Implementation of a Pre-X-Ray Safety CHECK in Neonates

Radiographs are diagnostic tools used in neonatal medicine for diagnosis, reducing harm from vascular devices, and monitoring endotracheal tube placement. The lack of neonatal exposure guidelines and the repetition of radiographs due to poor quality have cumulative effects of radiation overexposure. This project aimed to improve the radiographic quality of films by 15% by using a standardized checklist before radiographic exposure, thus reducing repeat exposures.

Radiographs were classified into 3 groups. The All-X-Ray Group consisted of all abdominal, baby gram, and chest films. Two subgroups included films with an indwelling device (peripherally inserted central catheter or an endotracheal tube). Data were compared from a Baseline Period through an Intervention Period and a Sustain Period (June-July 2022). Three sequential interventions were implemented: the implementation of a standardized safety check, increased unit presence, and hands-on simulation training. The primary outcome was a high-quality diagnostic film that met 4 predefined criteria. Measures were assessed using statistical process control methods through a time-series design to identify changes over time.

The quality of films in the All-X-Ray Group improved by 46% (19%-65%), whereas the quality of films in the peripherally inserted central catheter and endotracheal tube subgroups improved by 79% (2%-81%) and 73% (1%-74%), respectively.

Standardization of the radiograph process led to improved quality of neonatal films in this unit. Consistent hands-on training enabled sustainable impact. Empowering bedside staff resulted in a positive culture change. A standard pre-x-ray checklist improved the diagnostic quality of films in a neonatal unit when combined with increased provider presence during the x-ray procedure and staff education.