Thermal Index) on the screen for the operator (and our clients) to see. The premise being that if we know what the MI and TI are, what their limits are, and most importantly how to lower them, then we are being as safe as we possibly can.
The Mechanical Index is a safety metric which lets the operator know how much energy is being transmitted into the patient during a sonography examination. Remember that sound is created by pressure waves, so mechanical energy is transmitted into any object which receives sound. Sound waves can be quite powerful. For example, think of the thump on your chest when sitting next to a teenager's car with the high dollar stereo system. It is defined as the peak negative pressure (PNP) of the ultrasound wave (point of maximal rarefaction). In easier terms; think pressure change divided by time. Lots of pressure change over short periods of time can be damaging. The FDA has established a maximum MI of 1.9 for diagnostic imaging. Any machine capable of generating MI greater than 1.0 must display the MI onscreen. The FDA MI limit for obstetric sonography is 1.0.
The Thermal Index is another safety metric which lets the operator know the potential of creating heat (hyperthermia) with the ultrasound beam. Many assumptions are made in this calculation, and it is often thought that the heating potential is underestimated. So keep in mind that the TI formulation was not intended to, and cannot provide an accurate measure of temperature rise within a specific patient. Instead it was designed to provide the operator with a relative measure of risk for a particular imaging mode. A Thermal Index of one (TI 1) indicates conditions under which the rise in temperature would be likely to be 1°C. The thermal index is different for different types of tissue, and can be displayed on your system accordingly: soft tissue (TIs), bone (TIb) and cranium (TIc). In the first trimester, when using Doppler to hear and demonstrate the fetal heart, the TIs setting us used. The limit for TI varies with time, please reference the chart below from the British Medical Ultrasound Society, the entire document may be found here.
Enough about what the MI and TI are, how do we as operators keep them at safe levels? There are two basic concerns to remember.
First is the AIUM ALARA policy2; which is an acronym for As Low As Reasonably Achievable. Simply translated, it means to keep the output power settings as low as possible, that still allows for adequate images. Most ultrasound systems can operate with output power settings at about 50% and still produce quite satisfactory OB images. Have your system presets adjusted so that when you are performing OB sonography both (abdominally and transvaginally), the output power settings are set low. You can always increase them if clinically necessary. And keep in mind that you can increase the gain to make your image brighter, as gain is just how well the system is "listening", it has no effect on the TI.
The second concern is time. Keep the overall examination as short as is reasonable. If using Doppler to allow Mom to hear her baby's heartbeat, depending upon your ceter's policy, keep the Doppler exposure to about 5-10 seconds. Know where to find the MI and TI displays on your system. If you don't know, consult your operator's manual or contact the manufacturer of your ultrasound system for more information.
Diagnostic ultrasound in obstetrics has been around for the better part of 40 years. To date, no one has been able to prove (and many have tried) that diagnostic ultrasound, when used prudently (MI,<1.0 and TI<0.7), has had any adverse effects developing fetuses; and this includes the limited use of Doppler in the first trimester "Thus far, there have been no significant thermal effects documented in humans and at this time the possibility of having all the factors present to is highly unlikely 3." However, it has been shown that aborting a living fetus is fatal, every time.
1. Ultrasound Is Safe . . . Right? Resident and Maternal-Fetal Medicine Fellow KnowledgeRegarding Obstetric Ultrasound Safety. J Ultrasound Med 2011; 30:21–27Sheiner E, Abramowicz JS. Clinical end users worldwide show poor knowledge regarding safety issues of ultrasound during pregnancy. J Ultrasound Med. 2008;27(4):499-501
2. As Low As Reasonably Achievable (ALARA) Principle Approved 4/2/2014 aium.org/officialStatements/39
3. FDA Recommendations for the Safe Use of Ultrasound in Obstetrics CNE article authored by Sherri A. Longo, M.D. Assistant Professor in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tulane University School of Medicine in New Orleans, Louisiana; e-edcredits.com/nursingcredits/article.asp?testID=29
Connie Ambrecht RDMS, Executive Director Equip Leaders Now/Sonography Now Beverly Anderson, J.D., CEO Dove Medical Susan Dammann RN LASm Medical Specialist
In April 2014, the American Institute of Ultrasound in Medicine (AIUM) sent an email to its members stating it had "Updated Guidelines and Official Statements." Included in the list was the guideline titled "Documentation of an Ultrasound Examination."
First, it is valuable to revisit who AIUM is, as well as its role in ultrasound imaging. In its own words, "the AIUM is an association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation."
In the first section of the guidelines, AIUM outlines what it considers high-quality patient care. The guidelines state a permanent record should always be kept of the images, and an interpretation should be provided for patient records. All medical professionals involved should be able to communicate well and work as a team to provide what is expected: quality patient care.
The next section lists what should be included in the official report. In some clinical settings, the interpretation of the images is transcribed and a separate report page is generated for the patients chart. In the PMC setting it is common that a signature is obtained on the ultrasound report page and serves as the final report.
Section three discusses the final report from the interpreting physician or medical director of the clinic. According to this April 2014 update, the final report should be generated in 24 hours. I know you are thinking or asking... "How can we do that?!"
We restate the following from the AIUM guideline: Practice guidelines of the AIUM are intended to provide the medical ultrasound community with guidelines for the performance and recording of high-quality ultrasound examinations. The guidelines reflect what the AIUM considers the minimum criteria for a complete examination in each area but are not intended to establish a legal standard of care.
This AIUM Guideline is NOT a legal requirement. It is a national practice standard.
We at Sonography Now live in the service trenches with you as we train on-site. We understand that getting interpretations in a timely fashion versus every 24 hours can seem unnecessary. Taking one step at a time can ease such a transition. If you want to make changes to accommodate a faster interpretation time, it doesn't need to change immediately.
Building a plan of action can remedy the feeling of urgency. Some clinics we work with have images interpreted daily so that the final report can be given to the patient. You have the freedom to choose your course of action based on your mission and vision.
Concerning our routine ultrasound report procedure, we need to answer the questions:
Our patients feel an urgency to have definitive information about their pregnancy. They need their confirmed diagnosis, not the nurse's preliminary findings.
My nightmare concerning delays in the physician reading Dove Medical's ultrasound exams is that our nurse will miss an ectopic pregnancy the physician would have caught, the patient will not have received the appropriate instructions and/or referral for immediate care, and the patient will suffer injury as a result. I strive to insure both the skill level of our nurses and also the prompt reading of all exams.
While some Medical Directors feel it would be consistent with the highest level of care which we strive for, that these standards should be recommended/set and then the center should work toward them, other Medical Directors who have discussed the issue feel strongly that we do not need to comply with the 24 hour mandate and that it would be impossible for most centers to do so.
We must remember that our Medical Directors are volunteering their services. If pressure is put upon them to comply with this standard, are we risking losing them as a Medical Director? If that scenario is a high probability, we must ask "How is this patient best served?" What do we tell the patient?
We can't do the sonogram because we can't turn the report around in 24 hours? Is a longer turn around period better for the patient than having no service at all? Also it is critical that we not alienate our Medical Directors who are sacrificing their time and skills to serve the patients in our clinic. Without them, we cannot offer ultrasound services at all.
If we set this as policy because it meets national standards but we cannot comply, what are the consequences? Is it better to adopt a policy set on the highest excellence we are feasibly able to provide so that we can continue serving our patients, rather than potentially losing our medical director or other consequences which would impede serving the patient? Then as we can, going forward, do what is possible to shorten the turn-around time.
Centers should make efforts to have ultrasound reports read, signed and returned within the shortest time frame that is reasonably feasible. Any scans with questionable findings of concern or emergency problems should be referred promptly to a physician or hospital emergency room. This policy should be made known to the patient on the intake form.
You may want to consider the following options, among others, as means to improve your turn-around time. This is only a sampling of options and not a recommendation of any specific option.
Inform your Medical Director of the recommendation by the AIUM and have a conversation with them. Let him/her know that it is a practice standard, not law. Discuss the best and most feasible policy for your center. Examine your current policy and practice – how well is that working? Does it meet the goal for the best service your clinic can provide for the patient? Look at and discuss some of the options for improving the turn-around time. Are there any steps you feel you should take at this time? Set a time to re-examine and evaluate.
The AIUM Official Statement concerning Limited Obstetric Ultrasound (LOU), reaffirmed on 4/2/2014, makes some clear statements about the services we provide. I am reminded again that we must see ourselves as competent medical professionals and our services as medical diagnosis. Points of emphasis in the AIUM Official Statement include:
As an education organization Equip Leaders Now and Sonography Now have responsibility to keep ourselves informed of changes that may impact your specialized clinical setting. Our role is to pass information along and let you decide how it fits in your clinic. At Sonography Now, our mission is to provide education related to imaging, at Equip Leaders Now, our mission is to build leaders by providing the tools needed to make informed decisions to build strong communities. In doing this we have an obligation to give you information so you can be empowered with the information to form your own talking points and messaging so you can be represented well in your community and to the patients you serve.
Contact Connie Ambrecht or Beverly Anderson at 702-925-8737 with any questions or for a private webinar for your team on this topic.
As the Ebola outbreak has spread from West Africa to isolated cases in parts of Europe and now the United States, there has been no shortage of panic and paranoia among Westerners—even those working in the health care fields.
Still, it is an established and repeated fact that Ebola's spread can be prevented simply by following proper safety procedures in a medical setting. An informational page on Ebola published at the World Health Organization's (WHO) website points to the sad reality of Ebola's largely preventable spread:
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD [Ebola Virus Disease]. This has occurred through close contact with patients when infection control precautions are not strictly practiced.1
As those involved in the life-saving work of pregnancy help in the medical setting, how can you protect yourself, your clinic, and your clients from this deadly virus?
The answer starts with educating yourself, your staff and volunteers, and your clients as to how Ebola spreads, which, again according to WHO, involves the following:
Ebola... spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.2
Consider the functions of your Pregnancy Help Medical Center or Clinic.
With these points of contact posing risks in light of the Ebola virus—in addition to several diseases that are much more likely to spread—make sure your center is paying special attention to policies such as Universal Precautions as defined by the Centers for Disease Control (CDC) and OSHA Regulations.
Under Universal Precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, (Hepatitis B), and other blood-borne pathogens. Universal Precautions involve the routine wearing of gloves, other protective clothing, hand washing, and such infection control measures that are designed to place a barrier between potentially infectious blood or body fluids and employees.3
For more information on how you can keep your center protected from the spread of viral infection, check out Heartbeat International's Medical Essentials for Pregnancy Help Organizations©.
1. "Ebola virus disease," World Health Organization, http://www.who.int/mediacentre/factsheets/fs103/en/ (accessed Oct. 17, 2014).
3. Medical Essentials for Pregnancy Help Organizations©, Heartbeat International, 2014, Part IV, page 4.
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