American Lithotripsy Society Patient Care Clinical Considerations


 

Allied Personnel Guidelines for
Patient Care in Lithotripsy

These guidelines were unanimously approved by the ALS Board of Directors on May 14, 1993.

The guidelines for lithotripsy clinical practice focus on the process of providing care and performance of activities in the lithotripsy setting. These guidelines, while focusing on the procedures of lithotripsy, should be used in conjunction with ALS Standards of Care and the Nursing standards which most closely define one's particular Lithotripsy environment. (AORN, ASC, PACU, JCAHO, etc.).

 

I. APPROPRIATELY QUALIFIED ALLIED PERSONNEL HAVE THE FOLLOWING ACCOUNTABILITY/RESPONSIBILITY IN THE LITHOTRIPSY SETTING:

Criteria

1. Allied personnel have a duty to:

A. Be an advocate for the patient and ensure patients' rights.

B. Follow standards of nursing care.

C. Maintain training and skill levels appropriate to their duties.

D. Develop, implement and revise policies and procedures.

E. Provide continuing education for staff.

F. Maintain a clean and safe working environment.

G. Establish a systematic and ongoing quality improvement program.

II. ALLIED PERSONNEL COLLECT HEALTH DATA SO THAT THE PATIENT CAN BE EVALUATED AND CANDIDACY FOR LITHOTRIPSY TREATMENT DETERMINED, BY THE PHYSICIAN, FOLLOWING ALS GUIDELINES AND RECORD IT IN A SYSTEMATIC AND RETRIEVABLE FORM.

Criteria

1. Health care data collection involves the patient, family, and/or significant others. Information may be gathered by patient interview, review of medical records, and contact with other health care providers.

2. Documentation may be evidenced by, but not limited to, a written nursing care plan, preprocedure check list, pre-admission questionnaire, and pertinent protocol forms.

3. Health data collection should be obtained with recognition of the following selection criteria:

A. A patient's health habitus and medical history (H&P) must be obtained to document that he/she is an acceptable candidate to undergo lithotripsy and anesthesia/analgesia if required.

B. Patients on medications which may inhibit normal coagulation or effect platelet adhesiveness should be noted and reviewed by the physician prior to scheduling Lithotripsy.

C. Patients should be free of urinary tract infections and/or be placed on appropriate anti-biotic coverage pre-procedure.

D. Urinary tract calculus meets size and location criteria.

E. Review of possible contraindications for lithotripsy such as: pregnancy, renal malignancy, etc.

III. ALLIED PERSONNEL ENSURE THAT PATIENTS, FAMILIES, AND SIGNIFICANT OTHERS ARE EDUCATED FOCUSING ON PERTINENT PRE- AND POST-PROCEDURAL ASPECTS OF TREATMENT.

Criteria:

1. Provision of information specifically related to Lithotripsy may include, but not limited to the

following:

A. Printed and verbal pre-procedural patient instructions.

B. Informational brochures/pamphlets.

C. Facility tour.

D. Audio visual films.

E. Printed and verbal post-procedural instructions.

F. Opportunity to speak with other patients who have undergone Lithotripsy.


2. There is documentation of patient education.

IV. ALLIED PERSONNEL DEVELOP A PRE-PROCEDURAL PLAN OF CARE REFLECTING PRE-PROCEDURAL ASSESSMENT TO MEET EFFECTIVE OUTCOMES.

Criteria:

1. The plan of care will include, but not be limited to the following:

A. Identification of patient and patient acknowledgement of planned procedure(s).

B. Obtaining patient's informed consent.

C. Review of pre-procedural testing results and completion of medical records.

D. Communication of care plan to appropriate staff.

V. FOLLOWS ALS QUALITY ASSURANCE GUIDELINES.

Criteria:

See the American Lithotripsy Society publication "Planning a Quality Assurance Program for Your Lithotripsy Unit".

 

VI. STAFF DEVELOPMENT PROGRAMS SHOULD BE PROVIDED.

Criteria:

1. Staff development programs for clinical Allied personnel shall include but not be limited

to the following:

A. Job specific orientation program.

B. Library of current literature for review.

C. Encourage attendance at ALS Annual meetings and provide networking opportunities when appropriate.

D. Lithotripsy Certification and recertification is strongly recommended.

VII. LITHOTRIPSY DEVICES SHOULD BE MAINTAINED AND USED IN A MANNER WHICH ASSURES PATIENT ACCESS AND SAFETY.

Criteria:

1. Systematic biomedical preventative maintenance and repairs should be performed by the manufacturer technicians and/or an acceptable alternative. Maintenance and repair records should readily be available.

2. Policies which establish parameters for the use of the Lithotripsy devise should be available. (See ALS guidelines for the treatment of urinary tract stones).

3. Policies and procedures that establish authority and accountability for the use and maintenance of the Lithotripsy devices which verifies ongoing quality improvement.

4. Policies and procedures for cleaning and disinfection of the devices are present to maintain OSHA standards.

5. Documentation of equipment inspection.

VIII. PATIENTS AND PERSONNEL SHOULD BE PROTECTED FROM UNNECESSARY RADIATION EXPOSURE.

Criteria:

1. Appropriate building and personnel lead shield protection should be provided by the facility as proposed by state statutes.

2. Radiation monitoring devices should be worn by personnel in proximity to radiation.

3. Documentation on file of lead shield protection examined yearly for integrity.

4. When radiation is used for stone localization with Lithotripsy, user averages should be monitored through the quality improvement program.

5. Staff education for radiation safety should be systematic and ongoing.


References

Association of Operating Room Nurses, "Standards of Perioperative Nursing Practice"/Denver: AORN, Inc., 1992

JCAHO, Ambulatory Health Care Scoring Guidelines

American Lithotripsy Society, Standards of Care: "Guidelines for the Treatment of Urinary Tract Stones, with SWL"

top of page

back to guidelines




American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088
email:
als@lithotripsy.org