Training activity information
Details
Control the risks associated with performing ultrasound for patients
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Legislation
- Patient safety
- Troubleshooting
- Safety feature identification display for ultrasound image
- Safety of ultrasound in diagnostics
- Controls that effect safety outputs
- User responsibilities
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to successfully identifying, assessing, and mitigating risks to the patient during an ultrasound scan.
- Consider how the learning outcomes apply, specifically in relation to applying the principles of ultrasound safety and ergonomics whilst performing a scan.
- Discuss with your training officer to gain clarity of what is expected of you in relation to applying the safety guidelines for acoustic output parameters or implementing local ergonomic policies.
What is your prior experience of this activity?
- Think about what you already know about ultrasound safety (e.g., thermal/mechanical indices) and ergonomic posture during scanning.
- Consider possible challenges you might face during the activity, such as maintaining appropriate acoustic output limits during complex Doppler assessment or ensuring optimal ergonomic setup for a bedside scan.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the patient’s condition necessitates operating near the acoustic safety limit or if the environmental setup is ergonomically unsafe for prolonged scanning.
- Acknowledge how you feel about embarking on this patient risk management activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as adjusting scanner controls to minimise biological effects or correctly identifying poor ergonomic technique.
- Identify the specific insights you hope to gain regarding the practical application of ultrasound safety principles and ergonomic considerations when conducting scans for varied patient types.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of clinical risk assessment or adhering to safety protocols.
- Identify important information you need to consider before embarking on the activity, such as reviewing the academic content on safety recommendations and regulations and anticipating patient conditions that might elevate thermal risk.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst controlling the risks associated with performing ultrasound for patients?
- Are you encountering situations such as:
- The acoustic output indices (Thermal Index or Mechanical Index) unexpectedly approach regulatory limits during a complex Doppler assessment, challenging the adherence to safety guidelines?
- The patient exhibits unexpected movement or severe discomfort during the scan, compromising the optimal ergonomic setup for both you and the patient?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to adjusting scanning parameters to reduce acoustic output or repositioning the patient to mitigate ergonomic risk?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting the scanner controls (e.g., reducing depth or Doppler PRF) to decrease the acoustic output indices and maintain safety compliance.
- Pausing the scan to communicate empathetically with the patient, providing reassurance or repositioning them to ensure comfort and stability.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt the scanner settings quickly to manage the acoustic risk? Is it affecting your confidence in maintaining safety compliance?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully adjusting the power output independently to control thermal risk? Or are you needing support because the patient’s severe pain necessitates running acoustic output near safety limits, requiring senior approval?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for balancing image optimisation against safety compliance? Or gaining insight into the subtle signs of patient discomfort related to transducer pressure?
On action
What happened?
- Begin by summarising the key steps you took when controlling patient risks during the ultrasound scan.
- Consider specific events, actions, or interactions which felt important, such as how you ensured compliance with acoustic output limits during complex Doppler assessment or how you managed an immediate ergonomic adjustment for a bedside scan.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the scanner controls to reduce the Thermal Index when an unexpected risk parameter was approached.
- How did you feel during this experience, e.g., did you feel focused on maintaining patient safety or challenged by the need to balance safety compliance with image optimisation?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding safety and ergonomics. What strengths did you demonstrate, e.g., meticulous application of local safety guidelines or the ability to assess and mitigate risks quickly?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific acoustic output indices required for different patient types or difficulty ensuring optimal ergonomic setup in restricted spaces?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying the principles of ultrasound safety and ergonomics whilst performing a scan?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the implementation of safety guidelines in complex patient scenarios (e.g., maintaining acoustic output limits in highly technical scans), and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to implementing ultrasound safety and ergonomic protocols in varied clinical settings.
- What will you do differently next time you approach patient risk control, for instance, by proactively conducting an ergonomic assessment of the scanning environment before starting the procedure?
- Do you need to practise any aspect of the activity further, such as refining the technique for rapidly adjusting scanner controls to minimise biological effects or key learning outcomes related to applying the principles of ultrasound safety and ergonomics whilst performing a scan?
Beyond action
Have you revisited previous experiences?
- How have your subsequent experiences of controlling the risks associated with performing ultrasound for patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent Doppler scan required operation near the acoustic safety limit forced you to re-evaluate the immediate decision-making process for balancing image optimisation against acoustic output parameters during your first attempt at this training activity.
- Considering what you understand about ultrasound safety, ergonomic principles, and risk mitigation strategies now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your risk management approach based on further learning and experiences? For example, how you proactively reviewed and integrated the local ergonomic policy regarding optimal scanning posture and patient positioning to prevent musculoskeletal strain for prolonged scans.
- Has discussing maintaining acoustic output compliance or the impact of poor ergonomic technique on sonographer health with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a case where poor parameter control led to an acoustic safety concern refined your understanding of the critical nature of diligent parameter monitoring.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent ultrasound safety and risk management experiences, contributed to your overall confidence and ability in applying the principles of ultrasound safety and ergonomics, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in applying the principles of ultrasound safety and ergonomics and mitigating acoustic risk enables you to confidently discuss the importance of ultrasound safety and QA during an OCE assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to controlling patient risks during ultrasound? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when patient condition necessitates operating near acoustic safety limits, recognizing this requires senior input to ensure compliance with safety recommendations and regulations.
- Looking holistically at your training journey, how has this initial ultrasound risk control experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying the principles of ultrasound safety and ergonomics whilst performing a scan and evaluating protocols and national guidelines? For example, how this foundational experience has supported your development in meeting learning outcomes related to ultrasound safety and ergonomics.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply the principles of ultrasound safety and ergonomics whilst performing a scan. |
| # 10 |
Outcome
Evaluate protocols and national guidelines and their impact of vascular science practice. |