Was the MRI screening form faxed to the department prior to patients arrival?

Did the patient arrive to the department wearing MRI safe hospital approved attire?

Hospital provided: gowns, pajamas, scrubs etc.

If question #1 or #2 was now - please list the RN name

If questions #1 and #2 were compliant select "N/A"

Did all patient's personal belongings remain in the Inpatient Unit, Emergency Department or secured in a locker?

No personal items should be brought to the MRI department.

Examples include: toys, jewelry, cell phones, iPad, aid pods etc.

Were the patients' LARs present with them in MRI Zones 3 and 4? If so, were they changed into hospital-approved, MRI-safe attire, and were their personal belongings properly secured?

If the patient arrives without a LAR select "N/A"

Was a time-out performed including: conducting a verbal review of the MRI Screening Form(s) (Patient and Non-Patient if applicable), clarify any outstanding concerns, and perform a visual inspection of the patient, LAR, and/or accompanying care providers for metal, non-MRI-safe clothing, or other prohibited items?

For ambulatory patients was the Metrasens Screener used for the patient and their accompanying LAR?

Non ambulatory patients select "N/A"

For non-ambulatory patients, did a Level 2 MRI Technologist perform both a manual assisted and visual inspection, which includes rolling the patient to the left and right sides and ensuring no hidden objects -such as phones, metal items, or monitoring devices are present on or beneath the patient?

If the patient is ambulatory select "N/A"

Were all the patients, accompanying LARs, and care providers screened properly per MRI departmental policies?

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