PWS_Attachment_11-_I-131_clearance.pdf

RADIATION SAFETY CHECKLIST FOR IN-HOUSE IODINE THERAPY

(Do NOT Retain)

DRS-405 Revised 8/7/08 1

Pre-administration

Prior to the day of administration, visit therapy room.

Verify nurse’s station survey meter calibration is current and the batteries are good.

Perform constancy check to ensure meter is operating properly.

Ensure adequate supply of Radiation Safety Procedures Survey forms (NIH 88-7a and

b) when patient is in room (a) and upon patient release (b).

Have copies of the “I-131 Iodine Therapy for In-Patients” and “Caution Radioactive

Material Internal Dose” chart sticker are available.

_____ Ensure radiation warning signs and radiation area rope is available

Ensure nursing staff and physicians providing care to patient have been trained in I-131 oral therapy procedures and precautions, and dosimetry has been provided.

Examine patient’s room – (See photos) Room and bathroom floors are covered with plastic-backed absorbent paper Surfaces that patient could touch are covered with plastic or absorbent paper Inside door knob is to be covered.

5 1

4 1

At least 4 medical pathological waste (MPW) boxes and a yellow laundry bag labeled with CRAM tape are in room.

Floor is marked at 1 meter from a patient position on the floor.

NOTE: Central 5NW Patient Care Unit phone is 301- 451- 0606. The telephone numbers at the desk nearest the therapy room are 0648 and 0649.

DRS-405 Revised 8/7/08 2

Administration of Dosage and Monitoring

Ensure ion chamber calibration is current, batteries are good, and the dose rate response is verified using a check source.

_____ Wear appropriate dosimetry.

_____ Obtain transport cart from loading dock

Prior to taking the source, verify the activity requested in the CRIS is within 10% of the assayed activity printed on the dosage label. If not within 10% of the prescribed dose, notify the Authorized User who ordered the dosage so that they may decide whether to cancel the dosage or submit a new request. Do not administer the dosage if assayed activity is less than 90% or greater than 110% of the prescribed dose.

Verify the patient information on the CRIS matches the information on the dosage label affixed to the lead pig.

Ensure that the shielded therapy dosage container lip is secure prior to loading it on the transportation cart, and take tongs for handling capsules.

Verify that the written directive, which will be signed by the authorized investigator

(physician), is available. This may be completed on the Patient Care Unit by the AU.

Remind the individual who assayed the I-131 dose of the requirement to have a bioassay.

Verify that the physician has met with the patient and provided necessary instructions.

Meet with patient prior to the administration of the dose to discuss isolation procedures and answer any questions. Emphasize the following:

Change clothes and shower frequently, e.g., twice a day Drink as much liquids as possible and eat well.

Personal items such as eyeglasses or false teeth need to be washed frequently in order to be released with the patient

Place soiled linen and disposable items in proper containers Patient must stay in the room for the duration of the therapy and request any supplies from the nursing staff Visitors are not allowed in the room, but may stand or sit outside the door to visit.

Patient should remain near the bed, NO physical contact Maintenance and food service staff are not allowed in the room

Instruct patient on putting food cart by door and return to the bed when the food and other items are placed in the room.

Ask the patient if they have problems swallowing pills.

Prior to administering dose have a pitcher of water on the dosing table and inform the patient the number of capsules they will be taking. An MPW box should be close by in case the patient regurgitates.

After the Clinical AU gives verbal orders to give the dose, the capsules are placed one-at-a-time in a pill cup in the presence of the physician.

(Clinical AUs -- James Reynolds, Clara Chen, MD, MD Ron Neumann, MD, Karen Kurdziel, MD, Richard C. Reba, MD)

DRS-405 Revised 8/7/08 3

Following the administration of the dosage, dose rate measurements are made at

1 meter from the standing patient, and 1 foot from the patient lying in bed. With the patient lying in the bed, dose rate measurements are made at the doorway with the door open and closed, and in the adjacent rooms 1 foot from the wall.

_____ Measurements of the patient and adjacent areas will be made every working day that the patient is in isolation. The patient will also be reminded to shower frequently and drink plenty of liquids. If the patient is expected to be released the next day, instruct the patient to shower and change into fresh pajamas prior to the time of release measurements.

Complete and post the NIH 88-7a Form by the door. The “emergency time limits” will be calculated as follows:

Bedside – [100 ÷ exposure rate at 30 cm] Hours/Day At 1 Meter – [100 ÷ exposure rate at 1 m] Hours/Day At Doorway – [100 ÷ exposure rate at open door] Hours/Day

Emergency Time -- [500 ÷ exposure rate at 30 cm] Hours/Person

_____ Attach a radiation warning sign on both the inside and outside of the corridor door. Fix the radiation rope to the outside of the corridor door and wall so the tape will drape across the doorway when the door is open.

Affix a CRAM sign to the adjacent room and have nurses restrict access for one day if the dose rate measurement exceeds 2 mrem/hr in the room.

In the CRC/6NW interstitial space above the therapy room, radiation warning signs will be put along walkway approximately 8 feet on either side of the room marking. Iron support rods are at these locations. The signs will indicate that the DRS needs to be contacted before maintenance work in the area between the signs is to be started. The sign are to be removed when the patient is released.

Provide the MCAB HP responsible for internal monitoring the name of the individual in

Nuclear Medicine who assayed the dose.

Use the exposure rate values at 1 foot and 1 meter from the patient to determine the number of days the patient has to follow instructions upon release.

_____ Use the exposure rates for the standing patient at 1 meter and lying down at 30 cm (1 ft) should be inserted in the cells (I:14) and (J:14) in the “In patient release_Precautions_Spreadsheet only” located in the folder S:\Safety\CLINICAL\THERAPY\In Patient Therapy. The days when the cumulated exposures are less than the limits are the values be used in the patient release instructions that the physician needs to review with the patient. For clarification, see the In-patient SOP in the folder listed in this section

DRS-405 Revised 8/7/08 4

Patient Discharge and Room Decontamination

On the day the patient is expected to be released, request the 5NW nursing staff instruct the patient to shower and change into clean pajamas before the HP’s arrival.

_____ Perform patient dose rate measurements and note them on the NIH 88-7b form. The patient can be released when the exposure dose rate at one meter is less than 7 mrem/hour.

If neither release criteria are met, the patient is to be instructed to drink more liquids and shower and change pajamas again prior to the HP’s return.

_____ As the patient leaves the room, clean slippers will be provided by the nursing staff.

Absorbent pads will be placed on the floor outside the therapy room. The patient will be instructed to remove his/her contaminated slippers and step onto the pad. The patient will put on the clean slippers and will be escorted to his/her pre-administration room.

_____ The patient will be instructed to change clothes again and the pajamas and slippers will be returned to the therapy room. Dispose of the absorbent step-off pad in the MPW box.

_____ Monitor the immediate area around the therapy room door to verify there is no contamination. With a GM probe (assume detection efficiency of 16%) counts should not exceed 32 cpm for a release limit of 200 dpm/100 cm2 for loose surface contamination, and a fixed limit of 480 dpm/100 cm2. Decontamination efforts will be verified with wipes.

_____ Indicate on the release sheet that the attending physician is to review with the patient the recommended days of precaution that the patient should follow. A guidance table of recommend restriction times based on the initial exposure measurements made at the time of dosing. It is the responsibility of the physician to give these instructions and obtain the signatures. Ensure that a copy of the signed instructions is obtained. The instruction sheet does not have to be completed if activity in the patient is < 7 mCi, but the attending physician may want to provide instructions to the patient.

Following the patient releases, the therapy room will be locked and the contractor informed that decontamination and release of the therapy room can be completed.

Release levels for the room are 200 dpm/100 cm2. If another patient is to be treated, the level is 2000 dpm/100 cm2. Coordination is to be made with the nursing staff.

_____ Upon patient release, the radiation signs on CRC/6NW are removed.

The patient room is to remain locked and restricted until free released to the Patient

Care Unit.

Copies of (1) written directive, (2) the CRIS report with dose calibrator label, (3) the signed patient release instructions, (4) all NIH 88-7 forms, (5) the contactor’s survey and

(6) cover page of the smear counting reports will be filed together in the appropriate cabinet outside of the RSO’s Office.